A Case of Autoimmune Pancreatitis Showing Narrowing of the Main Pancreatic Duct after Cessation of Steroid Therapy in the Clinical Course

Shimizu, Shuya; Naitoh, Itaru; Nakazawa, Takahiro; Hayashi, Kazuki; Okumura, Fumihiro; Miyabe, Katsuyuki; Kondo, Hiromu; Yoshida, Michihiro; Yamashita, Hiroaki; Ohara, Hirotaka; Joh, Takashi

doi:10.2169/internalmedicine.51.7992

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…In this study, the authors did not mention the timing of recovery of biliary findings in their cases. Another report indicated that only 2 weeks of steroid treatment induced an improvement in the pancreatic morphology in a case with mass-forming IgG4-related autoimmune pancreatitis (10). In our case, after 10 days of corticosteroid treatment, CBD involvement was the first to disappear completely on MRI and it took a couple of months to see a similar complete response in the pancreatic parenchyma and MPD.…”

Section: Discussionsupporting

confidence: 51%

Sequential Evaluation of Pancreato-Biliary Findings in a Case with IgG4-Associated Cholangiopathy and Autoimmune Pancreatitis during Corticosteroid Treatment

et al. 2016

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Background: Immunoglobulin G4 (IgG4)-associated diseases mostly involve the pancreatico-biliary tree and pancreatic parenchyma. This disease complex is characterized by marked response to corticosteroid therapy and response to steroids is incorporated in the diagnostic algorithm of IgG4 associated diseases. However, there is much unknown about the sequences and duration of healing during the corticosteroid therapy in the literature. Case Report: In this case report, we report a young male patient with IgG4 associated extrahepatic biliary stricture and autoimmune pancreatitis successfully treated with corticosteroids. Recovery in the laboratory and radiological findings seemed to correlate well with the decrease in serum IgG4 levels in this patient. We also discussed sequences and the duration of healing in the pancreaticobiliary tree and pancreatic parenchymal manifestations in this case report. Conclusion: There is a gap in our knowledge about the evaluation of response criteria after steroid trial with regard to the duration and sequences of healing in the pancreaticobiliary involvement in diagnosing IgG4-related biliary and pancreatic diseases.

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Section: Discussionsupporting

confidence: 51%

Sequential Evaluation of Pancreato-Biliary Findings in a Case with IgG4-Associated Cholangiopathy and Autoimmune Pancreatitis during Corticosteroid Treatment

et al. 2016

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“…Moreover, recent reports have demonstrated atypical cases that did not meet the criteria before or during the steroid therapy, but nevertheless fulfilled the condition of definitive AIP after steroid withdrawal with the development of narrowing of the main pancreatic duct [30] or hilar bile duct [21]. These phenomena suggested another necessity of careful follow-up after a course of steroids, after a negative work-up by EUS-FNAB [11].…”

Section: Discussionmentioning

confidence: 99%

Determination of steroid response by abdominal ultrasound in cases with autoimmune pancreatitis

Matsubayashi

Yoneyama

Nanri

et al. 2013

Digestive and Liver Disease

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“…However, one case in this study showed no response by US and CT and required ERCP, which revealed an improvement in the narrowing of the MPD and the occurrence of hilar bile duct stenosis after the withdrawal of corticosteroid [33,48] . Similarly, some cases of AIP fulfill the diagnostic criteria after cessation of steroid [73] , so that clinicians need to remain aware of this. Many diagnostic criteria including those for ICDC (Table 2) can include evaluation of a steroid response either in the pancreatic or extrapancreatic lesions [9,17,18,25] , but the diagnosis is worrisome when the steroid response is seen only in the extrapancreatic lesions and not in the pancreas.…”

Section: Response To Steroidmentioning

confidence: 99%

Diagnosis Autoimmune Pancreatitis

Hart¹,

Chari²

The Pancreapedia: Exocrine Pancreas Knowledge Base

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Autoimmune pancreatitis (AIP) is a distinct form of chronic pancreatitis that is increasingly being reported. The presentation and clinical image findings of AIP sometimes resemble those of several pancreatic malignancies, but the therapeutic strategy differs appreciably. Therefore, accurate diagnosis is necessary for cases of AIP. To date, AIP is classified into two distinct subtypes from the viewpoints of etiology, serum markers, histology, other organ involvements, and frequency of relapse: type 1 is related to IgG4 (lymphoplasmacytic sclerosing pancreatitis) and type 2 is related to a granulocytic epithelial lesion (idiopathic duct-centric chronic pancreatitis). Both types of AIP are characterized by focal or diffuse pancreatic enlargement accompanied with a narrowing of the main pancreatic duct, and both show dramatic responses to corticosteroid. Unlike type 2, type 1 is characteristically associated with increasing levels of serum IgG4 and positive serum autoantibodies, abundant infiltration of IgG4-positive plasmacytes, frequent extrapancreatic lesions, and relapse. These findings have led several countries to propose diagnostic criteria for AIP, which consist of essentially similar diagnostic items; however, several differences exist for each country, mainly due to differences in the definition of AIP and the modalities used to diagnose this disease. An attempt to unite the diagnostic criteria worldwide was made with the publication in 2011 of the international consensus diagnostic criteria for AIP, established at the 2010 Congress of the International Association of Pancreatology (IAP).

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A Case of Autoimmune Pancreatitis Showing Narrowing of the Main Pancreatic Duct after Cessation of Steroid Therapy in the Clinical Course

Cited by 4 publications

References 22 publications

Sequential Evaluation of Pancreato-Biliary Findings in a Case with IgG4-Associated Cholangiopathy and Autoimmune Pancreatitis during Corticosteroid Treatment

Sequential Evaluation of Pancreato-Biliary Findings in a Case with IgG4-Associated Cholangiopathy and Autoimmune Pancreatitis during Corticosteroid Treatment

Determination of steroid response by abdominal ultrasound in cases with autoimmune pancreatitis

Diagnosis Autoimmune Pancreatitis

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