Autoimmune Chronic Pancreatitis Research Articles

IgG4-Related Disease and Monoclonal Gammopathy: Case Report

Background: IgG4-related disease (IgG4-RD) is a progressive, chronic, atypical presenting clinical entity characterized by an elevated serum IgG4 level, leading to an immune-mediated fibroinflammatory condition affecting various organs.Case Summary: We present the case of a patient with clinical manifestations compatible with chronic pancreatitis due to the time of evolution. Physical examination revealed submaxillary, axillary, and inguinal lymphadenopathy and pain on abdominal palpation. Laboratory tests showed eosinophilia and a hepatocellular pattern in the liver profile. Immunofixation showed a monoclonal IgG lambda band with IgG4 values of 1183 mg/dl. To confirm the diagnosis of autoimmune chronic pancreatitis associated with IgG4-related sclerosing cholangitis, imaging tests were performed, which showed intrahepatic and extrahepatic cholestasis associated with pancreatic parenchymal alterations compatible with this entity. Subsequently, upon initiating glucocorticoid therapy, the patient evolved favorably. Conclusion: ER-IgG4 is a rare condition that causes inflammation and scarring in various organs. It is hard to diagnose and often mistaken for other diseases. The pancreas and biliary tract are frequently affected.

IgG4-Related Disease and Monoclonal Gammopathy: Case Report

Background: IgG4-related disease (IgG4-RD) is a progressive, chronic, atypical presenting clinical entity characterized by an elevated serum IgG4 level, leading to an immune-mediated fibroinflammatory condition affecting various organs. Case Summary: We present the case of a patient with clinical manifestations compatible with chronic pancreatitis due to the time of evolution. Physical examination revealed submaxillary, axillary, and inguinal lymphadenopathy and pain on abdominal palpation. Laboratory tests showed eosinophilia and a hepatocellular pattern in the liver profile. Immunofixation showed a monoclonal IgG lambda band with IgG4 values of 1183 mg/dl. To confirm the diagnosis of autoimmune chronic pancreatitis associated with IgG4-related sclerosing cholangitis, imaging tests were performed, which showed intrahepatic and extrahepatic cholestasis associated with pancreatic parenchymal alterations compatible with this entity. Subsequently, upon initiating glucocorticoid therapy, the patient evolved favorably. Conclusion: ER-IgG4 is a rare condition that causes inflammation and scarring in various organs. It is hard to diagnose and often mistaken for other diseases. The pancreas and biliary tract are frequently affected.

Emerging role of non-invasive and liquid biopsy biomarkers in pancreatic cancer

A global increase in the incidence of pancreatic cancer (PanCa) presents a major concern and health burden. The traditional tissue-based diagnostic techniques provided a major way forward for molecular diagnostics; however, they face limitations based on diagnosis-associated difficulties and concerns surrounding tissue availability in the clinical setting. Late disease development with asymptomatic behavior is a drawback in the case of existing diagnostic procedures. The capability of cell free markers in discriminating PanCa from autoimmune pancreatitis and chronic pancreatitis along with other precancerous lesions can be a boon to clinicians. Early-stage diagnosis of PanCa can be achieved only if these biomarkers specifically discriminate the non-carcinogenic disease stage from malignancy with respect to tumor stages. In this review, we comprehensively described the non-invasive disease detection approaches and why these approaches are gaining popularity for their early-stage diagnostic capability and associated clinical feasibility.

News of European Pancreatology (based on the materials of the 53rd meeting of the European Pancreatic Club)

The 53rd meeting of the European Pancreatic Club (online) took place in Verona (Italy) on June 9–11, 2021. The meeting was attended by 690 delegates from 40 countries. More than 400 oral and poster presentations were presented.
 The results of advances in the diagnosis and treatment of chronic pancreatitis, as well as the crucial research directions, were summarized in a lecture by E. de-Madaria et al. (Italy). The main medical and social characteristics of chronic pancreatitis (CP): chronic disease; often manifests itself in pain, which is often disabling; leads to complications, including pancreatic cancer; diagnosis and treatment are complex. Despite this, the number of randomized controlled trials (RCTs) on CP is significantly less than on acute pancreatitis, and in recent years, the annual number of studies on CP has even decreased. Problems to be solved: we do not have antifibrotic drugs, a “gold standard” for diagnosis, and we do not even have good methods for diagnosing early CP. The main etiological CP options are alcoholic and idiopathic ones. A more detailed analysis showed that toxic CP (alcoholic and smoking-induced) account for 46% of cases of the disease, idiopathic CP — 24%, genetically predisposed CP — 7%, obstructive CP — 7%, autoimmune CP — 2%, CP of other etiology — 12% of cases. We have made progress in the study of autoimmune pancreatitis, however, the frequency of pancreatic cancer due to autoimmune CP, features of the disease in children, increased accuracy of pancreas imaging and the effectiveness of treatment require further study in RCTs.
 Lithotripsy, endoscopy, and surgery are used to treat CP with dilated pancreatic ducts. There were 3 RCTs that showed the advantages of surgical treatment over endoscopic one (long-term pain relief, fewer complications, higher efficiency), but lithotripsy and endoscopy were not compared.
 “Small ducts disease” is treated by the blockade of the solar plexus and/or nn. splanchnici, V-shaped excision of the pancreas, pancreatectomy with autotransplantation of the islets of Langerhans (only in specialized centers). The effectiveness of these techniques requires further study. The main techniques for diagnosing exocrine pancreatic insufficiency (EPI) are: probe (laborious), fecal elastase test (low sensitivity in mild EPI), tests for assessing trophological status (low specificity), breath tests (not available everywhere and laborious).
 Thus, we need an more RCTs (international efforts), definition of early CP; we need to better understand the relationship between genetic and environmental factors, advance in understanding of the autoimmune pancreatitis, and understanding the role of endoscopy and lithotripsy in pain management; it is necessary to develop new techniques of treating pain in the “small ducts disease”; we need easy-to-perform, accurate and widespread tests to diagnose EPI.
 The article analyzes the results of studies on the diagnosis and treatment of pancreatitis, cysts and pancreatic tumors.

Klotho protein, albumin level, left ventricular and left atrium dimensions are independently associated with moderate and severe cardiac allograft vasculopathy in heart transplant recipients

Abstract Background Cardiac allograft vasculopathy (CAV) is one of the main risk factors influencing graft loss and patients survival. An important element of monitoring the patient after heart transplantation (HT) is the assessment of non-invasive indicators associated with the occurrence and progression of CAV. Therefore, new noninvasive sensitive and specific tools are necessary for detecting CAV early, which may result in the modification of immunosuppressive therapy, increase in statin doses, and intensive treatment of CAV-related comorbidities. Purpose The aim of the study was to research for factors associated with occurrence of moderate to severe CAV in heart transplant recipients. Methods Our analysis included consecutive adult patients after HT with CAV who underwent routine visits in our institution between 2015–2017. Exclusion criteria included history of kidney diseases, hepatitis B and C, autoimmune diseases, chronic pancreatitis or thyroid diseases, and cerebrovascular accidents. During each visit, all patients underwent echocardiography, laboratory tests, immunosuppressive drugs serum concentration analyses, and coronary angiographies. In addition, Klotho protein concentration was measured in all patients using sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit. Coronary angiographies of all patients enrolled to the study were reviewed by two independent interventional cardiologists to accurately classify coronary artery lesions according to International Society for Heart and Lung Transplantation (ISHLT) guidelines. Then, patients were divided into a group with mild CAV (1) and moderate to severe CAV (2/3). The local institutional review board of the Medical University of Silesia approved the study protocol, and all patients provided informed consent. Results The final group consisted of 141 patients with CAV. The age of the patients was 60.0 (53.0–66.0) and 77.5% of them were male. The median time from HT to include in the study was 11.6 (8.5–15.0) years. The frequency of CAV 2/3 in the analysed population was 36.6%. All included patients received optimal immunosuppressive therapy consisting of a calcineurin inhibitor (tacrolimus or cyclosporin) and mycophenolate mofetil. Multivariate analysis of logistic regression showed that Klotho protein (OR = 0.719 [0.598–0.866], p<0.001), albumin (OR=0.790 [0.686–0.910] p<0.001), left ventricular diastolic dimension (OR =1.135 [1.054–1.222], p<0.001), and left atrium dimension (OR=1.058 [1.013–1.106] p=0.012) were independent factors of CAV 2/3 presence. Conclusions Lower Klotho and albumin levels, as well as left ventricular and left atrium dimensions are the independent factors of moderate to severe CAV presence. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): MEdical University of Silesia, Katowice, Poland

Differences in Gut Microbiota Profiles between Autoimmune Pancreatitis and Chronic Pancreatitis.

Host-derived factors alter gut microenvironment, and changes in gut microbiota also affect biological functions of host. Alterations of gut microbiota have been reported in a wide variety of diseases, but the whole picture of alterations in pancreatic diseases remains to be clarified. In particular, the gut microbiota may be affected by malnutrition or impaired exocrine pancreas function that is associated with pancreatic diseases. We here conducted comprehensive analysis of gut microbiota in patients with type 1 autoimmune pancreatitis (AIP), a pancreatic manifestation of the systemic IgG4-related disease, and chronic pancreatitis (CP). The two diseases were selected, because altered immune reactions in AIP and/or long-standing malnutrition in CP may influence the gut microbiota. Fecal samples were obtained from 12 patients with AIP before the steroid therapy and 8 patients with CP. Metagenome DNA was extracted, and microbiota was analyzed by next generation sequencing. Gut microbiota profiles were different between patients with AIP and those with CP; namely, the proportions of Bacteroides, Streptococcus and Clostridium species were higher in patients with CP. The reasons for the increased proportion of these bacterial species remain unknown, but may reflect malabsorption and/or decreased pancreatic enzymes, both of which are associated with CP. Incidentally, the identified Streptococcus species are oral cavity inhabitants and also known as pathogens for endocarditis. Despite the small sample size, this study has shown the differences in gut microbiota profiles between AIP and CP. Comprehensive analysis of the gut microbiota may be useful for the differential diagnosis of pancreatic diseases.

Distinct pathophysiological cytokine profiles for discrimination between autoimmune pancreatitis, chronic pancreatitis, and pancreatic ductal adenocarcinoma

BackgroundDiscriminating between autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic ductal adenocarcinoma (PDAC) can be challenging. In this retrospective study, levels of serum and tissue cytokines were analyzed as part of the clinical strategy for the preoperative differentiation between AIP and PDAC. The identification of differential cytokine profiles may help to prevent unnecessary surgical resection and allow optimal treatment of these pathologies.MethodsTo compare the cytokine profiles of AIP, CP, and PDAC patients, serum and pancreatic tissue homogenates were subjected to multiplex analysis of 17 inflammatory mediators. In total, serum from 73 patients, composed of 29 AIP (14 AIP-1 and 15 AIP-2), 17 CP, and 27 PDAC, and pancreatic tissue from 36 patients, including 12 AIP (six AIP-1 and six AIP-2), 12 CP, and 12 PDAC, were analyzed.ResultsComparing AIP and PDAC patients’ serum, significantly higher concentrations were found in AIP for interleukins IL-1β, IL-7, IL-13, and granulocyte colony-stimulating factor (G-CSF). G-CSF also allowed discrimination of AIP from CP. Furthermore, once AIP was divided into subtypes, significantly higher serum levels for IL-7 and G-CSF were measured in both subtypes of AIP and in AIP-2 for IL-1β when compared to PDAC. G-CSF and TNF-α were also significantly differentially expressed in tissue homogenates between AIP-2 and PDAC.ConclusionsThe cytokines IL-1β, IL-7, and G-CSF can be routinely measured in patients’ serum, providing an elegant and non-invasive approach for differential diagnosis. G-CSF is a good candidate to supplement the currently known serum markers in predictive tests for AIP and represents a basis for a combined blood test to differentiate AIP and particularly AIP-2 from PDAC, enhancing the possibility of appropriate treatment.

A Difficult and Rare Diagnosis of Autoimmune Enteropathy in a Patient Affected by Down Syndrome

Patients with Down syndrome are more susceptible to autoimmune pathologies, in particular endocrine or digestive diseases such as celiac disease. Autoimmune enteropathy is another form of digestive autoimmune disease, non-gluten-dependant, more often diagnosed in male neonates with immunodysregulation and polyendocrinopathy such as the Immunodysregulation, Polyendocrinopathy, Enteropathy, X-linked syndrome. It also exists in the adult, but this pathology is less known and therefore frequently under-diagnosed. Clinical manifestations are similar to celiac disease, but not improved after a gluten-free diet. Autoimmune enteropathy is frequently associated with other autoimmune diseases, such as thyroiditis, myasthenia gravis, lupus or immune deficiencies, as Common Variable Immunodeficiency. Pathological analysis of intestinal biopsies can frequently distinguish autoimmune enteropathy and celiac disease. Autoimmune enteropathy usually has an important lymphoplasmacytic infiltration of the mucosa and a lack of intraepithelial lymphocytes in the gastrointestinal mucosal surface, while celiac disease usually has a polymorph infiltration of the mucosa and an important intraepithelial lymphocytes infiltration. Nevertheless, the two pathological patterns may overlap. Here we report the first case of a patient with Down syndrome associated to autoimmune enteropathy (initially diagnosed as celiac disease), chronic pancreatitis and cutaneous lupus erythematosus. Even if autoimmune pathologies are much more common in patients with Down syndrome, we would like to report on this rare and original association found in our patient.

A new descriptor for computer-aided diagnosis of EUS imaging to distinguish autoimmune pancreatitis from chronic pancreatitis

Computer-aided diagnosis of EUS images was quite useful in differentiating pancreatic cancer from normal tissue and chronic pancreatitis. This study investigated the feasibility of using computer-aided diagnostic techniques to extract EUS image parameters to distinguish autoimmune pancreatitis from chronic pancreatitis. A new descriptor, local ternary pattern variance, was introduced to improve the performance of the classification model. Patients with autoimmune pancreatitis (n= 81) or chronic pancreatitis (n= 100) were recruited for this study. Representative EUS images were selected, and 115 parameters from 10 categories were extracted from the region of interest. Distance-between-class and sequential forward selection algorithms were used for their ideal combination of features that allowed a support vector machine predictive model to be built, trained, and validated. The accuracy, sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were used to evaluate the performance of experimental results. Fourteen parameters from 3 categories were selected as an ideal combination of features. The sample set was randomly divided into a training set and a testing set by using two different algorithms-the leave-one-out algorithm and the half-and-half method. The half-and-half method yielded an average (± standard deviation) accuracy of 89.3 ± 2.7%, sensitivity of 84.1 ± 6.4%, specificity of 92.5 ± 3.3%, PPV of 91.6 ± 3.7%, and NPV of autoimmune pancreatitis of 88.0 ± 4.1%. This study shows that, with the local ternary pattern variance textural feature, computer-aided diagnosis of EUS imaging may be valuable to differentiate autoimmune pancreatitis from chronic pancreatitis. Further refinement of such models could generate tools for the clinical diagnosis of autoimmune pancreatitis.

Digital imaging processing of EUS image in differentiating autoimmune pancreatitis from chronic pancreatitis

Objective To explore the feasibility of using digital imaging processing (DIP) to extract EUS image parameters for the differential diagnosis of autoimmune pancreatitis (AIP) and chronic pancreatitis (CP). Methods A total of 81 patients with AIP and 100 patients with CP diagnosed from May 2005 to January 2013 were recruited to this study. A total of 105 parameters of 9 categories were extracted from the region of interest by using computer-based techniques. Then the distance between class algorithm and sequential forward selection (SFS) algorithm were used for a better combination of features. A support vector machine (SVM) predictive model was built, trained, and validated. Results Overall, 25 parameters of 5 categories were selected as a better combination of features when the incidence of accurate category was max (90.08%). A total of 181 sample sets were randomly divided into a training set and a testing set by using two different algorithms and 200 random tests were performed. The average accuracy, sensitivity, specificity, the positive and negative predictive values of AIP based on the half-and-half method were (86.04±3.15)%, (83.66±6.57)%, (88.54±4.37)%, (85.96±4.44)% and (87.12±4.39)%, respectively. Conclusion Computer-aided diagnosis of EUS images is objective and non-invasive, which can improve the accuracy in differentiating AIP from CP. This technology provides a new valuable diagnostic tool for the clinical determination of AIP. Key words: Autoimmune pancreatitis; Chronic pancreatitis; Endoscopic ultrasonograghy; Digital imaging processing; Support vector machine

A proteomic comparison of formalin-fixed paraffin-embedded pancreatic tissue from autoimmune pancreatitis, chronic pancreatitis, and pancreatic cancer.

Formalin-fixed paraffin-embedded (FFPE) tissue is a standard for specimen preservation, and as such FFPE tissue banks are an untapped resource of histologically-characterized specimens for retrospective biomarker investigation for pancreatic disease. We use liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) to compare FFPE specimens from three different diseases of the exocrine pancreas. We investigated the proteomic profile of FFPE pancreatic tissue from 9 archived specimens that were histologically classified as: autoimmune pancreatitis (n=3), chronic pancreatitis (n=3), and pancreatic cancer (n=3), using LC-MS/MS. This is a proteomic analysis experiment of FFPE pancreatic tissue in an academic center. FFPE tissue specimens were provided by Dana-Farber/Harvard Cancer Center (Boston, MA, USA). FFPE tissue specimens were collected via routine surgical resection procedures. We compared proteins identified from chronic pancreatitis, autoimmune pancreatitis, and pancreatic cancer FFPE pancreatic tissue. We identified 386 non-redundant proteins from 9 specimens. Following our filtering criteria, 73, 29, and 53 proteins were identified exclusively in autoimmune pancreatitis, chronic pancreatitis, and pancreatic cancer specimens, respectively. We report that differentially-expressed proteins can be identified among FFPE tissues specimens originating from individuals with different histological diagnoses. These proteins merit further confirmation with a greater number of specimens and orthogonal validation, such as immunohistochemistry. The mass spectrometry-based methodology used herein has the potential to enhance diagnostic biomarker and therapeutic target discovery, further advancing pancreatic research.

Correction: Characteristics of Pediatric Pancreatitis on Magnetic Resonance Cholangiopancreatography

[This corrects the article on p. 73 in vol. 18, PMID: 26157692.].

PTH-003 Fully Covered Self Expanding Metals Stents Are Effective In Remodelling Benign Biliary Strictures In Patients With Chronic Pancreatitis

IntroductionSymptomatic benign biliary strictures (BBS) in chronic pancreatitis (CP) have historically been treated with surgical biliary bypass or multiple plastic stents. We report our experience of fully covered self-expanding metal...

Development of a new allogeneic hematopoietic stem cell transplantation method with co-thymus transplantation from the same donor —mechanism and application for intractable diseases—

Allogeneic Hematopoietic stem cell transplantation (allo-HSCT) is effective for several diseases, including leukemia, solid tumors, and immunodeficiency. However, there are still some intractable diseases that cannot be treated with HSCT alone. We have developed a new HSCT method, allo-HSCT + thymus transplantation (TT) from the same donor, which induces elevated T cell function with mild graft-versus-host disease (GVHD) in comparison to conventional HSCT alone and HSCT + donor lymphocyte infusion (HSCT + DLI). This method leads to improvement of immune function and the ability of engraftment, and is effective for treatment of autoimmune chronic pancreatitis and sialoadenitis in aging, lupus nephritis in hosts with radioresistance, and supralethal irradiation, in which conventional HSCT alone is ineffective. This method may become a valuable form of clinical therapy for intractable diseases.

Models of Acute and Chronic Pancreatitis

Animal models of acute and chronic pancreatitis have been created to examine mechanisms of pathogenesis, test therapeutic interventions, and study the influence of inflammation on the development of pancreatic cancer. In vitro models can be used to study early stage, short-term processes that involve acinar cell responses. Rodent models reproducibly develop mild or severe disease. One of the most commonly used pancreatitis models is created by administration of supraphysiologic concentrations of caerulein, an ortholog of cholecystokinin. Induction of chronic pancreatitis with factors thought to have a role in human disease, such as combinations of lipopolysaccharide and chronic ethanol feeding, might be relevant to human disease. Models of autoimmune chronic pancreatitis have also been developed. Most models, particularly of chronic pancreatitis, require further characterization to determine which features of human disease they include.

Autoimmune Chronic Pancreatitis with IgG4-Related Pancreatic Pseudocyst in a Patient Undergoing Total Pancreatectomy Followed by Autologous Islet Transplantation

Autoimmune Chronic Pancreatitis with IgG4-Related Pancreatic Pseudocyst in a Patient Undergoing Total Pancreatectomy Followed by Autologous Islet Transplantation

Autoimmune pancreatitis and treatment approaches with case reports.

In this study, we aimed to review retrospectively the data of 10 patient who were treated and followed-up in our clinic and to review the current approaches in the diagnosis and treatment of autoimmune pancreatitis (AIP). We reviewed 10 patients retrospectively who were operated on and had the diagnosis of AIP histopathologically in the Ege University School of Medicine Department of General Surgery. Between June 2001-November 2010, 10 patients who were diagnosed as AIP were examined retrospectively. Radiologically, a pancreatic mass was found in the pancreatic head with ultrasound in 7 (70%) of 10 patients and suspicious lesions were identified in the head of the pancreas in 3 (30%) patients. All patients were operated on in our clinic with the preliminary diagnosis of pancreatic head tumor; 8 patients underwent Whipple's procedure, 1 patient underwent pylorus preserving pancreaticoduodenectomy, and in 1 patient an exploratory pancreatic biopsy (frozen section) was carried out. Autoimmune pancreatitis is a disease with increasing incidence and characterized by lymphoplasmocytic cell infiltration and fibrosis. Patients with a pancreatic mass, if there is an autoimmune disease or chronic pancreatitis suspected in the detailed history, it is necessary to evaluate patients in terms of AIP serologically to protect the patients from an incoorectng diagnosis and morbidity of surgery.

Les nouvelles maladies pancréatiques à la lumière de l'imagerie

Imaging methods are crucial for investigating the pancreas, a deep-seated organ. Technical and analytical parameters must be optimized for accurate interpretation. Thin-slice CT and pancreatic MRI are the principal methods, while endoscopic ultrasonography is a second-line procedure. The concept of familial (syndromic or non syndromic) pancreatic cancer has emerged in recent years, leading to complex management decisions. Genetic counseling is poorly developed in this specific setting, and the place of prophylactic total pancreatectomy remains to be established. Better knowledge of intraductal papillary neoplasms of the pancreas (IPMN) has led to a revolution in pancreatology. IPMN is frequent and may soon emerge as a public health problem. Its natural history is well known in the medium term (<10 years) but not in the longer term. A careful workup is necessary before choosing between pancreatic resection and watchful waiting. Autoimmune chronic pancreatitis (AICP) is a problem of internal medicine. AICP has a pseudo-tumoral aspect in 30% of cases. Diagnosis relies on a body of evidence, particularly imaging data and the clinical context. AICP is usually highly steroid-sensitive.

Reduction of splenic volume by steroid therapy in cases with autoimmune pancreatitis

Splenomegaly is sometimes recognized in autoimmune diseases and chronic pancreatitis; however, it has not yet been studied in autoimmune pancreatitis (AIP). The current study analyzed splenic volume and its associated factors in cases with AIP. Splenic volume was measured using computed tomography (CT) volumetric analysis in 46 cases with AIP and compared with 92 age- and gender-matched controls, and 46 disease controls (liver cirrhosis). Forty-six cases of chronic pancreatitis were also analyzed. Cases with AIP were investigated for factors associated with splenic volume and splenic volume change in response to steroid therapy. Splenic volume was significantly larger in AIP (149±86ml) than in controls (97±38ml) and in CP (108±79ml) (P<0.0001 and 0.0002), and was smaller than in disease controls (222±134ml) (P=0.003). In AIP cases, splenic volume was associated with age and gender (P=0.04 and 0.02), and splenomegaly was recognized in 20% (9/46) of cases. Abnormal uptake of (18)F-fluorodeoxyglucose was not detected in the spleen by positron emission tomography. Splenic vein (SpV) was frequently involved in AIP (67%), but was all recanalized after steroid therapy. Splenic volume in cases with AIP was minimized to 77% of the original (122±40ml) (P<0.0001) and this trend was remarkable in cases with splenomegaly (66%). In AIP, high serum IL-2 receptor level, diffuse pancreatic enlargement, and SpV stenosis were significantly associated with splenic shrinkage due to steroid treatment (P=0.002, 0.02, and 0.03). Splenomegaly was sometimes recognized in cases with AIP; however, these cases can be treated with steroids, especially in cases with diffuse pancreatic swelling and SpV stenosis.

Autoimmune Pancreatitis Presenting as Obstruction Jaundice

Autoimmune pancreatitis is a type of chronic pancreatitis characterized by an autoimmune inflammatory process in which prominent lymphocyte infiltration with associated fibrosis of the pancreas causes organ dysfunction. Clinically it is very important to be aware of autoimmune pancreatitis because autoimmune chronic pancreatitis (AIP) can clinically disguise as pancreaticobiliary malignancies, ordinary chronic or acute pancreatitis. Here we report a case of autoimmune pancreatitis presented with obstructive jaundice with initial diagnosis of carcinoma of head of the pancreas. DOI: http://dx.doi.org/10.3329/jbcps.v29i4.11344 J Bangladesh Coll Phys Surg 2011; 29: 231-234