Bellido-Caparó Álvaro, Espinoza-Ríos Jorge, Aguilar Víctor, García Carlos, Pinto José Luis, Tagle Arróspide Martin, Bussalleu Rivera Alejandro
Servicio de Gastroenterología, Hospital Cayetano Heredia. Lima, Perú.
Servicio de Gastroenterología, Hospital Cayetano Heredia. Lima, Perú; Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú.
Rev Gastroenterol Peru. 2017 Jul-Sep;37(3):254-257.
Autoimmune pancreatitis type 1 (AIP) is the pancreatic manifestation of IgG4-related disease. The most frequent presentation of AIP is with obstructive jaundice. For definite diagnosis of type 1 Autoimmune pancreatitis international consensus diagnosis criteria (ICDC) for AIP are used. ICDC criteria include pancreatic parenchymal imaging, ductal imaging, serology, other organ involvement, histology, and response to steroid. We report a 52-years-old woman with rheumatoid arthritis without treatment presented with two months of abdominal pain in up-right quadrant with moderate intensity. She also presented jaundice, acholia, xerophtalmia, xerostomia, and a weight loss of 5 pounds. On examination jaundice, symmetrically enlarged submandibular glands, and epigastric pain was observed. On laboratory, a cholestasis pattern and conjugated bilirubin predominance was found. CT Abdominal, CMR revealed a dilated common bile duct with a diffuse pancreatic enlargement with delayed enhancement. Immunological studies show a IgG4 610 u/l and ANA 1/640. The patient responds to steroid clinically and in the laboratorial values. In conclusion, autoimmune pancreatitis type 1 should be suspected in case of an obstructive jaundice with a pancreatic inflammatory image, and complete ICDC criteria for a definite diagnosis.
