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KEY WORDS: sarcoidosis; hyperlipasemia; pancreatic sarcoid.
Use of serum lipase has increased at our institution in recent years due to availability of a reliable automated method (1) and recent literature (2, 3) recommending measurement of serum lipase for investigation of acute pancreatitis. With its wider use it has become increasingly apparent that transient elevations in serum lipase occur in conditions other than acute pancreatitis (3). However, chronically elevated lipase is rare and has only been described in patients with malignancy (4, 5) and macrolipasemia (6, 7). We encountered a patient with sarcoidosis (malignancy and macrolipasemia were ruled out) who had persistently elevated lipase levels.
CASE REPORT
A 56-year-old Jamaican woman with a past history of mild asthma, left facial palsy, and recurrent iritis also exhibited elevated transaminases (two to three times the upper reference interval limit) over a period of one year. In 1996 her serum enzyme levels were as follows: aspartate transaminase 89 IU/liter (normal 5 10-32 IU/liter), alanine transaminase 71 IU/liter (normal 5 ,32 IU/liter), alkaline phosphatase 119 IU/liter (normal 5 30-120 IU/liter), and g-glutamyltransferase 59 IU/liter (normal 5 5-29 IU/liter). Her amylase level was also elevated at 271 IU/liter (normal ,120 IU/liter) and her lipase level was markedly increased at 1620 IU/liter (normal , 190 IU/liter). Her serum creatinine level was within the reference interval.
She had symptoms of general fatigue but no abdominal pain. There was no history of ethanol abuse, no specific risk factors for viral hepatitis such as blood transfusions or intravenous drug abuse and no history of gallbladder or biliary tract disease. On physical examination, she had no stigmata of chronic liver disease and was anicteric. She had a normal sized liver with no hepatomegaly, no palpable spleen, and no abdominal tenderness.
The following work-up was performed to further investigate her chronically elevated liver enzymes: hepatitis A, B and C serology was negative. An autoimmune assessment for anti-nuclear antibody, anti-smooth muscle antibody, and anti-mitochondrial antibody was negative. A Mantoux test was negative and an energy screen was positive. Alpha-1-antitrypsin level and serum ferritin were normal. An ultrasound of her abdomen revealed cholelithiasis within a normal gallbladder. The biliary tree was unremarkable. A computed tomography (CT) scan of her abdomen demonstrated cholithiasis. Her pancreas was normal, and...