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Pancreatic Head Mass: A Rare Manifestation of Granulomatosis With Polyangiitis
Michael Castillo1, Adalberto Gonzalez1, Asad Ur Rahman2
1Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL.
Abstract:
Granulomatosis with polyangiitis may rarely present as an inflammatory pancreatic mass and mimic pancreatic cancer. We report a 73-year-old man who presented with fever and weight loss. Computed tomography imaging demonstrated a mass in the pancreatic head along with multiple cavitary pulmonary nodules. Our differential included metastatic pancreatic cancer vs an autoimmune process. Positive cytoplasmic antineutrophil cytoplasmic antibodies coupled with the lung biopsy findings established the diagnosis of granulomatosis with polyangiitis, a very rare cause of pancreatic masses. After completion of immunosuppressive therapy, magnetic resonance imaging demonstrated no evidence of a pancreatic mass. More studies are required to establish the management of these masses.
Insights
Granulomatosis with polyangiitis can rarely cause pancreatic masses, mimicking cancer. Treatment with immunosuppression resolved the pancreatic mass in this rare case.
Area of Science:
- Internal Medicine
- Rheumatology
- Gastroenterology
Background:
- Granulomatosis with polyangiitis (GPA) is a rare systemic vasculitis.
- GPA typically affects the respiratory tract and kidneys.
- Pancreatic involvement in GPA is exceptionally rare.
Observation:
- A 73-year-old male presented with fever and weight loss.
- CT imaging revealed a pancreatic head mass and pulmonary nodules.
- Differential diagnosis included pancreatic cancer and autoimmune processes.
Findings:
- Diagnosis of GPA was confirmed by positive cytoplasmic antineutrophil cytoplasmic antibodies and lung biopsy.
- The pancreatic mass resolved completely after immunosuppressive therapy.
- This case highlights GPA as a rare cause of pancreatic masses.
Implications:
- GPA should be considered in the differential diagnosis of pancreatic masses, especially with concurrent pulmonary findings.
- Successful treatment of GPA can lead to resolution of pancreatic lesions.
- Further research is needed to define optimal management strategies for GPA-associated pancreatic masses.
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