A rare case of autoimmune pancreatitis with pancreatic divisum
Keywords:Autoimmune pancreatitis, IgG4, Pancreatic divisum
Chronic pancreatitis has a fibro-inflammatory subtype called autoimmune pancreatitis. A combination of imaging tests, including a CT scan and pancreatography, lab tests that check for IgG4 and/or autoantibodies, histological analysis, and a favourable response to corticosteroid treatment are used for diagnosis. Hereby we present a case of a young boy who presented to our hospital with recurrent abdominal pain and on further investigation was found to have elevated levels of IgG4 as well as a developmental abnormality of pancreatic duct known as pancreatic divisum.
Kim KP, Kim MH, Song MH, Lee SS, Seo DW, Lee SK. Autoimmune chronic pancreatitis. Am J Gastroenterol. 2004;99:1605-16.
Okazaki K, Uchida K, Ohana M, Nakase H, Uose S, Inai M et al. Autoimmune-related pancreatitis is associated with autoantibodies and Th1/Th2-type cellular immune response. Gastroenterology. 2000;118:573-81.
Aparisi L, Farre A, Gomez-Cambronero L, Martinez J, De Las Heras G, Corts J et al. Antibodies to carbonic anhydrase and IgG4 levels in idiopathic chronic pancreatitis: relevance for diagnosis of autoimmune pancreatitis. Gut. 2005;54:703-9.
Shinji A, Sano K, Hamano H, Unno H, Fukushima M, Nakamura N. et al. Autoimmune pancreatitis is closely associated with gastric ulcer presenting with abundant IgG4-bearing plasma cell infiltration. Gastrointest Endosc. 2004;59:506-11.
Ozden I, Dizdaroglu F, Poyanli A, Emre A. Spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis. Pancreatology. 2005;5:300-303.
Sahani DV, Kalva SP, Farrell J, Maher MM, Saini S, Mueller PR. et al. Autoimmune pancreatitis: imaging features. Radiology. 2004;233:345-52.
Wakabayashi W, Tokio T, Kawaura K, Yukimitsu Y, Satomura S, Yoshitake Y et al. Clinical study of chronic pancreatitis with focal irregular narrowing of the main pancreatic duct and mass formation: comparison with chronic pancreatitis showing diffuse irregular narrowing of the main pancreatic duct. Pancreas. 2002;25:283-9
Nakazawa T, Ohara H, Sano H, Aoki S, Kobayashi S, Okamoto T et al. Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis. Gastrointest Endosc. 2004;60:937-44.
Finkelberg D, Sahani D, Deshpande V, Brugge W. Autoimmune Pancreatitis. N Eng J Med. 2006;355:2670-6.
Löhr JM, Beuers U, Vujasinovic M. European Guideline on IgG4-related digestive disease - UEG and SGF evidence-based recommendations. United Eur Gastroenterol J. 2020;8:637-66.