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[Autoimmune pancreatitis (AIMP) - a clinical entity of its own?]
M A Susset1, A Kunz, B Sczepanski
1Medizinische Klinik, Klinikum am Steinenberg Reutlingen, Germany. masusset@aol.com
History And Admission Findings:
A 34-year-old man with chronic inflammation of both tear glands for 10 years was admitted because of severe upper abdominal pain and jaundice.
Investigations:
Transaminase and cholestasis parameters were raised, as were gamma-globulins on electrophoresis. Ultrasound revealed an echo-poor diffusely enlarged pancreas with hypervascularity on colour-Doppler. Endoscopic retrograde cholangiopancreatography (ERCP) indicated chronically changed pancreatic ducts of varying diameter and stenosis, as well as a filiform distal stenosis of the common bile duct. A pancreatic biopsy showed chronic sclerosing pancreatitis with broad periductal lymphocytic infiltration.
Treatment And Course:
ERCP and a guide-wire papillotomy were performed, followed by placement of a nasobiliary catheter. All findings markedly improved on oral prednisone.
Conclusion:
This case supports the supposition that in idiopathic chronic pancreatitis autoimmune processes may be responsible for the changes in the pancreatic ducts. Immunosuppressive treatment is thus recommended in these cases.