A Response-able Diagnosis: Type 2 Autoimmune Pancreatitis in the Setting of Ulcerative Colitis

Excerpt

A previously healthy 36-year-old male was evaluated in the emergency department with two weeks of left-sided abdominal pain and diarrhea. The pain radiated to his back and was associated with poor oral intake and a 25-pound weight loss. Bowel movements numbered 4–5 per day, with urgency and intermittent bleeding. Initial evaluation revealed a normal complete blood count and liver function tests, although lipase 722 U/L (ULN = 90 U/L), CRP 3.5 mg/dL and calprotectin 750 µg/g were elevated. Stool tests were negative for infection (Clostridioides difficile, ova/parasites, Giardia, and bacteria). A CT scan demonstrated peripancreatic fat stranding (Image 1); a right upper quadrant ultrasound was negative for gallstones or biliary dilation (common bile duct = 3 mm). Serum calcium was normal (9.3 mg/dL) as were non-fasting triglycerides (97 mg/dL). He denied alcohol use, recent travel, sick contacts, as well as family history of pancreatitis or inflammatory bowel disease. Genetic testing was negative for cystic fibrosis transmembrane regulator (CFTR), chymotrypsin C (CTRC), human cationic trypsinogen (PRSS)1, and serine protease inhibitor, Kazal-type (SPINK)1 mutations. IgG subclasses showed a normal serum IgG4 level (82.5 mg/dL).

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