Sequential Evaluation of Pancreato-Biliary Findings in a Case with IgG4-Associated Cholangiopathy and Autoimmune Pancreatitis during Corticosteroid Treatment

Year 2016, Volume: 33 Issue: 4, 458 - 461, 01.07.2016

İsmail Şerifoğlu İbrahim İlker Öz Yücel Üstündağ Sevil Uygun İlikhan Özlem Tokgöz

Abstract

Background: Immunoglobulin G4 (IgG4)-associated diseases mostly involve the pancreatico-biliary tree and pancreatic parenchyma. This disease complex is characterized by marked response to corticosteroid therapy and response to steroids is incorporated in the diagnostic algorithm of IgG4 associated diseases. However, there is much unknown about the sequences and duration of healing during the corticosteroid therapy in the literature. Case Report: In this case report, we report a young male patient with IgG4 associated extrahepatic biliary stricture and autoimmune pancreatitis successfully treated with corticosteroids. Recovery in the laboratory and radiological radiological findings seemed to correlate well with the decrease in serum IgG4 levels in this patient. We also discussed sequences and the duration of healing in the pancreaticobiliary tree and pancreatic parenchymal manifestations in this case report. Conclusion: There is a gap in our knowledge about the evaluation of response criteria after steroid trial with regard to the duration and sequences of healing in the pancreaticobiliary involvement in diagnosing IgG4-related biliary and pancreatic diseases.

Keywords

Autoimmune pancreatitis , corticosteroid , IgG4 associated diseases , IgG4 , imaging

References

• 1. Kitagawa S, Zen Y, Harada K, Sasaki M, Sato Y, Minato H , et al. Abundant IgG4-positive plasma cell infiltration characterizes chronic sclerosing sialadenitis (Küttner’s tumor). Am J Surg Pathol 2005;29:783-91. [Crossref]
• 2. Yamamoto M, Harada S, Ohara M, Suzuki C, Naishiro Y, Yamamoto H, et al. Clinical and pathological differences between Mikulicz’s disease and Sjögren’s syndrome. Rheumatology 2005;44227-34. [Crossref]
• 3. Zen Y, Onodera M, Inoue D, Kitao A, Matsui O, Nohara T, et al. Retroperitoneal fibrosis: a clinicopathologic study with respect to immunoglobulin G4. Am J Surg Pathol 2009; 33:1833- 9. [Crossref]
• 4. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med 2001;344:732-8. [Crossref]
• 5. Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011;40:352-8. [Crossref]
• 6. Takuma K, Kamisawa T, Igarashi Y. Autoimmune pancreatitis and IgG4-releated sclerosing cholangitis. Curr Opin Rheumatol 2011;23:80- 7. [Crossref]
• 7. Okazaki K, Tomiyama T, Mitsuyama T, Sumimoto K,Uchida K. Diagnosis and classification of autoimmune pancreatitis. Autoimmun Rev 2014;13:451-8. [Crossref]
• 8. Kamisawa T, Okazaki K, Kawa S, Shimosegawa T, Tanaka M. Japanese consensus guidelines for management of autoimmune pancreatitis: III. Treatment and prognosis of AIP. J Gastroenetrol 2010;45:471-7. [Crossref]
• 9. Kamisawa T, Okamoto A, Wakabayashi T, Watanabe T, Sawabu N. Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome. Scand J Gastroenterol 2008;43:609-13. [Crossref]
• 10. Shimizu S, Naitoh I, Nakazawa T, Hayashi K, Okumura F, Miyabe K, et al. A case of autoimmune pancreatitis showing narrowing of the main pancreatic duct after cessation of steroid therapy in the clinical course. Intern Med 2012;51:2135-40. [Crossref