Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 11882-11888
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11882
Brachiocephalic to left brachial vein thrombotic vasculitis accompanying mediastinal pancreatic fistula: A case report
Reiji Kokubo, Daisuke Yunaiyama, Yu Tajima, Natsumi Kugai, Mitsuru Okubo, Kazuhiro Saito, Takayoshi Tsuchiya, Takao Itoi
Reiji Kokubo, Daisuke Yunaiyama, Yu Tajima, Natsumi Kugai, Mitsuru Okubo, Kazuhiro Saito, Department of Radiology, Tokyo Medical University, Tokyo 160-0023, Japan
Takayoshi Tsuchiya, Takao Itoi, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan
Author contributions: Kokubo R and Yunaiyama D designed the report; Kokubo R, Tajima Y, and Kugai N collected the patient’s clinical data; Kokubo R, Yunaiyama D, Tajima Y, Kugai N, Okubo M, Saito K, Tsuchiya T, and Itoi T analyzed the data and wrote the paper; and all authors have read and approved the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daisuke Yunaiyama, MD, PhD, Assistant Professor, Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. yuunai@tokyo-med.ac.jp
Received: May 24, 2022
Peer-review started: May 24, 2022
First decision: August 21, 2022
Revised: August 29, 2022
Accepted: October 9, 2022
Article in press: October 9, 2022
Published online: November 16, 2022
Abstract
BACKGROUND

Pancreatitis is a severe inflammatory pancreatic disease commonly due to bile duct stones or excessive alcohol usage, with clinical manifestations of abdominal pain, nausea, fever, and fluid collections. Healthy persons with less symptomatic pancreatitis are quite rare. Herein, we report a case of a patient with an undetermined onset of pancreatitis mimicking left arm cellulitis due to thrombotic vasculitis of the brachiocephalic vein.

CASE SUMMARY

A 50-year-old woman visited our hospital for tenderness in the left arm over several recent days. She was diagnosed with cellulitis on the left arm due to left elbow tenderness. Intravenous antibiotics administration did not improve symptoms and laboratory data worsened; thus, chest and abdominal computed tomography (CT) was performed. CT demonstrated pancreatitis with pseudocyst around the pancreas extending to the mediastinum. Thrombotic vasculitis of the brachiocephalic to left brachial vein was observed, which could be the cause of left elbow pain. A pancreatic fistula was found in the head of the pancreas by endoscopic retrograde cholangiopancreatography, so a pancreatic cyst drainage tube via the duodenum was placed in the pseudocyst. Cyst content culture was positive for Escherichia coli infection. Clinical symptoms, imaging findings, and inflammatory reactions resolved gradually after starting therapeutic intervention. The mediastinal pancreatic pseudocysts shrunk, and the venous thrombi remained but shrunk.

CONCLUSION

The case of a patient with pancreatitis with an undetermined onset that mimics left arm cellulitis is reported. Deep vein thrombosis should be kept in mind when treating patients with severe inflammatory disease.

Keywords: Pancreatic fistula, Thrombotic vasculitis, Pancreatitis, Computed tomography, Case report

Core Tip: Pancreatitis is a severe inflammatory disease commonly caused by bile duct stones or alcohol usage, with clinical manifestations of abdominal pain, nausea, fever, fluid collections, etc. Because of its severity, it is rare to experience patients with less symptomatic pancreatitis. Herein, a 50-year-old Japanese woman was referred to our hospital due to a history of cough and fatigue for 2 mo and recent left elbow tenderness. Computed tomography showed pancreatic pseudocysts in adjacent tissues and mediastinum, with thrombotic vasculitis in the brachiocephalic to left brachial vein. A history of pancreatitis might cause systemic coagulopathy, which may result in brachiocephalic vein thrombosis.