TY - JOUR
T1 - A case of autoimmune pancreatitis effectively treated with an immunosuppressant (azathioprine)
AU - Yamabe, Akane
AU - Irisawa, Atsushi
AU - Notohara, Kenji
AU - Shibukawa, Goro
AU - Fujisawa, Mariko
AU - Sato, Ai
AU - Yoshida, Yoshitsugu
AU - Arakawa, Noriyuki
AU - Ikeda, Tsunehiko
AU - Igarashi, Ryo
AU - Maki, Takumi
AU - Yamamoto, Shogo
N1 - Publisher Copyright:
© 2016, Japanese Society of Gastroenterology.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - Autoimmune pancreatitis
KW - Azathioprine
KW - Immunosuppressant
UR - http://www.scopus.com/inward/record.url?scp=84979258370&partnerID=8YFLogxK
U2 - 10.1007/s12328-016-0673-4
DO - 10.1007/s12328-016-0673-4
M3 - Article
C2 - 27450404
AN - SCOPUS:84979258370
SN - 1865-7257
VL - 9
SP - 324
EP - 328
JO - Clinical Journal of Gastroenterology
JF - Clinical Journal of Gastroenterology
IS - 5
ER -