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Lanke G, Songtanin B, Das K. Lupus Pancreatitis Masquerading as Pancreatic Cancer: A Rare Clinical Presentation. ACG Case Rep J 2023; 10:e01157. [PMID: 37753102 PMCID: PMC10519543 DOI: 10.14309/crj.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune multisystemic inflammatory disease. SLE-associated pancreatitis is uncommon, and pancreatic cancer in SLE is very rare. Imaging findings in SLE with pancreatitis can mimic malignancy. Endoscopic ultrasound with fine-needle aspiration/biopsy can guide in the accurate diagnosis and management of SLE-associated pancreatitis.
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Affiliation(s)
- Gandhi Lanke
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Busara Songtanin
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Kanak Das
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
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2
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Nagpal SJS, Sharma A, Chari ST. Autoimmune Pancreatitis. Am J Gastroenterol 2018; 113:1301. [PMID: 29910463 DOI: 10.1038/s41395-018-0146-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
Over the course of the last 2 decades our knowledge of autoimmune pancreatitis has increased exponentially. In this review, we summarize the clinical presentation, diagnosis and treatment of AIP, to better allow general gastroenterologists and primary care providers to consider AIP as a as a rare but important cause of painless obstructive jaundice and recurrent acute pancreatitis. While steroids remain the mainstay of first line therapy, a number of patients with type 1 AIP require immunomodulators or rituximab to maintain remission; recommendations on the management of relapses continue to evolve.
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Affiliation(s)
| | - Ayush Sharma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Suresh T Chari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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3
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Abstract
Acute pancreatitis is an inflammation of the glandular parenchyma of the retroperitoneal organ that leads to injury with or without subsequent destruction of the pancreatic acini. This inflammatory process can either result in a self-limited disease or involve life-threatening multiorgan complications. Chronic pancreatitis consists of endocrine and exocrine gland dysfunction that develops secondary to progressive inflammation and chronic fibrosis of the pancreatic acini with permanent structural damage. Recurrent attacks of acute pancreatitis can result in chronic pancreatitis; acute and chronic pancreatitis are different diseases with separate morphologic patterns. Acute pancreatitis has an increasing incidence but a decreasing mortality.
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Affiliation(s)
- Abdulrahman Y Hammad
- Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Michael Ditillo
- Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
| | - Lourdes Castanon
- Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA.
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4
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Ben Dhaou B, Aydi Z, Boussema F, Ben Dahmen F, Baili L, Ketari S, Cherif O, Rokbani L. La pancréatite lupique : une série de six cas. Rev Med Interne 2013; 34:12-6. [DOI: 10.1016/j.revmed.2012.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 02/20/2012] [Accepted: 07/01/2012] [Indexed: 01/04/2023]
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5
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Pezzilli R, Cariani G, Santini D, Calculli L, Casadei R, Morselli-Labate AM, Corinaldesi R. Therapeutic management and clinical outcome of autoimmune pancreatitis. Scand J Gastroenterol 2011; 46:1029-38. [PMID: 21619507 DOI: 10.3109/00365521.2011.584896] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Autoimmune pancreatitis, in comparison to other benign chronic pancreatic diseases, is characterized by the possibility of curing the illness with immunosuppressant drugs. The open question is whether to differentiate autoimmune pancreatitis as a primary or secondary disease based on the presence or absence of other autoimmune diseases or whether to consider autoimmune pancreatitis a clinical and pathological systemic entity, called IgG4-related sclerosing disease, since this aspect is also very important from a therapeutic point of view. METHODS In this paper, we reviewed the conventional therapeutic approach used to treat autoimmune pancreatitis patients and the clinical outcome related to each treatment modality. We also reviewed some aspects which are important for the correct management of autoimmune pancreatitis, such as the surgical approach, the outcome of surgically treated autoimmune pancreatitis patients, whether medical treatment is always necessary, and, finally, when medical treatment should be initiated. CONCLUSIONS Steroids are useful in alleviating the symptoms of the acute presentation of autoimmune pancreatitis, but some questions remain open such as the dosage of steroids in the acute phase and the duration of steroid therapy; finally, it should be assessed if other immunosuppressive non-steroidal drugs may become the first-line therapy in patients with AIP without jaundice and without atrophic pancreas.
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Affiliation(s)
- Raffaele Pezzilli
- Pancreas Unit, Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy.
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6
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Abstract
In this review article, we will briefly describe the main characteristics of autoimmune pancreatitis and then we will concentrate on our aim, namely, evaluating the clinical characteristics of patients having recurrence of pain from the disease. In fact, the open question is to evaluate the possible presence of autoimmune pancreatitis in patients with an undefined etiology of acute pancreatitis and for this reason we carried out a search in the literature in order to explore this issue. In cases of recurrent attacks of pain in patients with “diopathic”pancreatitis, we need to keep in mind the possibility that our patients may have autoimmune pancreatitis. Even though the frequency of this disease seems to be quite low, we believe that in the future, by increasing our knowledge on the subject, we will be able to diagnose an ever-increasing number of patients having acute recurrence of pain from autoimmune pancreatitis.
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7
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Gutierrez SC, Pasqua AV, Casas H, Cremaschi MB, Valenzuela ML, Cubilla AA, Garcia A. Chronic pancreatitis and systemic lupus erythematosus: an uncommon association. Case Rep Gastroenterol 2008; 2:6-10. [PMID: 21490830 PMCID: PMC3075158 DOI: 10.1159/000112861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The association between systemic lupus erythematosus (SLE) and chronic pancreatitis (CP) is extremely rare. Up to now, only six cases have been reported. We report the case of a young woman who presented her first episode of abdominal pain and hyperamylasemia at the onset of SLE and developed chronic calcifying pancreatitis after a two year period.
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Affiliation(s)
- Silvia C Gutierrez
- Service of Gastroenterology, Department of Medicine, Hospital Posadas, Buenos Aires, Argentina
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8
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van Buuren HR, Vleggaar FP, Willemien Erkelens G, Zondervan PE, Lesterhuis W, Van Eijck CHJ, Puylaert JBCM, Van Der Werf SDJ. Autoimmune pancreatocholangitis: a series of ten patients. Scand J Gastroenterol 2007:70-8. [PMID: 16782625 DOI: 10.1080/00365520600664326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND During a 10-year period we observed 10 patients who suffered from an inflammatory-fibrosing disease mimicking pancreatic carcinoma and primary sclerosing cholangitis (PSC). METHODS A review of the presenting features, the clinical course and the relevant literature. RESULTS Ten male patients (mean age 55 years) presented with weight loss, jaundice and pruritus. Pancreatic cancer was suggested by imaging studies, which showed focal or generalized pancreatic enlargement and compression of the distal common bile duct. Cholangiography also demonstrated intrahepatic biliary stenoses consistent with sclerosing cholangitis. None had evidence of IBD. Exocrine pancreatic insufficiency was found in six cases and diabetes in four. Pancreatic histology (n=3) showed fibrosis and extensive inflammatory infiltrates. Immunosuppressive treatment was instituted in five patients. Clinical and biochemical remission occurred in three; in one other patient, previously documented intrahepatic biliary strictures had disappeared after 3 months. One patient had concomitant Sjögren's disease. The clinical features, pancreatic involvement, age at presentation, absence of IBD and response to steroids all plead against a diagnosis of "classical" PSC. The natural course of the disease was highly variable. Thirty-five comparable cases, with a largest series of three, have been reported in the literature. The disease has been associated with Sjögren's disease, retroperitoneal fibrosis and other fibrosing conditions, and may be a manifestation of a systemic fibro-inflammatory disorder. CONCLUSION Autoimmune pancreatocholangitis is a distinct inflammatory disorder involving the pancreas and biliary tree. The disease may mimick pancreatic carcinoma and PSC and responds to immunosuppressives.
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Affiliation(s)
- Henk R van Buuren
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
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9
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Agoumi S, Himdi B, Abidi K, Zeggwagh A, Abouqal R. Pancréatite aiguë révélatrice d'un lupus érythémateux aigu disséminé. Rev Med Interne 2006; 27:799-802. [PMID: 16884831 DOI: 10.1016/j.revmed.2006.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 05/19/2006] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acute pancreatitis is rarely seen in systemic lupus erythematous. CASE REPORT A 28-year-old woman without significant past medical history, was hospitalized for sepsis and diagnosed with acute pancreatitis, which was found to be the initial presentation of a newly diagnosed systemic lupus erythematous. DISCUSSION Acute pancreatitis as an initial presentation of systemic lupus erythematous is rare and is reported in only 10 cases in the literature. Multiple factors are involved in the pathogenesis. The role of corticosteroids in its apparition or resolution is still a subject of controversy.
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Affiliation(s)
- S Agoumi
- Service de réanimation médicale, hôpital Ibn-Sina, CHU de Rabat, Rabat, Maroc.
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10
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Suzuki Y, Okamoto H, Koizumi K, Tateishi M, Hara M, Kamatani N. A case of severe acute pancreatitis, in overlap syndrome of systemic sclerosis and systemic lupus erythematosus, successfully treated with plasmapheresis. Mod Rheumatol 2006; 16:172-5. [PMID: 16767557 DOI: 10.1007/s10165-006-0476-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 03/24/2006] [Indexed: 11/25/2022]
Abstract
Here, we describe a case of severe pancreatitis in overlap syndrome of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) in an adult female patient. Treatment with plasmapheresis and high-dose prednisone successfully saved her life and led to remission of the pancreatitis. This is the first case report of severe acute pancreatitis in the setting of overlap syndrome of SLE and SSc. The advantages and disadvantages of the use of corticosteroids are discussed.
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Affiliation(s)
- Yukie Suzuki
- Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
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11
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Breuer GS, Baer A, Dahan D, Nesher G. Lupus-associated pancreatitis. Autoimmun Rev 2006; 5:314-8. [PMID: 16782555 DOI: 10.1016/j.autrev.2005.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 11/10/2005] [Indexed: 10/25/2022]
Abstract
A number of lupus patients develop episodes of acute "idiopathic" pancreatitis, unrelated to the known causes of mechanical obstruction of the pancreatic duct or toxic-metabolic etiologies. This lupus-associated pancreatitis is rare. The estimated annual incidence was 0.4-1.1/1000 lupus patients. A literature search found detailed descriptions of this condition in 77 lupus patients. Their median age was 27, and 88% were females. Abdominal pain was the most frequent pancreatitis-related symptom (88%). In 97% the diagnosis of pancreatitis was based on laboratory evidence of elevated serum amylase or lipase. Most cases were unrelated to treatment with steroids or azathioprine. Most of the patients (84%) had active lupus at the time of pancreatitis. Mortality rate was 27%, higher than in non-SLE associated pancreatitis. Active lupus and several biochemical abnormalities, but not treatment with steroids or azathioprine, were significantly associated with increased mortality. Treatment with steroids lowered the mortality by 67% compared to non-treated patients.
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Affiliation(s)
- Gabriel S Breuer
- Department of Internal Medicine, Shaare-Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel.
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12
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Nesher G, Breuer GS, Temprano K, Moore TL, Dahan D, Baer A, Alberton J, Izbicki G, Hersch M. Lupus-Associated Pancreatitis. Semin Arthritis Rheum 2006; 35:260-7. [PMID: 16461071 DOI: 10.1016/j.semarthrit.2005.08.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Involvement of the pancreas in systemic lupus erythematosus is rare. The purpose of this article is to provide a detailed review of lupus-associated pancreatitis. METHODS We describe 3 patients with lupus-associated pancreatitis and review the English literature of the last 30 years, including the demographic, clinical, therapeutic, and prognostic aspects of this disorder. RESULTS There were detailed descriptions of 77 patients, 88% were females. Median age was 27 years. In 44% of the patients pancreatitis developed within 1 year of the diagnosis of lupus, and 84% had active lupus at the time of pancreatitis. Abdominal pain was the most frequent pancreatitis-related symptom (88%), followed by nausea or vomiting (67%). In 97% the diagnosis of pancreatitis was based on laboratory evidence of elevated serum amylase or lipase. Abdominal computerized tomography and ultrasonography did not show signs of pancreatic involvement in 24 and 45%, respectively. The mortality rate was 27%; active lupus and some biochemical abnormalities were significantly associated with increased mortality. Treatment with corticosteroids or azathioprine was not associated with increased mortality. On the contrary, mortality was decreased in patients who were treated with these agents after the onset of pancreatitis (20% mortality, compared with 61% among those who were not treated with steroids for their pancreatitis, P = 0.005). CONCLUSIONS Pancreatitis should be suspected in any SLE patient with abdominal pain. Mortality rate is related to both active lupus and some biochemical markers. In most cases, the onset of pancreatitis appears unrelated to previous treatment with steroids or azathioprine. Moreover, treatment with these medications improves prognosis.
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Affiliation(s)
- Gideon Nesher
- Department of Internal Medicine A, Rheumatology Service, Shaare-Zedek Medical Center, Jerusalem, Israel.
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13
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Abstract
Gastrointestinal manifestations are common in systemic lupus erythematous (SLE), occurring in 35% to 40% of patients at some stage of their illness. SLE is an uncommon etiology of pancreatic disease. Only 3 cases of chronic pancreatitis associated with SLE have been reported in adults. We report the case of a 59-year-old white woman with a history of mechanic aortic valve replacement and SLE presented to the emergency unit for acute pancreatitis with no other identifiable etiology.
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Affiliation(s)
- Hassane Izzedine
- Department of Nephrology, Pitie-Salpetriere Hospital, Paris, France.
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14
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Lalani TA, Kanne JP, Hatfield GA, Chen P. Imaging Findings in Systemic Lupus Erythematosus. Radiographics 2004; 24:1069-86. [PMID: 15256629 DOI: 10.1148/rg.244985082] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systemic lupus erythematosus (SLE) is an unusually complex autoimmune disease that is encountered in every radiology subspecialty because of its multisystem involvement and the wide age range of affected patients. There are no universally accepted diagnostic imaging criteria for SLE, and in fact, many SLE patients present with systemic findings and laboratory abnormalities and do not require imaging. Nevertheless, radiology plays an ancillary role in the diagnosis and management of this often insidious disease, and knowledge of the spectrum of radiologic findings in SLE and its complications is crucial for proper image interpretation. Imaging is often performed in patients with a known diagnosis of SLE to determine the extent and severity of disease, which depend on the extent of organ involvement, and to monitor complications. In addition, imaging may be important in selected patients with diseases such as pneumonia who present with atypical symptoms due to immunosuppressive therapy.
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Affiliation(s)
- Tasneem A Lalani
- Department of Radiology, University of Washington Medical Center, University of Washington School of Medicine, 1959 NE Pacific, Box 357115, Seattle, WA 98195-7115, USA.
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15
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Jouffret C, Garçon S, Fikri M, Bennathan M, Lecoroller T, Charrier A, Durieux O, Agostini S. Pancréatites inflammatoires. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.emcrad.2004.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Swol-Ben J, Bruns CJ, Müller-Ladner U, Hofstädter F, Link J, Hechenrieder C, Jauch KW. Leukoencephalopathy and chronic pancreatitis as concomitant manifestations of systemic lupus erythematosus related to anticardiolipin antibodies. Rheumatol Int 2004; 24:177-81. [PMID: 12937945 DOI: 10.1007/s00296-003-0366-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2003] [Accepted: 07/26/2003] [Indexed: 02/03/2023]
Abstract
Symptoms of leukoencephalopathy led to hospital admission of a 59-year-old woman. In addition, a tumor of unknown nature in the pancreas was identified by abdominal ultrasound and CT scan. Following explorative laparotomy and pancreas tail resection, histopathologic analysis revealed a pancreatic pseudotumor with chronic fibrotic pancreatitis. Systemic lupus erythematosus (SLE) was diagnosed due to the presence of antinuclear antibodies (ANA) in serum, antiphospholipid antibodies, and involvement of the central nervous system. Leukoencephalopathy related to anticardiolipin antibodies in serum is a known but rare manifestation of SLE. The concomitant occurrence of chronic pancreatitis can be caused by the development of SLE-induced vasculitis in the pancreas. Subsequent complications of pancreatitis are responsible for the critical, life-threatening state of these patients and may be prevented by early identification of anticardiolipin antibodies and therapy for SLE.
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MESH Headings
- Aged
- Antibodies, Anticardiolipin/blood
- Antibodies, Antinuclear/blood
- Chronic Disease
- Female
- Fibrosis/pathology
- Humans
- Leukoencephalopathy, Progressive Multifocal/blood
- Leukoencephalopathy, Progressive Multifocal/etiology
- Leukoencephalopathy, Progressive Multifocal/pathology
- Leukoencephalopathy, Progressive Multifocal/therapy
- Lupus Vasculitis, Central Nervous System/blood
- Lupus Vasculitis, Central Nervous System/complications
- Lupus Vasculitis, Central Nervous System/pathology
- Lupus Vasculitis, Central Nervous System/therapy
- Pancreas/pathology
- Pancreatitis/complications
- Pancreatitis/pathology
- Pancreatitis/therapy
- Treatment Outcome
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Affiliation(s)
- J Swol-Ben
- Department of Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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Penalva JC, Martínez J, Pascual E, Palanca VM, Lluis F, Peiró F, Pérez H, Pérez-Mateo M. Chronic pancreatitis associated with systemic lupus erythematosus in a young girl. Pancreas 2003; 27:275-7. [PMID: 14508137 DOI: 10.1097/00006676-200310000-00016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Systemic lupus erythematosus (SLE) is an uncommon etiology of pancreatic disease. Up to now, only 3 cases of chronic pancreatitis associated with SLE have been reported in adults. We report the case of a 14-year-old girl with SLE and calcifying chronic pancreatitis. At the age of 4 she was diagnosed with SLE. She presented with several acute exacerbations of SLE that were managed with prednisone and azathioprine. At the age of 9, she was admitted with abdominal pain and elevation of serum amylase and lipase levels; no gallstones were found on ultrasound, and treatment with azathioprine was withdrawn. Thereafter, she developed numerous episodes of acute pancreatitis. Later, an ERCP showed pancreatic calcifications and distortion of the main pancreatic duct, both findings consistent with established chronic pancreatitis. At the age of 14, her condition worsened progressively, and a surgical procedure (corporo-caudal spleno-pancreatectomy) was performed. The pathology specimen showed acinar atrophy and intense fibrosis. After surgery, the patient has remained pain-free and is enjoying a normal life.
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Affiliation(s)
- J C Penalva
- Department of Digestive Diseases, Hospital General Universitario, Alicante, Spain
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18
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Saito T, Tanaka S, Yoshida H, Imamura T, Ukegawa J, Seki T, Ikegami A, Yamamura F, Mikami T, Aoyagi Y, Niikawa J, Mitamura K. A case of autoimmune pancreatitis responding to steroid therapy. Evidence of histologic recovery. Pancreatology 2003; 2:550-6. [PMID: 12435868 DOI: 10.1159/000066092] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report a case of autoimmune pancreatitis without obvious evidence of autoimmunological participation, which responded well to steroid treatment and provided histologic and radiographic evidence for this improvement. A 68-year-old woman presented abdominal fullness, diffuse pancreatic swelling on abdominal computed tomography and ultrasonography, and diffuse narrowing of the main pancreatic duct on endoscopic retrograde pancreatography. Transgastric aspiration needle biopsy of the body of the pancreas performed under endoscopic ultrasonography showed severe atrophy of acinar cells, infiltration of T lymphocytes. She was diagnosed as having autoimmune pancreatitis without obvious evidence of autoimmunological participation. Administration of 30 mg/day of predonisolone was started. Computed tomography showed marked improvement of the diffuse swelling of the pancreas, and endoscopic retrograde pancreatograpy showed amelioration of the narrowing of the main pancreatic duct after the start of treatment. Pancreatic tissue obtained by needle biopsy after the start of treatment with predonisolone revealed marked histologic improvement, including amelioration of the fibrosis, and infiltration of inflammatory lymphocytes, and a substantial increase in the number of pancreatic acinar cells. The present report is the first to demonstrate histologic recovery of autoimmune pancreatitis after steroid therapy.
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Affiliation(s)
- Takeshi Saito
- Second Department of Internal Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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Cavestro GM, Frulloni L, Neri TM, Seghini P, Nouvenne A, Zanetti A, Bovo P, Di Mario F, Okolicsanyi L, Cavallini G. Association of HLA-DRB1*0401 allele with chronic pancreatitis. Pancreas 2003; 26:388-91. [PMID: 12717273 DOI: 10.1097/00006676-200305000-00013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Chronic pancreatitis (CP) is characterized by irreversible morphologic and functional alterations of the pancreas, clinically presenting with upper abdominal pain as well as exocrine and endocrine insufficiencies. According to a more recent hypothesis, the pathogenesis may involve genetic and immunologic factors. AIM To investigate the major histocompatibility complex (MHC) genes as a genetic background of chronic pancreatitis. METHODOLOGY Allelic polymorphisms were investigated in the genes of the MHC region (HLA B, DRB, DQB) with PCR-based methodologies (PCR-SSP) in 56 patients with CP (44 males and 12 females) and 183 normal controls (78 males and 105 females) of the same ethnic group. All patients and controls gave their informed consent. RESULTS Among HLA-DRB1 genes, DRB1*04 was significantly higher in CP patients than in controls (26.78% versus 8.1%; pc < 0.003; OR = 4.1; CI = 1.85-9.06). DRB1*04 allele specificities in the DRB1*04-positive patients demonstrated significantly higher frequencies of DRB1*0401 allele (14.3% versus 1.1%; p = 0.00017; OR = 15.08; CI = 3.1-73.36). Neither HLA-B nor HLA-DQB1 associations with the disease were found. CONCLUSIONS This study supports a role of HLA-DRB1*0401 as a susceptibility factor for patients with CP. HLA DRB1*0401 contains the 70QKRAA74 amino acid sequence, which is also expressed by several human pathogens, including Epstein-Barr virus. T cells may be triggered in the pancreatic tissue upon exposure to foreign peptides similar enough to cross-react and to break immunologic tolerance.
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Matsubayashi H, Seki T, Niki S, Mizumura Y, Taguchi Y, Moriyasu F, Go K. Wegener's granulomatosis with onset of acute pancreatitis and rapid progress. A case report. Pancreatology 2002; 1:263-6. [PMID: 12120205 DOI: 10.1159/000055821] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although Wegener's granulomatosis is a rare disorder, the clinical and histological characteristics are well known. However, Wegener's granulomatosis with the onset of acute pancreatitis has rarely been reported. We discuss the case of Wegener's granulomatosis in a 65-year-old man, presenting with acute pancreatitis and whose disease progressed rapidly.
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Affiliation(s)
- H Matsubayashi
- Fourth Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan
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21
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Singh M, Wani S, Murtaza M, Joglekar S, Kasubhai M. Systemic lupus erythematosus presenting with acute fatal pancreatitis as an initial manifestation. Am J Gastroenterol 2001; 96:2280-1. [PMID: 11467682 DOI: 10.1111/j.1572-0241.2001.03992.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Venu RP, Radke JS, Brown RD, Deutsch SF, Zaytsev PM, Miyaji E, Nishimori I. Autoimmune pancreatitis, pancreatic mass, and lower gastrointestinal bleed. J Clin Gastroenterol 1999; 28:364-7. [PMID: 10372940 DOI: 10.1097/00004836-199906000-00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Autoimmune pancreatitis (AIMP) is a recently described clinical entity causing chronic pancreatitis. It often presents with diffuse enlargement of the pancreas and/or a focal mass at the head of the pancreas causing common bile duct obstruction and jaundice. In most instances, AIMP is mistaken for pancreatic cancer. A number of laboratory abnormalities such as positive antinuclear antibody, hypergammaglobulinemia, and antibody to carbonic anhydrase are often present in these patients. Currently, pancreatic biopsy demonstrating characteristic histopathologic changes is essential to establish the diagnosis. We report the first case of AIMP presenting as a pancreatic tail mass and lower gastrointestinal bleed.
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Affiliation(s)
- R P Venu
- University of Illinois at Chicago Medical Center, USA
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Bailey M, Chapin W, Licht H, Reynolds JC. The effects of vasculitis on the gastrointestinal tract and liver. Gastroenterol Clin North Am 1998; 27:747-82, v-vi. [PMID: 9890113 DOI: 10.1016/s0889-8553(05)70032-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vasculitis can affect every organ of the digestive system. In many cases, it may first present with gastrointestinal symptoms. In several forms of vasculitis, including Churg Strauss syndrome, Henoch-Schönlein purpura, and lupus, the majority of patients have gastrointestinal involvement. The astute gastroenterologist should consider vasculitic causes of the symptoms seen in many patients. Making the correct diagnosis requires a thorough understanding of the potential role of vasculitis in causing these symptoms and the appropriate path to making a diagnosis. This article reviews the variety of manifestations of vasculitis on the digestive system, and emphasizes diagnosis and clinical manifestations.
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Affiliation(s)
- M Bailey
- Department of Medicine, Allegheny University of the Health Sciences-Medical College of Pennsylvania, USA
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Nur MA, Contractor QQ, Ibrahim AE, Hassan EM. Systemic lupus erythematosus presenting as massive ascites and pancreatitis. Ann Saudi Med 1996; 16:77-8. [PMID: 17372425 DOI: 10.5144/0256-4947.1996.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M A Nur
- Department of Medicine, King Fahad Specialist Hospital, Buraidah, Gassim
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Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995; 40:1561-8. [PMID: 7628283 DOI: 10.1007/bf02285209] [Citation(s) in RCA: 891] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Several authors have reported a case of chronic pancreatitis associated with Sjögren's syndrome in which an autoimmune mechanism may have been involved in the etiology and in which steroid therapy was effective. We recently encountered a patient with pancreatitis who had hyperglobulinemia, was autoantibody-positive, and responded to steroid therapy. This patient, however, failed to show any evidence of association with Sjögren's syndrome or other collagen diseases. Although the concept of autoimmune hepatitis and the criteria for diagnosing it have been established, autoimmune pancreatitis has not yet been defined as a clinical entity. We report a case of chronic pancreatitis in which an autoimmune mechanism is involved in the etiology and summarize the cases of pancreatitis suspected of being caused by an autoimmune mechanism in the Japanese and English literature.
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Affiliation(s)
- K Yoshida
- Institute of Gastroenterology, Tokyo Women's Medical College, Japan
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Hortas C, de Las Heras G, López-Arias MJ, Martín L, Pons-Romero F. Chronic calcifying pancreatitis in rheumatic diseases. Ann Rheum Dis 1995; 54:77-8. [PMID: 7880129 PMCID: PMC1005520 DOI: 10.1136/ard.54.1.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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