A case of autoimmune pancreatitis effectively treated with an immunosuppressant (azathioprine)
The patient was a 42-year-old man who presented at our hospital with obstructive jaundice. Although antinuclear antibody test results were negative, and immunoglobulin G4 (IgG4) was not elevated, endoscopic ultrasound revealed a mixed internal hyperechoic and diffuse hypoechoic pattern, a finding co...
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Published in | Clinical journal of gastroenterology Vol. 9; no. 5; pp. 324 - 328 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Tokyo
Springer Japan
01.10.2016
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Abstract | The patient was a 42-year-old man who presented at our hospital with obstructive jaundice. Although antinuclear antibody test results were negative, and immunoglobulin G4 (IgG4) was not elevated, endoscopic ultrasound revealed a mixed internal hyperechoic and diffuse hypoechoic pattern, a finding consistent with autoimmune pancreatitis. Endoscopic retrograde cholangiopancreatography further revealed irregular narrowing of the main pancreatic duct and sclerosing cholangitis with distal biliary stricture. In addition, endoscopic ultrasound with fine needle aspiration cytology resulted in a diagnosis of type 1 autoimmune pancreatitis. Oral prednisolone treatment was initiated at 30 mg/day, and the dosage was gradually decreased. However, in accordance with the patient’s wishes, maintenance treatment was discontinued once dosage reached 5 mg/day. Despite this, relapse of obstructive jaundice occurred 1 month post discontinuation, and was treated with methyl-prednisolone pulse therapy (500 mg/day) followed by oral prednisolone. However, computed tomography, magnetic resonance imaging, and endoscopic ultrasound did not reveal sufficient improvement after 6 months of treatment. Therefore, an immunosuppressant (azathioprine) was introduced. Subsequent imaging analyses and endoscopic ultrasound fine needle aspiration revealed clear improvements in pathology. |
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AbstractList | The patient was a 42-year-old man who presented at our hospital with obstructive jaundice. Although antinuclear antibody test results were negative, and immunoglobulin G4 (IgG4) was not elevated, endoscopic ultrasound revealed a mixed internal hyperechoic and diffuse hypoechoic pattern, a finding consistent with autoimmune pancreatitis. Endoscopic retrograde cholangiopancreatography further revealed irregular narrowing of the main pancreatic duct and sclerosing cholangitis with distal biliary stricture. In addition, endoscopic ultrasound with fine needle aspiration cytology resulted in a diagnosis of type 1 autoimmune pancreatitis. Oral prednisolone treatment was initiated at 30 mg/day, and the dosage was gradually decreased. However, in accordance with the patient’s wishes, maintenance treatment was discontinued once dosage reached 5 mg/day. Despite this, relapse of obstructive jaundice occurred 1 month post discontinuation, and was treated with methyl-prednisolone pulse therapy (500 mg/day) followed by oral prednisolone. However, computed tomography, magnetic resonance imaging, and endoscopic ultrasound did not reveal sufficient improvement after 6 months of treatment. Therefore, an immunosuppressant (azathioprine) was introduced. Subsequent imaging analyses and endoscopic ultrasound fine needle aspiration revealed clear improvements in pathology. |
Author | Yamamoto, Shogo Shibukawa, Goro Sato, Ai Arakawa, Noriyuki Yamabe, Akane Fujisawa, Mariko Yoshida, Yoshitsugu Igarashi, Ryo Notohara, Kenji Irisawa, Atsushi Maki, Takumi Ikeda, Tsunehiko |
Author_xml | – sequence: 1 givenname: Akane orcidid: 0000-0002-5413-9636 surname: Yamabe fullname: Yamabe, Akane email: yamaaka0110@yahoo.co.jp organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 2 givenname: Atsushi surname: Irisawa fullname: Irisawa, Atsushi organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 3 givenname: Kenji surname: Notohara fullname: Notohara, Kenji organization: Department of Pathology, Kurashiki Central Hospital – sequence: 4 givenname: Goro surname: Shibukawa fullname: Shibukawa, Goro organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 5 givenname: Mariko surname: Fujisawa fullname: Fujisawa, Mariko organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 6 givenname: Ai surname: Sato fullname: Sato, Ai organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 7 givenname: Yoshitsugu surname: Yoshida fullname: Yoshida, Yoshitsugu organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 8 givenname: Noriyuki surname: Arakawa fullname: Arakawa, Noriyuki organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 9 givenname: Tsunehiko surname: Ikeda fullname: Ikeda, Tsunehiko organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 10 givenname: Ryo surname: Igarashi fullname: Igarashi, Ryo organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 11 givenname: Takumi surname: Maki fullname: Maki, Takumi organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center – sequence: 12 givenname: Shogo surname: Yamamoto fullname: Yamamoto, Shogo organization: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center |
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SubjectTerms | Abdominal Surgery Adult Autoimmune Diseases - diagnostic imaging Autoimmune Diseases - drug therapy Azathioprine - therapeutic use Case Report Cholangiopancreatography, Endoscopic Retrograde Colorectal Surgery Gastroenterology Hepatology Humans Immunosuppressive Agents - therapeutic use Male Medicine Medicine & Public Health Pancreatitis - diagnostic imaging Pancreatitis - drug therapy Surgical Oncology Tomography, X-Ray Computed |
Title | A case of autoimmune pancreatitis effectively treated with an immunosuppressant (azathioprine) |
URI | https://link.springer.com/article/10.1007/s12328-016-0673-4 https://www.ncbi.nlm.nih.gov/pubmed/27450404 https://search.proquest.com/docview/1823033933 |
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