RESUMO
Autoimmune pancreatitis (AIP) is a distinct subtype of pancreatitis, rare in the pediatric population. Its pathophysiology is poorly understood. A pancreatic focal mass is frequently the clinical presentation, which imposes the differential diagnosis with a pancreatic tumor. This distinction is essential because the treatment of pancreatic tumors is surgical in contrast to the treatment of AIP, which is pharmacological. We describe a case of a 16-year-old girl with AIP who presented with obstructive jaundice, weight loss, fatigue, and a pancreatic mass. This case emphasizes the importance of considering this diagnosis to correctly treat and prevent an abusive pancreatic resection.
A pancreatite autoimmune (PAI) é um subtipo distinto de pancreatite, raro na população pediátrica, e com fisiopatologia ainda pouco conhecida. A apresentação clínica com massa pancreática é frequente, o que impõe o diagnóstico diferencial com neoplasia pancreática. A distinção entre estas duas entidades é fundamental uma vez que o tratamento dos tumores pancreáticos é cirúrgico, ao contrário da terapêutica farmacológica da PAI. Descrevemos o caso de uma adolescente de 16 anos diagnosticada com PAI, cujas manifestações clínicas foram icterícia obstrutiva, perda de peso, fadiga e massa pancreática. Realçamos a importância da suspeição e reconhecimento deste diagnóstico, para uma adequada intervenção terapêutica, que pode obstar a uma abusiva resseção pancreática.
RESUMO
Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our Intensive-Care Unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the first reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.