Simultaneous Presentation of Idiopathic Duct-Centric Pancreatitis and Ulcerative Colitis

A 22-year-old female with no significant past medical history was admitted with chronic bloody diarrhea and persistent epigastric pain radiating to the back for the previous 2 months. There was no history of nonsteroidal anti-inflammatory drugs or alcohol consumption. Physical examination revealed tenderness in the epigastrum, without peritoneal signs. Laboratory results showed leukocytosis (15,400/mL), elevated C-reactive protein (26.4 mg/dL), elevated lipase (8,158 UI/L), and positive anti-saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmatic antibodies (ANCA). Neither abdominal ultrasound nor computed tomography showed any abnormality. A colonoscopy and ileoscopy were performed and revealed granular, swollen, and friable mucosa with continuous involvement of the entire colon and rectum, with terminal ileum spared (Figure 1). Biopsies from the colon and rectum showed distortion of crypt architecture with branching crypts, globet cells depletion, increased inflammatory cells in the lamina propria, and crypt abscesses (Figure 2). An endoscopic ultrasound revealed a dif-