Acute Biliary Pancreatitis as the Initial Clinical Manifestation of Beta-Thalassemia Minor in a Young Adult: A Case Report.

Background: Biliary pancreatitis in young, lean patients without typical risk factors warrants a thorough evaluation for underlying predisposing conditions. In individuals of Mediterranean descent, hemoglobinopathies should be considered a primary cause of gallstone formation due to chronic hemolysis. Case Presentation: A male in his early 20s with a slender habitus and no history of alcohol consumption or metabolic syndrome presented with jaundice and acute upper abdominal pain. Laboratory results revealed elevated lipase (210.9 U/L) and cholestatic markers. While initial imaging showed no large gallstones, significant splenomegaly (13 cm) and severe microcytic erythrocytosis (MCV 61.2 fL, RBC 6.24 ×10⁶/µL) were noted. The Mentzer Index was 9.8, strongly suggesting a hemoglobinopathy. Hemoglobin electrophoresis confirmed β-thalassemia minor (HbA2: 4.7%, HbF: 2.3%). Conclusions: β-Thalassemia minor can lead to pigment stone formation via chronic hemolysis, causing biliary complications. Clinicians should consider hemoglobinopathies in young patients with “idiopathic” or biliary pancreatitis, particularly when microcytosis and splenomegaly are present.