Coxsackievirus-associated pancreatitis mimicking metastatic carcinoma

The origin of idiopathic acute pancreatitis has not been well defined. Several enteroviruses, including coxsackievirus, have been implicated. We report the case of a 21-year-old woman with severe, acute pancreatitis with no classic risk factors. Initial evaluation failed to show choledocholithiasis. Her condition improved with conservative treatment, but symptoms recurred after resumption of oral intake. Computed tomography (CT) of the abdomen revealed an atypical pseudocyst and omental nodules suggestive of a metastatic malignancy. An acute coxsackievirus B5 titer delayed CT-guided omental biopsy. The patient showed improvement, but progression of the omental nodules prompted open laparotomy. No malignant or inflammatory process was identified. This is the first reported case of presumed viral pancreatitis causing reactive omental nodules. This case shows a benign process mimicking malignancy, requiring an extensive, potentially dangerous workup. It also emphasizes the need to consider viral causes for unusual presentations of common problems.