Clinical Images
An Unusual Case of Pancreatitis
Caterina Liu, B.A., Hala Borno, M.D.
April 30, 2016
A 72 year-old man with a history of bladder cancer in remission presented with acute on chronic epigastric pain radiating to the back. He denied alcohol use. On exam, he was tender to palpation in the right upper quadrant and epigastrium. Initial labs were notable for lipase 1354 u/L, AST 224 u/L, ALT 340 u/L, alkaline phosphatase 318 u/L, and total bilirubin 2.7 mg/dL. An abdominal CT showed pancreatitis and diffuse pancreatic enlargement. An MRCP showed an enlarged, sausage-shaped pancreas (Figure 1). During ERCP, a stricture was found and stented. Biliary brushings returned negative for neoplasm. During EUS, a mass was visualized and biopsied. Cytology returned consistent with pancreatitis without evidence of neoplasm. An IgG4 level returned at 301 mg/dL (reference 7-98 mg/dL). A final diagnosis of autoimmune pancreatitis (AIP) was made based on International Consensus Diagnostic Criteria for AIP. A decision to initiate prednisone therapy was deferred to the outpatient setting.
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References
1. Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. 2011;40(3):352-358. doi:10.2958/suizo.26.684.
Author Bios:
Caterina Liu, B.A.
Caterina.Liu@ucsf.edu
Caterina Liu is a 4th year medical student at UCSF.
Hala Borno, M.D.
Hala.Borno@ucsf.edu
Hala Borno is a 3rd year internal medicine resident at UCSF.