Massive Upper Gastrointestinal Bleeding From Ruptured Gastric Varices: A Rare Presentation of Type 1 Autoimmune Pancreatitis

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Abstract
A 59-year-old Thai woman presented with jaundice and massive hematemesis complicated by cardiac arrest. Emergency endoscopy revealed isolated gastric varices type 1, successfully treated with cyanoacrylate injection. Axial imaging demonstrated diffuse pancreatic enlargement with splenic vein compression and distal common bile duct obstruction. Endoscopic retrograde cholangiopancreatography with biliary stenting was performed. Endoscopic ultrasound (EUS) showed diffuse mixed-echogenic pancreatic infiltration, and EUS-guided biopsy revealed dense lymphoplasmacytic infiltration with 20 immunoglobulin G4-positive plasma cells per high-power field. Elevated serum immunoglobulin G4 (405 mg/dL) also confirmed type 1 autoimmune pancreatitis. Prednisolone therapy resulted in complete clinical and radiologic resolution at 6-week follow-up.

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