INTRODUCTION:Sarcoidosis is a multisystem disorder of unknown etiology. Some cases are attributed to genetic factors, an inflammatory response by specific antigens including self-antigen, and autoimmune involvement. Ninety percent of patients with sarcoidosis have lung involvement, and a vast portion is asymptomatic. Most common initial symptoms are dry cough and dyspnea, however, manifestation can be unspecific and broad. Ocular manifestations like uveitis are a classical presentation. Cutaneous manifestations have also been associated with sarcoidosis but incidence is around 1.9 per 100,000 with a female predominance. Diagnosis can be performed from clinical, and radiological findings yet one of the most essential criteria is histopathological findings of non-caseating granulomas on a tissue biopsy. Here is a rare presentation of a Hispanic male with sarcoidosis after exposure to an unusual antigen.CASE PRESENTATION: A 32-year-old man came to the emergency department with dyspnea, dry cough, and bilateral eye redness of one week of evolution and ten days after the second dose of the SARS-CoV-2 vaccine. Before these symptoms, the patient experienced multiple desquamating tattoos and bilateral eye redness after the first dose of the vaccine, which presumed that resolved with tobramycin and dexamethasone eye drops. Physical examination was notable for tattoo peeling with surrounding erythematous papules and tenderness to palpation. Eye examination revealed an intact visual acuity bilaterally with hyperemia and conjunctival injection. Ophthalmology made the diagnosis of non-granulomatous bilateral anterior uveitis. Routine laboratories were unremarkable including angiotensin-converting enzyme levels except for erythrocyte sedimentation rate on 32mm/Hr and arterial blood gas with a partial pressure of oxygen of 72 mmHg. Chest radiograph revealed innumerable bilateral centrilobular nodules. Chest Computerized tomography showed bilateral centrilobular diffuse pulmonary nodules with associated mediastinal paratracheal and mediastinal lymphadenopathy. Skin biopsy revealed a nodular infiltrate of histiocytes with black foreign body deposits with non-caseating sarcoid granulomas. Treatment consisted of prednisone and azathioprine resulting in an improvement of symptoms the following days. DISCUSSION:The side effects of this novel ribonucleic acid vaccine are not well described yet, but our case raises the suspicion if the vaccine arouses or unmask autoimmune diseases like the one previously described.CONCLUSIONS: More studies and data are required on side effects to assess other possible complications, response to the vaccine, and which patients are at risk of developing autoimmune or serious health conditions.

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Introduction: Any mass lesion in the pancreas typically raises concern of undiagnosed pancreatic malignancy. Presence of synchronous multiple pancreatic masses is a rare finding. In this case series, patients presented with two or more synchronous solid masses as a result of pancreatic cancer (PC), autoimmune pancreatitis (AIP), and sarcoidosis. Case Description/Methods: Case1:65-year-old female presented with abdominal pain and 20lbs unintentional weight loss over 4 months. CT scan revealed two suspicious solid masses in the body/tail of the pancreas (Figure A). IgG4 level was normal, but CA19-9 was elevated at 75u/mL. EUS with individual fine needle biopsies (FNB) of both masses confirmed infiltrative PC. Due to the significant cardiac history, the patient was deemed not a surgical candidate and was referred to oncology for chemoradiation/palliative therapy. Case2:76-year-old male presented to the hospital with postprandial abdominal discomfort and unintentional weight loss. CT Abdomen demonstrated localized inflammation in the pancreatic tail (Figure B). EUS showed mass-like lesions in the pancreatic head and tail. Immunohistochemistry was positive for IgG4-positive plasma cells. He was diagnosed with AIP and was started on steroids. Case3:54-year-old male with complicated sarcoidosis (pulmonary/extrapulmonary involvement), presented with an abnormal PET scan showing focal increased uptake in the head/tail of the pancreas. His CT scan did not show any mass or duct dilation. EUS demonstrated ill-defined, infiltrative masses involving the pancreatic head and the tail. FNB showed scattered non-necrotizing granulomas (Figure C). After excluding other causes of granulomatous diseases, he was diagnosed with pancreatic sarcoidosis. Discussion: Only a few examples of synchronous pancreatic masses have been recorded in the medical literature. Our case series includes three distinct pancreatic diseases that result in multiple mass lesions with similar appearance on imaging (Table ). The clinical course for all of the patients differed greatly depending on the pathology. The plurality of solid masses and comparable imaging features of each with PC, which is the 4th highest cause of cancer-related deaths in the United States is the highlight of this series. When encountering such individuals, a broad differential should be examined, as the clinical history of the illness varies. The whole pancreas should be investigated with multimodal imaging and EUS-guided acquisition histopathology to reach a clear diagnosis.

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