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ACUTE PANCREATITIS IN A YOUNG MALE WITH NO APPARENT EITOLOGY : A DIAGNOSTIC CHALLANGE
Majdi Salahie
*, Prince Shah-Riar, Sriramachandra M. Badiga
DHR Health, Edinburg, TX
Introduction:We report a unique case of acute pancreatitis in a 20-year-old male with no significant past medical history. Despite extensive evaluation, the etiology remains uncertain, highlighting the complexities of diagnostic challenges in young, otherwise healthy individuals.
Case Presentation:A 20-year-old male presented with six days of progressive, sharp left-sided abdominal pain radiating to the back, exacerbated by activity, and minimally alleviated by rest. Initial laboratory findings indicated elevated serum lipase levels (218 U/L, subsequently 140 U/L). Imaging studies, including CT, USG, and MRI, confirmed findings consistent with acute pancreatitis involving the pancreatic tail with associated peripancreatic edema and fluid. There were no abnormalities in the biliary system, pancreatic duct, or evidence of gallstones or choledocholithiasis. Triglycerides and calcium levels were normal, and no history of alcohol use, recent trauma, or drug use was reported.
Investigations and Management:Comprehensive investigations ruled out common causes, including gallstones and hypertriglyceridemia. Autoimmune pancreatitis was considered due to elevated IgG4 levels (90.4 mg/dL), though additional autoimmune markers are pending. Diagnostic viral panels were negative. The patient was managed conservatively with intravenous fluids, pain control, and a gradual dietary advancement, leading to clinical improvement. Genetic testing was not pursued as there was no family history of pancreatitis
Discussion:This case underscores the importance of a systematic diagnostic approach in acute pancreatitis, especially in younger patients with no identifiable risk factors. The elevated IgG4 levels point toward a potential autoimmune process, warranting further evaluation. This report highlights the need for heightened clinical awareness and multidisciplinary management in atypical presentations.
Conclusion:The case illustrates an atypical presentation of acute pancreatitis of unclear etiology, emphasizing the role of thorough diagnostic workup and consideration of rare causes such as autoimmune pancreatitis in young adults. Further follow-up and investigations will refine the diagnosis and guide long-term management.
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