Autoimmune pancreatitis: Functional and morphological recovery after steroid therapy

Autoimmune pancreatitis, a recently recognized type of chronic pancreatitis, is not rare in Japan, but reports of it elsewhere are relatively uncommon. We report the first preoperatively diagnosed case of autoimmune pancreatitis in Hungary, which responded well to steroid treatment and provided radiographic and functional evidence of this improvement. A 62-year-old female presented with a 4-month history of recurrent epigastric pain and a 5-kg weight loss. The oral glucose tolerance test （OGTT） indicated diabetes mellitus and the result of the fecal elastase test was abnormal. Ultrasonography （US） and the CT scan demonstrated a diffusely enlarged pancreas, and endoscopic retrograde cholangiopancreatography （ERCP） an irregular main pancreatic duct with long strictures in the head and tail. Autoimmune pancreatitis was diagnosed. The patient was started on 32 mg prednisolone daily, After 4 wk, the OGTT and faecal elastase test results had normalized. The repeated US and CT scan revealed a marked improvement of the diffuse pancreatic swelling, while on repeated ERCP, the main pancreatic duct narrowing was seen to be ameliorated. It is important to be aware of this disease and its diagnosis, because AIP can clinically resemble pancreatobiliary malignancies, or chronic or acute pancreatitis, However, in contrast with chronic pancreatitis, its symptoms and morphologic and laboratory alterations are completely reversed by oral steroid therapy.

自体免疫的胰腺炎，慢性胰炎的一种最近公认的类型，不在其它地方在它的日本，而是报告是稀罕的是相对不平常的。我们在匈牙利报导自体免疫的胰腺炎的第一个外科手术前地诊断的案例，它对类固醇处理作出回应很好并且提供了这改进的 X 光线照相术、功能的证据。与周期性的腹上部的疼痛和 5-kg 重量损失的 4 月的历史介绍的 62 岁的女性。口头的葡萄糖耐量测试(OGTT ) 显示糖尿病和烘便的弹性硬蛋白酶测试的结果是反常的。Ultrasonography (美国) 和 CT 扫描表明了广泛地扩大的胰，并且内视镜后退 cholangiopancreatography (ERCP ) 有在头和尾巴的长苛评的不规则的主要的胰腺的管。自体免疫的胰腺炎被诊断。病人每天在 32 mg 氢化尼松上被开始。在 4 wk 以后， OGTT 和排泄物的弹性硬蛋白酶测试结果使正常化。重复美国和 CT 扫描揭示了 diffuse 的显著改进胰腺，在重复 ERCP 上胀大，变窄的主要的胰腺的管被看见被改善。因为 AIP 能临床上类似于 pancreatobiliary 恶意，或长期或尖锐的胰腺炎，知道这疾病和它的诊断是重要的。然而在有慢性胰炎的对比，它的症状并且词法并且实验室改变被口头的类固醇治疗完全颠倒。