1.A Patient Diagnosed as Autoimmune Pancreatitis 6 Years after Onset of Jaundice.
Kap Hyun KIM ; Kyu Taek LEE ; Hyun Wook JUNG ; Sung Hyun PARK ; Jong Kyu KIM ; Kwang Hyuck LEE ; Jong Kyun LEE ; Kee Taek JANG
The Korean Journal of Gastroenterology 2009;53(4):257-260
The clinical manifestations of autoimmune pancreatitis (AIP) are diffuse pancreatic swelling, diffuse irregular narrowing of the main pancreatic duct, and increased serum IgG or positive serum autoantibody. Clinically, AIP can be improved dramatically with oral steroid therapy. In this report, we describe a 62-year-old woman diagnosed as autoimmune pancreatitis six years after onset of jaundice, who presented with uncontrolled blood glucose levels. The laboratory tests revealed obstructive jaundice, and the computed tomography of the pancreas showed pancreatic swelling. After six years of onset, she was diagnosed with AIP and successfully treated with steroid treatment.
Autoimmune Diseases/*diagnosis/drug therapy
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Female
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Humans
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Immunoglobulin G/blood
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Jaundice/*diagnosis
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Middle Aged
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Pancreatitis/*diagnosis/drug therapy
;
Steroids/therapeutic use
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Tomography, X-Ray Computed
2.Diagnosis and treatment of autoimmune pancreatitis: analysis of six cases.
Jin-Hua MEI ; Xiu-Jun CAI ; Xiao LIANG ; Jia-Guo WU ; Wei-Liang ZHENG ; Qiao-Wei ZHANG
Chinese Medical Journal 2013;126(24):4797-4799
Aged
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Autoimmune Diseases
;
diagnosis
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Female
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Humans
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Male
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Middle Aged
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Pancreatitis
;
diagnosis
;
drug therapy
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surgery
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Prednisone
;
therapeutic use
3.Henoch-Schönlein Purpura: A Rare Cause of Recurrent Acute Pancreatitis.
Dong-Ya HUANG ; Qiang LI ; Kui-Rong JIANG ; Bin XIAO ; Guo-Sheng CHEN ; Yi MIAO
Chinese Medical Journal 2016;129(20):2510-2511
4.Pancreatic Lymphoma Masquerading as Autoimmune Pancreatitis.
Jinoh PARK ; Dongwook OH ; Minseon CHEONG ; Jiyoon KIM ; Jin Sun OH ; Tae Jun SONG ; Seung Mo HONG ; Myung Hwan KIM
Korean Journal of Pancreas and Biliary Tract 2015;20(4):204-208
Accurate diagnosis of autoimmune pancreatitis (AIP) is important to clinicians since it is difficult to differentiate AIP from pancreatic malignancies. Furthermore, unlike pancreatic malignancies, AIP has dramatic response to steroids. A 61-years-old man presented with acute pancreatitis. Imaging studies showed two separate pancreatic masses, irregular narrowing of main pancreatic duct, and a renal mass that highly suggested AIP. Endoscopic ultrasound-guided core needle biopsy of the pancreatic masses and ultrasound-guided biopsy of the renal mass revealed peripheral T-cell lymphoma. The patient is currently undergoing chemotherapy. We present a case of pancreatic lymphoma masquerading as AIP with literature review.
Biopsy
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Biopsy, Large-Core Needle
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Diagnosis
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Drug Therapy
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Humans
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Lymphoma*
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Lymphoma, T-Cell, Peripheral
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Pancreatic Ducts
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Pancreatic Neoplasms
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Pancreatitis*
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Steroids
5.Microscopic polyangiitis with crescentic glomerulonephritis initially presenting as acute pancreatitis.
A Young CHO ; Byeong Gwan KIM ; Sang Sun KIM ; Seong Hee LEE ; Hong Shik SHIN ; Yeong Jin CHOI ; In O SUN
The Korean Journal of Internal Medicine 2016;31(2):403-405
No abstract available.
Acute Disease
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Biopsy
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Fatal Outcome
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Female
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Fluorescent Antibody Technique
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Glomerulonephritis/*complications/diagnosis/drug therapy/immunology
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Humans
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Immunosuppressive Agents/therapeutic use
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Microscopic Polyangiitis/*complications/diagnosis/drug therapy/immunology
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Middle Aged
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Pancreatitis/diagnosis/drug therapy/*etiology/immunology
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Treatment Outcome
6.A Case of Autoimmune Pancreatitis Combined with Extensive Involvement of Biliary Tract.
Chang Min LEE ; Myung Hwan ROH ; Chang Kil JUNG ; Jong Jin WON ; Yang Hyun BAEK ; Sung Wook LEE ; Seok Ryeol CHOI ; Jin Han CHO
The Korean Journal of Gastroenterology 2009;53(6):383-387
Autoimmune pancreatitis is a distinct disease characterized by the presence of autoantibodies and hypergammaglobulinemia, inflammation of the pancreatic parenchyma, and irregular stricture of the pancreatic duct. The involvement of distal common bile duct is frequently observed, but intrahepatic bile duct involvement is very rare, which seem to have similar feature to primary sclerosing cholangitis. We report a case of the patient with autoimmune pancreatitis combined with extensive involvement of extrahepatic and intrahepatic bile duct, which had a favorable response to steroid therapy.
Aged
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Autoimmune Diseases/complications/*diagnosis/drug therapy
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Bile Ducts, Extrahepatic/*radiography
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Bile Ducts, Intrahepatic/*radiography
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Humans
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Male
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Pancreatitis/complications/*diagnosis/radiography
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Prednisolone/therapeutic use
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Tomography, X-Ray Computed
7.A case of duodenal ulcer as prominent manifestation of IgG4-related disease.
Min FENG ; Zhe CHEN ; Yong Jing CHENG
Journal of Peking University(Health Sciences) 2023;55(6):1125-1129
A case of IgG4-related disease presented with a duodenal ulcer to improve the understan-ding of IgG4-related diseases was reported. A 70-year-old male presented with cutaneous pruritus and abdominal pain for four years and blackened stools for two months. Four years ago, the patient went to hospital for cutaneous pruritus and abdominal pain. Serum IgG4 was 3.09 g/L (reference value 0-1.35 g/L), alanine aminotransferase 554 U/L (reference value 9-40 U/L), aspartate aminotransferase 288 U/L (reference value 5-40 U/L), total bilirubin 54.16 μmol/L (reference value 2-21 μmol/L), and direct bilirubin 29.64 μmol/L (reference value 1.7-8.1 μmol/L) were all elevated. The abdominal CT scan and magnetic resonance cholangiopancreatography indicated pancreatic swelling, common bile duct stenosis, and secondary obstructive dilation of the biliary system. The patient was diagnosed with IgG4-related disease and treated with prednisone at 40 mg daily. As jaundice and abdominal pain improved, prednisone was gradually reduced to medication discontinuation. Two months ago, the patient developed melena, whose blood routine test showed severe anemia, and gastrointestinal bleeding was diagnosed. The patient came to the emergency department of Beijing Hospital with no improvement after treatment in other hospitals. Gastroscopy revealed a 1.5 cm firm duodenal bulb ulcer. After treatment with omeprazole, the fecal occult blood was still positive. The PET-CT examination was performed, and it revealed no abnormality in the metabolic activity of the duodenal wall, and no neoplastic lesions were found. IgG4-related disease was considered, and the patient was admitted to the Department of Rheumatology and Immunology of Beijing Hospital for further diagnosis and treatment. The patient had a right submandibular gland mass resection history and diabetes mellitus. After the patient was admitted to the hospital, the blood test was reevaluated. The serum IgG4 was elevated at 5.44 g/L (reference value 0.03-2.01 g/L). Enhanced CT of the abdomen showed that the pancreas was mild swelling and was abnormally strengthened, with intrahepatic and extrahepatic bile duct dilation and soft tissue around the superior mesenteric vessels. We pathologically reevaluated and stained biopsy specimens of duodenal bulbs for IgG and IgG4. Immunohistochemical staining revealed remarkable infiltration of IgG4-positive plasma cells into duodenal tissue, the number of IgG4-positive cells was 20-30 cells per high-powered field, and the ratio of IgG4/IgG-positive plasma cells was more than 40%. The patient was treated with intravenous methylprednisolone at 40 mg daily dosage and cyclophosphamide, and then the duodenal ulcer was healed. IgG4 related disease is an immune-medicated rare disease characterized by chronic inflammation and fibrosis. It is a systemic disease that affects nearly every anatomic site of the body, usually involving multiple organs and diverse clinical manifestations. The digestive system manifestations of IgG4-related disease are mostly acute pancreatitis and cholangitis and rarely manifest as gastrointestinal ulcers. This case confirms that IgG4-related disease can present as a duodenal ulcer and is one of the rare causes of duodenal ulcers.
Aged
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Humans
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Male
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Abdominal Pain/drug therapy*
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Acute Disease
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Bilirubin
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Duodenal Ulcer/etiology*
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Immunoglobulin G
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Immunoglobulin G4-Related Disease/diagnosis*
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Pancreatitis/drug therapy*
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Positron Emission Tomography Computed Tomography
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Prednisone/therapeutic use*
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Pruritus/drug therapy*
8.Hypertriglyceridemia-Induced Pancreatitis Treated with Insulin in a Nondiabetic Patient.
Seon Young PARK ; Jin Ook CHUNG ; Dong Keun CHO ; Wan Sik LEE ; Hyun Soo KIM ; Sung Kyu CHOI ; Jong Sun REW ; Min Young CHUNG
The Korean Journal of Gastroenterology 2010;55(6):399-403
Heparin and/or insulin stimulate lipoprotein lipase and are known to decrease serum triglyceride level. However, their efficacy in hypertriglyceridemia-induced acute pancreatitis in nondiabetic patients is not well documented. We report a case of hypertriglyceridemia-induced pancreatitis in 43-year-old nondiabetic woman in whom treatment with insulin was accompanied by reduction in serum triglyceride level and the resolution of pancreatitis. She presented to the emergency department with abdominal pain and biochemical evidence of acute pancreatitis. Her medical history was unremarkable. There was no history of alcohol consumption, and biliary imaging was not remarkable. Subsequent laboratory investigation revealed marked hypertriglyceridemia (1,951 mg/dL), impaired fasting glucose, and normal HbAlc level. The Ranson's score and APATCH II score were 1 and 4. Abdominal CT showed diffuse enlargement of pancreas, peripancreatic fat infiltration, and multiple fluid collections around the pancreas. We treated the patient with the infusion of 5% dextrose and 1.5 unit/hr regular insulin to reduce serum triglyceride level. The level of serum triglyceride was decreased to 305 mg/dL on day 5. During the remainder of hospitalization, her clinical symptoms and laboratory values gradually improved.
Acute Disease
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Adult
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Diabetes Mellitus/diagnosis
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Female
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Hemoglobin A, Glycosylated/analysis
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Humans
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Hypertriglyceridemia/*complications
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Insulin/*therapeutic use
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Pancreatitis/*drug therapy/etiology
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Severity of Illness Index
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Tomography, X-Ray Computed
9.An Update on Hypertriglyceridemia-Induced Acute Pancreatitis.
Korean Journal of Medicine 2018;93(6):518-524
Hypertriglyceridemia a major cause of acute pancreatitis, accounting for up to 10% of all cases. The pathophysiological mechanism of hypertriglyceridemia-induced acute pancreatitis (HTGP) is presumed to involve the hydrolysis of triglycerides by pancreatic lipase resulting in an excess of free fatty acids and elevated chylomicrons, which are thought to increase plasma viscosity and induce ischemia and inflammation in pancreatic tissue. Although the clinical course of HTGP is similar to other forms of acute pancreatitis, the clinical severity and associated complications are significantly higher in patients with HTGP. Therefore, an accurate diagnosis is essential for treatment and prevention of disease recurrence. At present, there are no approved guidelines for the management of HTGP. Different treatment modalities such as apheresis/plasmapheresis, insulin, heparin, fibric acids, and omega-3 fatty acids have been successfully implemented to reduce serum triglycerides. Following acute phase management, lifestyle modifications including dietary adjustments and drug therapy are important for the long-term management of HTGP and the prevention of relapse. Additional studies are required to produce generalized and efficient treatment guidelines for HTGP.
Chylomicrons
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Diagnosis
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Drug Therapy
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Fatty Acids, Nonesterified
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Fatty Acids, Omega-3
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Fibric Acids
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Heparin
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Humans
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Hydrolysis
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Hypertriglyceridemia
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Inflammation
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Insulin
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Ischemia
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Life Style
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Lipase
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Pancreatitis*
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Plasma
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Recurrence
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Triglycerides
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Viscosity
10.Suspected Pulmonary Involvement of Autoimmune Pancreatitis.
Seungmin BANG ; Jeong Youp PARK
The Korean Journal of Gastroenterology 2011;58(1):58-60
No abstract available.
Autoimmune Diseases/*diagnosis/drug therapy/immunology
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Azathioprine/therapeutic use
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Common Bile Duct/pathology
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Emphysema
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Fibrosis
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Humans
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Immunoglobulin G/blood
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Immunosuppressive Agents/therapeutic use
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Lung/*radiography
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Male
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Middle Aged
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Pancreatitis/*diagnosis/drug therapy/immunology
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Stents
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Tomography, X-Ray Computed