Tropical Calcific Pancreatitis

Abstract

Tropical Calcifi c Pancreatitis (TCP) is a type of chronic calcifi c non-alcoholic pancreatitis. It is similar to non-alcoholic chronic pancreatitis, is commonly seen in the second and third decades of life, mostly in the developing countries of the tropical world. It is associated with the formation of calculi in the large ducts, ductal dilatation, and signifi cant fi brosis with a high probability of developing diabetes mellitus. Epidemiologic studies have shown that these patients have an increased lifetime risk of developing pancreatic carcinoma compared to both healthy controls and patients with chronic pancreatitis of diff ering etiology. Th e etiology of TCP remains uncertain, with the current consensus suggesting a role for genetics as well as possible toxicity from consuming large amounts of cassava, a tuber (Manihot esculenta). We report the case of a forty four year old male from the Dominican Republic diagnosed with TCP during a recent admission to our hospital. His fi rst episode of Acute Pancreatitis was when he was twenty years old. At that time he lived in the Dominican Republic. He moved to New York approximately twenty years ago; this inpatient admission was his fourth for pancreatitis. He denies consuming alcohol and has no family history of pancreatitis. Causes of acute pancreatitis, such as trauma, autoimmune diseases, scorpion sting, steroid use, infection, hyperlipidemia, hypercalcemia, drug use, and gall stones were excluded by history, by imaging as well as through laboratory studies. Computed tomography of the abdomen done this admission and in 2002, show multiple calcifi cations in the pancreas. A genetic study was done and he was found to have no variations in the SPINK1 gene. As of submission of this report, he has not developed any complications such as pancreatic necrosis, pancreatic pseudocyst or diabetes mellitus and remains healthy. Th is is a case of a rare entity in the United States. While this condition is uncommon, the increased lifetime risk of pancreatic carcinoma makes an accurate diagnosis of TCP in patients from the developing tropics vital in preventing morbidity and mortality. A 35 Year Old Caucasian male with past medical history of depression and alcohol abusewas brought to the hospital aft er a suicidal attempt. He was admitted to manage alcohol withdrawal, as well as psychosis with suicidal ideation. On the third day of admission he developed temperature of 101.1F. Physical examination did not reveal a source of fever. Laboratory parameters were unremarkable. Chest radiograph showed possible left lower lobe infi ltration and ipsilateral pleural eff usion. Despite antibiotic coverage for pneumonia, fever persisted. Pleural fl uid was exudative without empyema. Blood, urine cultures continued to be negative and WBC fl uctuated between 5700 to 8430/mcL. Due to persistence of fever, a CT chest/abdomen/pelvis was obtained which showed decreased enhancement of the pancreatic tail with extensive peripancreatic fl uid collection in the lesser sac as well as the greater s...