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Two Ducts, One Drug-Pembrolizumab-Induced Pancreatic Injury Manifesting as Double-Duct Sign
Journal article   Open access   Peer reviewed

Two Ducts, One Drug-Pembrolizumab-Induced Pancreatic Injury Manifesting as Double-Duct Sign

Tareq Alsaleh, Mohamad Khaled Almujarkesh, Abdullah Abbasi, Mustafa Arain and John George
ACG case reports journal, Vol.12(11), e01878
11/06/2025
DOI: 10.14309/crj.0000000000001878
PMCID: PMC12591698
PMID: 41209351
url
https://doi.org/10.14309/crj.0000000000001878View
Published (Version of record) Open Access

Abstract

ABSTRACT Immune checkpoint inhibitors (ICIs) can rarely result in ICI-induced pancreatic injury (ICI-PI). Its clinical and radiologic presentation is heterogenous, ranging from asymptomatic radiological signs to severe pancreatitis. Management is mainly with supportive measures and drug discontinuation. In this study, we present an unusual case of ICI-PI, secondary to pembrolizumab, resulting in dilation of both pancreatic and common bile ducts, displaying a "double-duct" sign on imaging. This radiologic sign, commonly associated with malignancy, has not been previously reported with ICI-PI. Endoscopic retrograde cholangiopancreatography with plastic stent placement resulted in quick improvement, highlighting the potential role of endotherapy in treatment of ICI-PI.
Pancreas pancreatitis ERCP immune checkpoint inhibitors stricture

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