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Autoimmune enteropathy is a rare condition seen in adults with limited therapeutic options available. It manifests with profuse diarrhea and malnourishment. The diagnosis is made through a combination of clinical, serologic, and histologic parameters. The cornerstone of therapy revolves around nutritional optimization and immunosuppression, most commonly in the form of corticosteroids. Alternate therapies, such as antitumor necrosis factor agents, can be considered if there is an inadequate response to steroids. We report a case of autoimmune enteropathy that was successfully treated with adalimumab, a rare treatment for an infrequent disease.

Splenic involvement secondary to acute pancreatitis is rare (approximately 2%), but can include hemorrhage, splenic rupture, vascular injury, or pseudocyst formation.1 A 46-year-old man presented with left upper quadrant (LUQ) abdominal pain 3 months after a moderately severe case of acute alcoholic pancreatitis. He was afebrile, hemodynamically stable, and with LUQ tenderness on exam. Labs were significant for an amylase level of 113 U/L and a normal lipase. Right upper quadrant (RUQ) ultrasound was unremarkable. Contrast-enhanced computed tomography (CT) revealed residual changes consistent with prior pancreatitis and an ill-defined, 1-cm focal hypodensity in the tail of pancreas consistent with a developing pancreatic pseudocyst (Figure 1). He was treated conservatively with bowel rest, pain control, and intravenous fluids, and his symptoms resolved. Five months later, the patient presented with similar complaints. Repeat CT demonstrated an interval progression of the pancreatic tail lesion with extension into the spleen, and increased peripancreatic inflammation at the splenic flexure with short segmental colonic wall thickening (Figure 2). Endoscopic ultrasound (EUS) revealed chronic pancreatitis, a 2.7 cm x 2.8 cm thin-walled cystic lesion in the pancreatic tail with extension into the spleen, and another 2.3 cm x 2.1 cm cystic lesion in the spleen. EUSguided fine needle aspiration yielded 5 mL of turbid, viscous fluid with an amylase level of 3,100 U/L, rare white blood cells, and inflammatory cells without evidence of malignancy, consistent with a pancreatic pseudocyst. The patient responded to conservative measures, and follow-up imaging after 3 months revealed resolution of the pseudocyst.