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A 13-year-old boy presented with a 4-day history of vomiting, jaundice, pruritus, pale stools and dark urine. He was apyrexic and had right-upper-quadrant abdominal tenderness. He had raised alkaline-phosphatase (620 U/L), gamma-glutamyl-transferase (435 U/L), total bilirubin (102 μmol/L), direct bilirubin (94 μmol/L), alanine-transaminase (123 U/L) and lipase (68 U/L), but normal amylase (37 U/L), faecal elastase (232 µg/g) and serum IgG4 levels.
Transabdominal ultrasound showed a distended gallbladder and dilated common bile duct (15 mm). He received prophylactic pancreatic enzyme supplementation, vitamin K, cholestyramine, rifampicin and …
Contributors All authors equally contributed to the draft of the 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.
Competing interests None declared.
Patient consent for publication Parental/guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.