Recurrent pancreatitis : it can get on your nerves! A rare case of B-cell lymphoma presenting as recurrent pancreatitis and multiple cranial neuropathy

To the editor we present the case of a 57-year old man with no relevant medical history beside an episode of acute edematous pancreatitis three months earlier. The etiology was assumed to be alcoholic due to the abscence of gallstones, dyslipidemia or hyperparathyroidism and the granted regular alcohol intake. Two months after this episode he was admitted at the Neurology Department with a left peripheral facial nerve paresis without any significant lesions on CT or gadolinium enhanced MRI. After initation of corticosteroids the patient recovered and got discharged. On month later he presented at the Emergency Department with acute epigastric pain without fever. He also reported vertigO. fatigue and a significant weight loss of 17 kg since discharge. There was no itching or night sweating. Biochemistry showed an elevated CRP (63 mg/l) and white blood cell count (12.8 10^9/mm3), disturbed liver enzymes with a normal bilirubin and an elevated lipase (1365 U/l). Ethanol, triglycerides and LDH were normal. The abdominal complaints regressed on supportive care whilst the vertigo got worse. On abdominal CT a focal zone of pancreatitis at the tail of the pancreas with scarce necrosis and infiltration of the peripancreatic fat was shown.