VID-HPB-06: Eosinophilic pancreatitis confirmed by cyst wall biopsy of walled-off necrosis through nagi stent

An 18-year-old male presented 3 months after acute severe pancreatitis with ascites and large pancreatic fluid collection (PFC). He had no history of alcohol, drug abuse, or allergies. Blood count showed peripheral eosinophilia (44%) with high absolute eosinophilic count (1800 cells/mm(3)). Percutaneous drainage (PCD) was done for significant pancreatic ascites. Ascitic fluid analysis showed low-gradient ascites with eosinophilic predominance (800 cells/mm(3) with 80% eosinophils) and raised fluid amylase levels (1331 U/L). Due to persistent pain and PFC, he underwent EUS-guided cystogastric drainage of walled-off necrosis (WON) with Nagi stent. WON fluid analysis had high amylase levels (49,500 U/l) with normal eosinophil count. He continued to have high volume drainage in PCD. Later, he required endoscopic necrosectomy for infected necrosis during which a cyst wall biopsy was also taken. Histology confirmed eosinophilic pancreatitis. After resolution of infected WON, he was treated with oral prednisolone (40 mg/day) with rapid recovery.