Multiple Organ Failure Secondary to Pancreatitis Due to Biliary Ascariasis in a Young Patient: A Case Report on the Importance of a Good Anamnesis.
Hugo-Malik Cherif, Daniela Ocampo, Belisa Nicolle Espinoza et al.
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Case in brief
A 22-year-old man from rural Honduras presented in refractory shock with encephalopathy, jaundice, gastrointestinal bleeding, severe hepatic dysfunction, acute kidney injury, and rhabdomyolysis after taking large amounts of analgesics and herbal extracts. Drug-induced liver injury was initially suspected. Further history revealed severe epigastric pain radiating to the back before admission; review of testing found elevated lipase and ultrasonographic tubular “railway-track” images in the common bile duct. These findings supported severe acute pancreatitis from biliary ascariasis, coexisting with acute drug-induced liver injury. With supportive care and hemodialysis, he expelled Ascaris orally, biliary clearance was confirmed, and organ function improved, though sequelae remained.
What made this case unusual
The severe multiorgan presentation and reported ingestion of analgesics and herbal extracts initially focused attention on drug-induced liver injury, while biliary ascariasis causing pancreatitis was identified only after targeted history-taking and reassessment of earlier tests.
Diagnostic / clinical pearl
In endemic settings, severe organ failure and suspected drug toxicity should not preclude evaluation for biliary obstruction. A focused history of preceding epigastric pain, pancreatic enzyme testing, and careful review of biliary imaging helped identify pancreatitis due to ascariasis in this case.