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一个诊断难题:一例儿童自身免疫性胰腺炎

A Diagnostic Conundrum: A Case of Pediatric Autoimmune Pancreatitis.

作者信息

Ravanbakhsh Naseem, Shillingford Nick, Piester Travis L

机构信息

From the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Division of Pathology, Children's Hospital Los Angeles, Los Angeles, CA, USA.

出版信息

JPGN Rep. 2023 Jun 9;4(3):e326. doi: 10.1097/PG9.0000000000000326. eCollection 2023 Aug.

Abstract

Autoimmune pancreatitis (AIP) is rare cause of abdominal pain in children who often present with obstructive jaundice, mimicking malignancy. An investigation of clinical symptoms, serology, imaging, and histopathology is necessary for diagnosis. We report a 10-year-old female presenting with abdominal pain and jaundice, ultimately found to have AIP after confirmation with tissue pathology. Our patient's prompt response to corticosteroid initiation is characteristic of this disease state. AIP has 2 subtypes, the second of which is more frequently found in children. Our patient's pathology did not fit perfectly with either subtype, but had features found in each one. While diagnostic criteria for AIP have not established in pediatrics, our case highlights the combination of clinical symptoms, imaging, and histopathology that children classically present with. While rare, the diagnosis of AIP is associated with comorbidities and must be considered in any child presenting with a pancreatic mass or biliary stricture.

摘要

自身免疫性胰腺炎(AIP)是儿童腹痛的罕见病因,常表现为梗阻性黄疸,类似恶性肿瘤。诊断需要对临床症状、血清学、影像学和组织病理学进行检查。我们报告了一名10岁女性,她因腹痛和黄疸就诊,经组织病理学确诊为AIP。我们的患者对皮质类固醇治疗的迅速反应是这种疾病状态的特征。AIP有2种亚型,其中第二种在儿童中更常见。我们患者的病理表现不完全符合任何一种亚型,但具有每种亚型的特征。虽然儿科尚未确立AIP的诊断标准,但我们的病例突出了儿童典型出现的临床症状、影像学和组织病理学的结合。虽然罕见,但AIP的诊断与合并症有关,任何出现胰腺肿块或胆管狭窄的儿童都必须考虑这一诊断。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c393/10435041/fb89525fea08/pg9-4-e326-g001.jpg

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