Autoimmune pancreatitis associated with pancreatic necrosis: A case report

• Published in: Suizo Vol. 34; no. 1; pp. 9 - 14
• Main Authors: KODAMA, Ryo, KAMAKURA, Masato, SAEGUSA, Hisanobu, USHIMARU, Hiroyasu, MAKINO, Mutsuki, KAWAGUCHI, Kenji
• Format: Journal Article
• Language: Japanese
• Published: Japan Pancreas Society 25.02.2019
• Subjects: Autoimmune pancreatitis; EUS-FNAB; Necrosis
• ISSN: 0913-0071; 1881-2805
• DOI: 10.2958/suizo.34.9

A 60-year-old male was hospitalized with appetite loss, weight loss, and jaundice. Laboratory examinations revealed aggravation of diabetes with elevated IgG and IgG4 levels of 2446 and 232 mg/dl, respectively. Magnetic resonance imaging revealed thickening and stenosis of the common bile duct, enlargement of the pancreatic head, and a capsule-like rim and diffuse narrowing of the main pancreatic duct. Autoimmune pancreatitis was suspected. A cyst-like lesion with a high-intensity area was observed in the pancreatic tail on both the T1- and the T2-weighted images. The high-intensity area was thought to indicate previous bleeding in the pancreas. Endoscopic ultrasound-guided fine needle aspiration biopsy was performed using a 22G Franseen needle. The patient was diagnosed with autoimmune pancreatitis based on the histology of a biopsy from the pancreatic body. The specimen of the cyst-like lesion in the pancreatic tail revealed pancreatic necrosis. Treatment with steroids normalized the hepatobiliary enzymes, and one month after treatment, stenosis of the biliary duct and enlargement of the pancreas improved. At three months after treatment, the pancreatic necrosis had resolved. This is the first report of autoimmune pancreatitis associated with pancreatic necrosis.