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Autoimmune pancreatitis in a child: a challenging diagnosis
  1. Graham King1,
  2. Emer O'Toole1,
  3. Kevin O'Hare2,
  4. Barbara M. Ryan3,
  5. Basil Elnazir4,
  6. Shoana Quinn1
  1. 1Paediatric Gastroenterology, Children's Health Ireland at Tallaght, Dublin, Ireland
  2. 2Pathology, Tallaght University Hospital, Dublin, Ireland
  3. 3Adult Gastroenterology, Tallaght University Hospital, Dublin, Ireland
  4. 4General Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
  1. Correspondence to Dr Graham King, Paediatric Gastroenterology Secretary, Tallaght University Hospital, Dublin D24 NR0A, Ireland; graham.king{at}hse.ie

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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 …

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