Abstracts: CLINICAL VIGNETTES/CASE REPORTS - BILIARY/PANCREAS
Autoimmune Pancreatitis Resolved Without Any Steroid Trial
Back ground: Autoimmune pancreatitis is a benign fibroinflammatory disease of the pancreas of probable autoimmune origin, which includes 2 different phenotypes: type 1 (lymphoplasmacytic sclerosing pancreatitis) and type 2 (idiopathic duct-centric pancreatitis). Its clinical presentation as obstructive jaundice in patients with a pancreatic mass is common and therefore it must be included in the differential diagnosis of pancreatic neoplasia. Autoimmune pancreatitis (AIP) and its histopathological features typically respond dramatically to steroid therapy.
Case report: A 74-year-old male with uncontrolled type II Diabetes Mellitus, essential hypertension presented to medicine clinic complaining of weight loss and jaundice. Patient lost about 5 pounds over 3 months. Review of systems is unremarkable. Routine work up revealed elevated LFT's (AST, ALT, Alk phos) and patient was hospitalized for further evaluation. MRCP was performed which revealed a pancreatic head mass with parapancreatic lymph nodes involvement suggestive of malignancy. CA 19-9 and CEA were normal. EUS with FNA biopsy did not reveal evidence of malignancy. ERCP with biliary stent and cytologic brushing was then performed. The CBD cytologic brushing failed to show malignant cells. Patient's hepatitis panel, workup for connective tissue disease, serum ceruloplasmin and autoimmune hepatitis were all normal except elevated IGG. Considering absence of malignancy, elevated IGG and advanced imaging, a diagnosis of autoimmune pancreatitis was made. Without any steroid trial, repeat imaging showed significant improvement in the pancreatic inflammation. Patient gained weight, and LFT became normal.
Conclusion: One of the main features of autoimmune pancreatitis is its dramatic response to steroid therapy, without the need for surgical treatment. Our case was unique given the fact that without using steroid; repeat imaging showed no mass or inflammation in the head of the pancreas.© The American College of Gastroenterology 2015. All Rights Reserved.