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Acute recurrent pancreatitis complicated by pancreatic-portal venous fistulisation, secondary chronic portal vein thrombosis, multiple hepatic abscesses and newly diagnosed cirrhosis
  1. Tess Calcagno1,
  2. Sara Marin2 and
  3. Lily Ostrer2
  1. 1Medicine, University of Miami Health System, Miami, Florida, USA
  2. 2Internal Medicine, University of Miami Health System, Miami, Florida, USA
  1. Correspondence to Dr Tess Calcagno; tesscalcagno{at}med.miami.edu

Abstract

Pancreatic-portal vein fistula, portal vein thrombosis and liver abscesses are rare complications of acute pancreatitis which occur in the setting of localised inflammation of the pancreatic tissues and surrounding structures. We discuss a 34-year-old woman with a medical history of intermittently controlled HIV and alcohol use disorder who presents with severe epigastric pain diagnosed with acute pancreatitis. Concerning CT findings showing hypoattenuating liver lesions likely to be abscesses and multiple pancreatic pseudocysts led us to order an MRI which showed thrombosis of the portal vein, porto-pancreatic pseudocyst fistulation and cirrhotic changes. Patient was treated conservatively in the hospital and ultimately given a course of antibiotics for hepatic abscesses. Workup for new diagnosis of cirrhosis revealed positive antimitochondrial antibodies, raising suspicion for autoimmune hepatitis possibly triggered by immune reconstitution in the setting of HIV infection. Patient was discharged on oral antibiotic therapy and home antiretroviral therapy.

  • gastrointestinal system
  • cirrhosis
  • pancreas and biliary tract
  • pancreatitis
  • HIV / AIDS

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Footnotes

  • Contributors TC, SM and LO analysed an interpreted patient data, imaging and treatment plan. TC was the major contributor in writing and editing the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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