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Diffuse type autoimmune pancreatitis: the first case report in Thailand
Varayu Prachayakul1, Pitulak Aswakul, Piyaporn Apisarnthanarak
1Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Autoimmune pancreatitis (AIP) is a treatable condition that can mimic pancreatic cancer. This case report confirms diffuse-type AIP exists in Thailand, crucial for accurate diagnosis and avoiding unnecessary surgery.
Area of Science:
- Gastroenterology
- Immunology
Background:
- Autoimmune pancreatitis (AIP) is a steroid-responsive pancreatic condition that can be mistaken for pancreatic cancer (PaC).
- While focal-type AIP has been reported in Thailand, diffuse-type AIP has not been previously documented in the region.
Observation:
- A 76-year-old male presented with obstructive jaundice, revealing a diffusely swollen pancreas with a characteristic capsule-like rim on CT scan.
- Elevated serum immunoglobulin G4 (IgG4) levels (468 mg/dL) and negative fine needle aspiration for PaC supported the diagnosis.
- The patient responded rapidly to corticosteroid treatment, with jaundice resolving and pancreatic swelling normalizing on follow-up CT.
Findings:
- This case confirms the existence of diffuse-type AIP in Thailand.
- The patient's presentation and diagnostic workup align with established criteria for diffuse-type AIP.
Implications:
- Accurate recognition of diffuse-type AIP is critical to prevent misdiagnosis as pancreatic cancer.
- Timely diagnosis and appropriate corticosteroid treatment can avoid unnecessary surgical interventions for AIP.
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