Autoimmune form of chronic pancreatitis and IgG4 positive mastitis

Česká verzia

Authors: Petr Dítě ¹ ; I. Novotný ²; Z. Kinkor ³; M. Hermanová ⁴; J. Trna ¹; J. Lata ⁵; M. Růžička ⁶; Marie Přecechtělová ¹; Bohuslav Kianička ⁷
Authors place of work: Interní gastroenterologická klinika, FN Brno ¹; Gastroenterologické oddělení, Masarykův onkologický ústav, Brno ²; Bioptická laboratoř s. r. o. a Šiklův ústav patologie, FN a LF UK, Plzeň ³; I. patologicko-anatomický ústav FN a LF MU, Brno ⁴; Lékařská fakulta FN Ostrava ⁵; Sheikh Khalifa Med. City – Cleveland Clinic, Abu Dhabi ⁶; II. interní klinika FN u sv. Anny, Brno ⁷
Published in the journal: Gastroent Hepatol 2011; 65(1): 22-25
Category: Klinická a experimentální gastroenterologie: kazuistika

Summary

The autoimmune form of pancreatitis (AIP) is frequently linked to the simultaneous impairment of other bodily organs. This applies particularly to the 1st subtype of the AIP form of lymphoplasmatic sclerosing pancreatitis (LPSP). This type of autoimmune pancreatitis is accompanied by concurrent sclerosing cholangitis, sialadenitis, retroperitoneal fibrosis, sicca syndrome and other ultrapancreatic lesions. A typical symptom is a high level of IgG4 immunoglobulin in blood serum and tissues. In our report, and for the first time in specialist literature, we describe the current findings of AIP (according to Asian criteria) and IgG4 positive mastitis, histologically verified in a patient with previously diagnosed Mikulicz syndrome. The effects of corticoid therapy supported the diagnosis of AIP and simultaneously led to the eradication of recurrent mastitis. Our findings confirm the fact that we are currently increasingly confronted with a group of multi-system autoimmune diseases, including autoimmune pancreatitis and its extrapancreatic symptoms. Timely diagnosis and the correct therapy can be effective against a high percentage of cases.

Key words:
autoimmune pancreatitis – immunoglobulin G4 – mastitis

Zdroje

1. Sarles H, Sarles JC, Muratote R et al. Chronic inflammatory sclerosis of the pancreas-an autonomous pancreatic disease? Am J Dig Dis 1961; 6: 688–698.

2. Yoshida K, Toki F, Takeuchi TA et al. Chronic pancreatitis cause by an autoimmune abnormality.Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995; 40: 1561–1568.

3. Park DH, Kim MHD, Chari ST. Recent advances in autoimmune pancreatitis. Gut 2009; 58: 1680–1689.

4. Sugumar A, Smyrk TC, Takahashi N et al. Lymphoplasmatic sclerosing pancreatitis (LPSP) and idiopathioc duct centric pancreatitis (IDCP) are distinct clinical forms of autoimmune pankreatitis (AIP). Pancreas 2008; 37: 497.

5. Kawaguchi K, Koika M, Tsuruta K et al. Lymphoplasmatic sclerosing pancreatitis with cholangitis : a variant of primary sclerosing cholangitis extensively involing pancreas. Hum Pathol 1991; 22: 387–395.

6. Kamisawa T, Egawa N, Nakajima H. Autoimmune pancreatitis is a systemic autoimmune disease. Am J Gastroenterol 2005; 98: 2811–2812.

7. Kamisawa T, Matsukawa M, Ohkawa M. Autoimmune pancreatitis associated with retroperitoneal fibrosis. JOP 2005; 6: 260–263.

8. Takahashi N, Kawashima A, Fletcher JG et al. Renal involvement in patiens with autoimmune pancreatitis.CT and MR imaging findings. Radiology 2007; 242: 791–801.

9. Kamisawa T, Nakajima H, Hishima T. Close correlation between chronic sclerosing sialoadenitis and immunoglobulin G4. Intern Med J 2008; 36: 527–529.

10. Kamisawa T, Nakajima H, Egawa N et al. IgG4 -related sclerosing disease incorporating sclerosing pancreatitis, cholangitis, sialoadenitis and retroperitoneal fibrosis with lymphadenopathy. Pancreatology 2006; 6: 132–137.

11. Sugumar A, Kloppel G, Chari ST. Autoimmune Pancreatitis: Pathologic subtypes and their implications for its diagnosis. Am J Gastroenterol 2009; 104: 2208–2210.

12. Frulloni CS, Scatolini C, Falconi M et al. Autoimmune pancreatitis differences between the focal and difuse forms in 87 patiens. Am J Gastroenterol 2009; 104: 1119–1127.

13. Kamisawa T, Funata N, Hayashi Y et al. A new clinicopathological entity of IgG4 -related autoimmune disease. J Gastroenterol 2003; 38: 982–984.

14. Deshpande V, Chiocca S, Finkelberg D et al. Autoimmune pancreatitis : a systemic immune complex mediated disease. Am J Surg Pathol 2006; 30: 1537–1545.

15. Deheragode MG, Church NI, Rodriguez-Justo M et al. The use of immunoglobulin G4 immunostaining in diagnosing pancreatic and extrapancreatic involvement in autoimmune pancreatitis. Clin Gastroenterol Hepatol 2007; 5: 1229–1234.

16. Kamisawa T, Okamoto A. Autoimmune pancreatitis: propsal of IgG4-related sclerosing cholangitis. J Gastroenterol 2006; 41: 613–625.

17. Kamisawa T, Egawa N, Nakajima H. Autoimmune pankreatitis is a systemic autoimmune disease. Am J Gastroenterol 2003; 98: 2811–2812.

18. Watson SJ, Jenkins DA, Bellamy CO. Nephropathy in IgG4 -related systemic disease. Am J Surg Pathol 2006; 30: 1472–1477.

19. Hirano K, Kawabe T, Komatsu Y et al. High-rate pulmonary involvement in autoimmune pankreatitis. Intern Med J 2006; 36: 58–61.

20. Sugumar A, Smyrk TC, Takahashi N et al. Lymphoplasmatic sclerosing pankreatitis (LPSP) and idiopathic duct centric pancreatitius (IDCP) are distinct clinical forms of autoimmune pancreatituis (AIP). Pancreas 2008; 37: 497.

21. Otsuki M, Chung JB, Okazaki K et al. Asian diagnostic kriteria for autoimmune pancreatitis: concensus of the Japan-Korean Symposium on Autoimmune Pancreatitis. J Gastroenterol 2008; 43: 403–408.

22. Chari ST. Diagnosis of autoimmune pancreatitis using its five cardinal features: introducing the Mayo Clinic´s HISORt criteria. J Gastroenterol 2007; 42 (Suppl. 18): 39–41.