Relapsing autoimmune pancreatitis type 1: case report

Česká verzia

Authors: Alena Ondrejková ¹; Bohuslav Kianička ¹; Hana Nechutová ¹; Lukáš Hruška ²; Ivo Novotný ³; Miroslav Souček ¹
Authors place of work: Gastroenterologické oddělení II. interní kliniky LF MU a FN u sv. Anny v Brně ¹; Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně ²; Gastroenterologické oddělení MOÚ, Brno ³
Published in the journal: Vnitř Lék 2017; 63(4): 277-283
Category: Case Reports

Summary

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis, classified into 2 subtypes – AIP type 1 and AIP type 2. We present a case of a 31-years-old female admitted to our institution with upper abdominal pain and obstructive jaundice. Endoscopic retrograde cholangiopancreatoscopy (ERCP) revealed stenosis of intrapancreatic distal bile duct. Diffuse parenchymal enlargement and typical features of AIP were shown by computed tomography (CT) and endoscopic ultrasonography (EUS). The patient´s serum IgG4 was elevated at 3.8 g/l (range 0.08–1.4 g/l). She was diagnosed with AIP type 1 and treated with prednisone (initial dose of 30 mg per day, then tapered by 5 mg/day every week). The maintenance dose of 5 mg per day was continued for 6 months. Despite clinical and radiological remission, serum levels of IgG4 remained elevated. The patient experienced disease relapse 25 months after first attack. Moreover, new finding of calcifications occured in pancreas. The relapse was managed with corticosteroids and maintenance immunosupression with azathioprin was started. Literature review on risk factor of relapse, long-term immunosupressive therapy indication and optimal follow-up of AIP type 1 patients are discussed.

Key words:
autoimmune pancreatitis type 1 – long-term follow-up – relapse – therapy

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