FASLG and autoimmune polyendocrinopathy: This case highlights a rare manifestation of patients with aPL positivity, as pancreatic involvement occurs in ~0.5% of antiphospholipid syndrome (APS) patients.[1] While pancreatitis is common, aPL-associated cystic lesions are unusual but clinically significant.[2, 3, 4] The proposed mechanism involves aPL-mediated microvascular thrombosis, leading to ischemic necrosis, inflammation, and cystogenesis.[1,5] Persistent aPL positivity and therapeutic responsiveness further support aPLs as the etiology.