A Case of Autoimmune Pancreatitis Combined with Extensive Involvement of Biliary Tract

Chang Min Lee; Myung Hwan Roh; Chang Kil Jung; Jong Jin Won; Yang Hyun Baek; Sung Wook Lee; Seok Ryeol Choi; Jin Han Cho

doi:10.4166/kjg.2009.53.6.383

Journal List > Korean J Gastroenterol > v.53(6) > 1006563

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Lee, Roh, Jung, Won, Baek, Lee, Choi, and Cho: A Case of Autoimmune Pancreatitis Combined with Extensive Involvement of Biliary Tract

Original Article

Korean J Gastroenterol 2009;53(6):383-387.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.53.6.383

A Case of Autoimmune Pancreatitis Combined with Extensive Involvement of Biliary Tract

Chang Min Lee, M.D., Myung Hwan Roh, M.D., Chang Kil Jung, M.D., Jong Jin Won, M.D., Yang Hyun Baek, M.D., Sung Wook Lee, M.D., Seok Ryeol Choi, M.D., Jin Han Cho, M.D.^∗

Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

^∗Department of Diagnostic Radiology, Dong-A University College of Medicine, Busan, Korea

Correspondence to: Myung Hwan Roh, M.D. Department of Gastroenterology, Dong-A University Medical Center, 3-1, Dongdaeshin-dong, Seo-gu, Busan 602-715, Korea Tel: +82-51-240-2862, Fax: +82-51-242-5852 E-mail: mhnho@dau.ac.kr

Received 30 January 2009 Accepted 31 January 2009

Abstract

Autoimmune pancreatitis is a distinct disease characterized by the presence of autoantibodies and hyper-gammaglobulinemia, inflammation of the pancreatic parenchyma, and irregular stricture of the pancreatic duct. The involvement of distal common bile duct is frequently observed, but intrahepatic bile duct involvement is very rare, which seem to have similar feature to primary sclerosing cholangitis. We report a case of the patient with autoimmune pancreatitis combined with extensive involvement of extrahepatic and intrahepatic bile duct, which had a favorable response to steroid therapy.

Keywords: Autoimmune pancreatitis, Bile duct

REFERENCES

1. Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995; 40:1561–1568.

2. Kim KP, Kim MH, Lee YJ, et al. Clinical characteristics of 17 cases of autoimmune chronic pancreatitis. Korean J Gastroenterol. 2004; 43:112–119.

3. Kim KP, Kim MH, Song MH, Lee SS, Seo DW, Lee SK. Autoimmune chronic pancreatitis. Am J Gastroenterol. 2004; 99:1605–1616.

4. Kim KP, Kim MH, Kim JC, et al. Diagnostic criteria for autoimmune chronic pancreatitis revisited. World J Gastroenterol. 2006; 12:2487–2496.

5. Okazaki K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006; 41:626–631.

6. Kim JY, Chang HS, Kim MH, et al. A case of autoimmune chronic pancreatitis improved with oral steroid therapy. Korean J Gastroenterol. 2002; 39:304–308.

7. Ryu JK, Lee JK, Kim YT, et al. Clinical features of chronic pancreatitis in Korea: a multicenter nationwide study. Digestion. 2005; 72:207–211.

8. Kim JY, Kim MH, Jung JH, et al. Comparison of clinical findings between autoimmune pancreatitis with bile duct involvement and primary sclerosing cholangitis. Korean J Gastroenterol. 2006; 48:104–111.

9. Nakazawa T, Ohara H, Sano H, et al. Clinical differences between primary sclerosing cholangitis and sclerosing cholangitis with autoimmune pancreatitis. Pancreas. 2005; 30:20–25.

10. Nakazawa T, Ohara H, Sano H, et al. Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis. Gastrointest Endosc. 2004; 60:937–944.

11. Yoon WJ, Kim YT, Yoon YB, et al. Three cases of autoimmune pancreatitis. Korean J Gastrointest Endosc. 2004; 28:52–59.

12. Weber SM, Cubukcu-Dimopulo O, Palesty JA, et al. Lym-phoplasmacytic sclerosing pancreatitis; inflammatory mimic of pancreatic carcinoma. J Gastrointest Surg. 2003; 7:129–137.

13. Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the mayo clinic experience. Clin Gastroenterol Hepatol. 2006; 4:1010–1016.

14. Nishino T, Toki F, Oyama H, et al. Biliary tract involvement in autoimmune pancreatitis. Pancreas. 2005; 30:76–82.

15. Hirano K, Shiratori Y, Komatsu Y, et al. Involvement of the biliary system in autoimmune pancreatitis: a follow-up study. Clin Gastroenterol Hepatol. 2003; 1:453–464.

16. Choi EK, Kim MH, Kim JC, et al. The longterm follow-up results after steroid treatment in patients with autoimmune chronic pancreatitis. Korean J Gastroenterol. 2006; 47:440–448.

18. Horiuchi A, Kawa S, Hamano H, Hayama M, Ota H, Kiyosawa K. ERCP features in 27 patients with autoimmune pancreatitis. Gastrointest Endosc. 2002; 55:494–499.

17. Chari ST. Current concepts in the treatment of autoimmune pancreatitis. JOP. 2007; 8:1–3.

Fig. 1.

CT and ERCP findings before steroid treatment. (A) CT scan demonstrated intrahepatic biliary dilatation secondary to diffuse stricturing of the biliary system and bile duct wall thickening at hilar portion (black arrows). (B) CT showed diffuse pancreatic enlarge-ment (asterisk) with homogenous texture and without calcification or stone. (C) Cholangiogram showed a complex hilar stricture and dif-fusely irregular intrahepatic biliary strictures (white arrows). (D) Pancreatogram showed diffuse and irregular narrowing of the entire main pancreatic duct (head arrows).

Fig. 2.

CT and ERCP findings after 4 weeks of steroid treatment. CT scan demonstrated (A) the appearance of intrahepatic biliary tree was significantly improved (black arrows) and (B) the size of pancreas markedly decreased and returned to normal (asterisk). ERCP shows (C) dramatic resolution of the stricture of the intrahepatic duct and hilar portion (white arrows) and (D) normalized main pancreatic duct (head arrows) were observed.

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