Abstract
IntroductionWe report on a case of autoimmune pancreatitis presenting as pancreatic head cancer, which is extremely rare in Iran. Currently, on the PubMed database, no such cases exist.Case presentationA 70-year-old Iranian man presented with recurrent abdominal pain, jaundice and elevated bilirubin and alkaline phosphatase levels. An abdominal computed tomography scan revealed a heterogeneous presence in the pancreatic head as well as dilated intra- and extrahepatic bile ducts. A common bile duct stent had been inserted. Our patient was subsequently diagnosed with pancreatic head cancer.Due to his continued recurrent abdominal pain, our patient returned to the hospital. His levels of bilirubin, alkaline phosphatase and tumor markers were all normal but his immunoglobulin G4 and antinuclear antibodies were extremely high. A biopsy of the pancreatic head heterogeneity by endoscopic ultrasonography was performed.Pathologic samples showed fibrosis associated with lymphoplasmacytic infiltration and no evidence of malignancy. A diagnosis of autoimmune pancreatitis was confirmed, the bile duct stent removed, and an appropriate treatment plan was undertaken.ConclusionAutoimmune pancreatitis should be considered in suspected cases of pancreatic cancer. In these instances, a biopsy of the pancreas will help to differentiate between the two and prevent complications due to disease progression as well as unnecessary surgery.
Highlights
We report on a case of autoimmune pancreatitis presenting as pancreatic head cancer, which is extremely rare in Iran
Autoimmune pancreatitis should be considered in suspected cases of pancreatic cancer
The diagnostic criteria defined by the Mayo Clinic include one or more of three characteristics: diagnostic histology; related features in abdominal magnetic resonance imaging (MRI) or computed tomography (CT) in association with increased levels of immunoglobulin G4 (IgG4); and the response of intra- or extrapancreatic manifestations to corticosteroid therapy [4]
Summary
AIP is an autoimmune disease with varying diagnostic criteria, which include a range of pancreatic. Author details 1Department of Internal Medicine, Qom University of Medical Sciences, Shahid Beheshti General Hospital, Qom, Iran. Authors’ contributions GM conducted the first approach and examinations, participated in the treatment of our patient and oversaw the manuscript to publication. He was responsible for final approval and supervision of the manuscript. GA contributed to the editing of the final manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests
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