Spontaneous Remission Of Autoimmune Pancreatitis: Four Case Reports
Zhang, B. B., Huo, J. W., Yang, Z. H., Wang, Z. C., & Jin, E. H. (2022). Spontaneous remission of autoimmune pancreatitis: Four case reports. World journal of clinical cases, 10(23), 8232–8241. https://doi.org/10.12998/wjcc.v10.i23.8232
View Original Source →Abstract
BACKGROUND: Autoimmune pancreatitis (AIP) is a particular type of chronic pancreatitis, and steroid treatment of AIP is effective. Spontaneous remission (SR) of AIP without steroids is relatively rare. The international consensus for the treatment of autoimmune pancreatitis suggests that patients with AIP with obstructive jaundice, abdominal pain, and back pain related to the pancreas or the bile duct should be treated with steroids; most asymptomatic patients with AIP may improve without steroids. However, in our clinical work, we found that the clinical characteristics of AIP patients with SR vary. Four of these cases are described here. In addition, to our knowledge, there is no previously published report of dynamic imaging before and after SR of AIP at present. CASE SUMMARY: We present the cases of four patients with AIP (two females and two males) in which the AIP improved spontaneously without steroid treatment. Two patients were asymptomatic, one patient had abdominal pain with obstructive jaundice, and one patient had intermittent right upper abdominal pain. Three patients presented with localized pancreatic enlargement and one with diffuse pancreatic enlargement. In addition to the pancreatic lesions, bile duct involvement was seen in two patients, and no extra-pancreatic organ involvement was found in the other two patients. The serum IgG4 level of all patients was more than twice the normal level. After SR in the four patients, the affected pancreases exhibited three types of image features: Return to normal, progressive fibrosis, and atrophy and calcification. CONCLUSION: The clinical features of SR in our four patients with AIP differ, but the imaging findings share some characteristics. After SR, in some cases the affected pancreas could return to normal, although some patients suffer from progressive fibrosis and atrophy as well as calcification.
Case Details
Disease Location
Pancreas
Personal Characteristics
76-year-old man. History of hypertension for more than 10 years; he regularly took 10 mg nifedipine sustained-release tablets twice a day. He had a history of a prior cerebral infarction more than 10 years ago without sequelae. This patient smoked 20 cigarettes and drank about 20 g of alcohol per day for more than 50 years.
Clinical Characteristics
One month before the first visit, this patient complained of right upper abdominal pain of unknown cause, accompanied by abdominal distension. He was diagnosed with gastroenteritis and was treated with traditional chinese medicine. Ten days before presentation, he reported yellow skin and sclera, and dark-colored urine. He went to a local hospital, where an abdominal ultrasound showed that his common bile duct was dilated and his pancreatic head was enlarged. At presentation, endoscopic cholangiopancreatography (ercp) was performed, and a severe common bile duct stenosis was seen. Later, he underwent duodenal papillotomy (est), endoscopic nasobiliary drainage (enbd), and endoscopic pancreatic stent drainage (erpd). After the operation, this patient was treated by fasting and water prohibition, acid inhibition, and nutritional support, but he refused steroid treatment. He took 50 mg ursodeoxycholic acid orally three times a day. The patient was diagnosed with diffuse autoimmune pancreatitis (aip).
Remission Characteristics
Twenty months after treatment, abdominal CT showed that the volume of the pancreas had decreased and the thickening of the bile duct wall had disappeared
Treatment & Mechanisms
Clinical Treatment
Biopsy
Non-Clinical Treatment
Chinese medicine