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

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.