Nijs J, Macken E, Struyf N, Gys T, Bergmans G, Pelckmans P
University Hospital Antwerp, Edegem.
Acta Gastroenterol Belg. 2004 Oct-Dec;67(4):346-50.
We report the case of a 47-year-old Caucasian male patient who presented with obstructive jaundice and mild epigastric pain. Autoimmune pancreatitis was diagnosed based on magnetic resonance imaging, biopsy and clinical evolution, and the patient was successfully treated with corticosteroids. However, a few months later ERCP showed an image compatible with sclerosing cholangitis. Again, treatment with corticosteroids was given, after which the bile ducts became normal. A few months later, again there was a relapse and azathioprine was started. After decreasing the dose of immunesuppression, we saw relapses of cholangitis and pancreatitis, with eventually evolution to chronic calcifying pancreatitis. The aim of this report is to describe autoimmune pancreatitis as a cause of obstructive jaundice, and to illustrate that evolution to an immunesuppression-responsive cholangitis, with evolution to chronic calcifying pancreatitis is possible. Also, our patient had a small fluid collection, possibly a pseudocyst, an unusual finding in autoimmune pancreatitis, which disappeared during treatment.
我们报告了一例47岁的白种男性患者，该患者出现阻塞性黄疸和轻度上腹部疼痛。基于磁共振成像、活检及临床病程，诊断为自身免疫性胰腺炎，患者接受皮质类固醇治疗后成功治愈。然而，几个月后，内镜逆行胰胆管造影（ERCP）显示图像符合硬化性胆管炎。再次给予皮质类固醇治疗，之后胆管恢复正常。几个月后，病情再次复发，遂开始使用硫唑嘌呤。在降低免疫抑制剂量后，我们观察到胆管炎和胰腺炎复发，最终发展为慢性钙化性胰腺炎。本报告的目的是描述自身免疫性胰腺炎作为阻塞性黄疸的一个病因，并说明其可能演变为对免疫抑制有反应的胆管炎，进而发展为慢性钙化性胰腺炎。此外，我们的患者有一个小的液体积聚，可能是假性囊肿，这在自身免疫性胰腺炎中是不常见的发现，在治疗过程中消失了。
