Taguchi Masashi, Aridome Gentaro, Abe Shintaro, Kume Keiichiro, Tashiro Mitsuo, Yamamoto Mitsuyoshi, Kihara Yasuyuki, Nakamura Hayato, Otsuki Makoto
Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan School of Medicine, 1-1 Iseigaoka, Kitakyushu 807-8555, Japan.
World J Gastroenterol. 2005 Sep 21;11(35):5577-81. doi: 10.3748/wjg.v11.i35.5577.
A 62-year-old male was referred to our hospital because of liver dysfunction, diffuse pancreatic swelling, and trachelophyma. At admission, the patient was free of pain. Physical examination showed enlarged and palpable bilateral submandibular masses, but no palpable mass or organomegaly in the abdomen. Laboratory findings were as follows: total protein 90 g/L with gamma-globulin of 37.3% (33 g/L), total bilirubin 4 mg/L, aspartate aminotransferase 39 IU/L, alanine aminotransferase 67 IU/L, gamma-glutamyl transpeptidase 1 647 IU/L, and amylase 135 IU/L. Autoantibodies were negative, and tumor markers were within the normal range. Serum IgG4 level was markedly elevated (18 900 mg/L). Computed tomography (CT) showed diffuse swelling of the pancreas and dilatation of both common and intra-hepatic bile ducts. Endoscopic retrograde pancreatography (ERP) revealed diffuse irregular and narrow main pancreatic duct and stenosis of the lower common bile duct. Biopsy specimens from the pancreas, salivary gland and liver showed marked periductal IgG4-positive plasma cell infiltration with fibrosis. We considered this patient to be autoimmune pancreatitis (AIP) with fibrosclerosis of the salivary gland and biliary tract, prescribed prednisolone at an initial dose of 40 mg/d. Three months later, the laboratory data improved almost to normal. Abdominal CT reflected prominent improvement in the pancreatic lesion. Swelling of the salivary gland also improved. At present, the patient is on 10 mg/d of prednisolone without recurrence of the pancreatitis. We present here a case of AIP with fibrosclerosis of salivary gland and biliary tract.
一名62岁男性因肝功能不全、胰腺弥漫性肿大及颈部肿块被转诊至我院。入院时,患者无疼痛。体格检查发现双侧颌下肿块肿大且可触及,但腹部未触及肿块或脏器肿大。实验室检查结果如下:总蛋白90 g/L,γ-球蛋白37.3%(33 g/L),总胆红素4 mg/L,天冬氨酸转氨酶39 IU/L,丙氨酸转氨酶67 IU/L,γ-谷氨酰转肽酶1647 IU/L,淀粉酶135 IU/L。自身抗体阴性,肿瘤标志物在正常范围内。血清IgG4水平显著升高(18900 mg/L)。计算机断层扫描(CT)显示胰腺弥漫性肿大,肝内外胆管扩张。内镜逆行胰胆管造影(ERP)显示主胰管弥漫性不规则狭窄及胆总管下段狭窄。胰腺、唾液腺和肝脏的活检标本显示导管周围有明显的IgG4阳性浆细胞浸润伴纤维化。我们认为该患者为自身免疫性胰腺炎(AIP)伴唾液腺和胆道纤维硬化,初始剂量给予泼尼松龙40 mg/d。3个月后,实验室数据几乎恢复正常。腹部CT显示胰腺病变明显改善。唾液腺肿大也有所改善。目前,患者服用泼尼松龙10 mg/d,胰腺炎未复发。我们在此报告一例伴有唾液腺和胆道纤维硬化的AIP病例。