AUTOIMMUNE PANCREATITIS ASSOCIATED WITH PANCREATIC PSEUDOCYST: A CASE REPORT.

Autoimmune pancreatitis is a sub-type of chronic pancreatitis. It has 2 further types; type I and II. Type I is associated with IgG4 disease. We describe a case of chronic pancreatitis that ultimately turned out to be IgG4 disease. A 45-year-old female with no co-morbidities presented on 18th November 2022 with epigastric pain, left hypochondrium pain, vomiting, and fever for 5 days. She had previously been admitted twice to the hospital with similar complaints and was diagnosed with acute pancreatitis. Examination revealed tenderness in the epigastrium and left hypochondrium; Laboratory investigations revealed serum Lipase 405 U/L, serum Amylase; 178 U/L, Lipid profile. cholesterol; 242 mg/dL triglycerides; 218 mg/dL HDL; 42 mg/dL LDL; 169 mg/dL. HbA1c; 9.53%. and IgG4 level; 1657mg/liter. CT abdomen with pancreatic protocol showed a cystic lesion in the body and tail of the pancreas suggestive of an infected pseudocyst or localized acute pancreatitis. The patient was diagnosed with type 1 autoimmune pancreatitis and a multidisciplinary team (MDT) was taken on board for further management. The patient was not deemed appropriate for percutaneous or endoscopic drainage of the pseudocyst. She therefore underwent distal pancreatectomy and splenectomy. The biopsy showed features favoring mucinous cystic neoplasm of the pancreas with no evidence of malignancy. On immunohistochemical stains, the reactivity pattern was positive for ER, inhibin, and CD 10 which highlighted the ovarian stroma and cytokeratin. The patient was discharged on 25th November 2022 on supportive treatment. [ABSTRACT FROM AUTHOR]