Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Hepatol. Nov 27, 2013; 5(11): 649-653
Published online Nov 27, 2013. doi: 10.4254/wjh.v5.i11.649
Diagnostic challenges of Wilson’s disease presenting as acute pancreatitis, cholangitis, and jaundice
Elchanan Nussinson, Azmi Shahbari, Fahmi Shibli, Elena Chervinsky, Philippe Trougouboff, Arie Markel
Elchanan Nussinson, Azmi Shahbari, Fahmi Shibli, Gastroenterology Institute, Emek Medical Center, Rabin st’ Afula 18101, Israel
Elena Chervinsky, The Genetic Institute, Emek Medical Center, Rabin st’ Afula 18101, Israel
Philippe Trougouboff, Department of Pathology, Emek Medical Center, Rabin st’ Afula 18101, Israel
Arie Markel, Internal Medicine A Department, Emek Medical Center, Rabin st’ Afula 18101, Israel
Author contributions: All authors contributed to conception and design of the study and to the collection of the data, drafting of the article, and approval of the version to be published.
Correspondence to: Elchanan Nussinson, MD, Gastroenterology Institute, Emek Medical Center, Rabin st’ Afula 18101, Israel. elchanann@gmail.com
Telephone: +972-5-44943922 Fax: +972-4-6495314
Received: June 17, 2013
Revised: July 30, 2013
Accepted: October 19, 2013
Published online: November 27, 2013
Processing time: 162 Days and 3.8 Hours
Abstract

Wilson’s disease is a rare disorder of copper transport in hepatic cells, and may present as cholestatic liver disease; pancreatitis and cholangitis are rarely associated with Wilsons’s disease. Moreover, cases of Wilson’s disease presenting as pigmented gallstone pancreatitis have not been reported in the literature. In the present report, we describe a case of a 37-year-old man who was admitted with jaundice and abdominal pain. The patient was diagnosed with acute pancreatitis, cholangitis, and obstructive jaundice caused by pigmented gallstones that were detected during retrograde cholangiopancreatography. However, because of his long-term jaundice and the presence of pigmented gallstones, the patient underwent further evaluation for Wilson’s disease, which was subsequently confirmed. This patient’s unique presentation exemplifies the overlap in the clinical and laboratory parameters of Wilson’s disease and cholestasis, and the difficulties associated with their differentiation. It suggests that Wilson’s disease should be considered in patients with pancreatitis, cholangitis, and severe protracted jaundice caused by pigmented gallstones.

Keywords: Wilson’s disease; Pancreatitis; Cholangitis; Obstructive jaundice; Cholestasis

Core tip: A 37-year-old male patient was diagnosed with acute pancreatitis, cholangitis, and jaundice caused by pigmented gallstones. Due to long-term jaundice and an obscure clinical course, the patient was evaluated for Wilson’s disease, which was confirmed using the Wilson’s disease score. This patient’s unique presentation exemplifies the overlap in the clinical and laboratory parameters of Wilson’s disease and cholestasis, and the difficulties associated with their differentiation. This very rare case of acute pancreatitis, as the presenting feature of Wilson’s disease, suggests that Wilson’s disease should be considered in patients with pancreatitis, cholangitis, and severe protracted jaundice caused by pigmented gallstones.