Autoimmune pancreatitis type 1 and type 2: A report on two cases
Abstract
Introduction. Autoimmune pancreatitis is a disease associated with autoimmune mechanisms, clinically manifested mostly as obstructive icterus with or with no entire or partial enlargement of the pancreas, histological lymphoplas-mocytic infiltration, fibrosis or granulocytic epithelial lesions with a favourable therapeutic response to the application of corticosteroids. Type 1 autoimmune pancreatitis is a systemic disease befalling the group of IgG4-related diseases in contrast to type 2 which is specific for pancreas disease. Case report. We presented two cases. The first one was a 64-year-old male patient with autoimmune pancreatitis complaining of abdominal pain, weight loss, weakness and exhaustion. Clinical examination showed a rare IgG4 autoimmune pancreatitis. The second one was a 37-year-old male patient complaining of abdominal pain with diarrhea. The diagnosis made revealed the presence of type 2 autoimmune pancreatitis. Following the diagnosis, immunosuppressive therapy was administered to both patients leading to the improvement of their general condition. Conclusion. Autoimmune pancreatitis is a rare disease, sometimes not easy to differ from pancreatic tumor or bile duct tumor with poor prognosis. Thus, early recognition of the disease is very important, since adequate treatment significantly increases the course and the outcomes of the disease.
References
Divatia M, Kim SA, Ro JY. IgG4-related sclerosing disease, an emerging entity: A review of a multi-system disease. Yonsei Med J 2012; 53(1): 15−34.
Sarles H, Sarles J, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas—An autonomous pancreatic disease. Am J Dig Dis 1961; 6(7): 688−98.
Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, et al. Diagnosis of autoimmune pancreatitis: The Mayo Clinic experience. Clin Gastroenterol Hepatol 2006; 4(8): 1010−6; quiz 934.
Kamisawa T. Diagnostic criteria for autoimmune pancreatitis. J Clin Gastroenterol 2008; 42(4): 404−7.
Chari ST, Kloeppel G, Zhang L, Notohara K, Lerch M, Shimosegawa T. Histopathologic and clinical subtypes of autoimmune pancreatitis. Pancreas 2010; 39(5): 549−54.
Cheuk W, Chan JK. IgG4-related sclerosing disease: A critical appraisal of an evolving clinicopathologic entity. Adv Anat Pathol 2010; 17(5): 303−32.
Hayashi M, Arisaka Y, Takeshita A, Tominaga Y, Ki T, Masuda D, et al. Differential diagnosis of pancreatobiliary carcinoma from autoimmune pancreatitis-related diseases: A report of three cases. J Gastrointest Cancer 2011; 42(4): 241−51.
Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995; 40(7): 1561−8.
Zen Y, Bogdanos DP, Kawa S. Type 1 autoimmune pancreatitis. Orphanet J Rare Dis 2011; 6: 82.
Hirano K, Isogawa A, Tada M, Isayama H, Takahara N, Miyabayashi K, et al. Long-term prognosis of autoimmune pancreatitis in terms of glucose tolerance. Pancreas 2012; 41(5): 691−5.
Okazaki K, Kawa S, Kamisawa T, Ito T, Inui K, Irie H, et al. Amendment of the Japanese consensus guidelines for management of autoimmune pancreatitis 2013. I. Concept and diagnosis of autoimmune pancreatitis. J Gastroenterol 2014; 49(4): 567−88.
Fantini L, Zanini N, Fiscaletti M, Calculli L, Casadei R, Campana D, et al. Autoimmune pancreatitis: The classification puzzle. Adv Med Sci 2007; 52: 71−5.
Kawa S, Okazaki K, Kamisawa T, Shimosegawa T, Tanaka M. Japanese consensus guidelines for management of autoimmune pancreatitis: II. Extrapancreatic lesions, differential diagnosis. J Gastroenterol 2010; 45(4): 355−69.
Maruyama M, Watanabe T, Kanai K, Oguchi T, Muraki T, Hamano H, et al. International consensus diagnostic criteria for autoimmune pancreatitis and its Japanese amendment have improved diagnostic ability over existing criteria. Gastroenterol Res Pract 2013; 2013: 456965.
Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenduson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis. Pancreas 2011; 40(3): 352−8.
Sah RP, Chari ST. Autoimmune pancreatitis: An update on classification, diagnosis, natural history and management. Curr Gastroenterol Rep 2012; 14(2): 95−105.
Pappa K, Angst E, Seidel S, Flury-Frei R, Hetzer FH. The diagnostic challenges of autoimmune pancreatitis. Case Rep Gastroenterol 2015; 9(1): 56−61.
Pezzilli R, Imbrogno A, Fabbri D. Autoimmune pancreatitis management: Reflections on the past decade and the decade to come. Expert Rev Clin Immunol 2012; 8(2): 115−7.
Kim HM, Chung MJ, Chung JB. Remission and relapse of autoimmune pancreatitis: Focusing on corticosteroid treatment. Pancreas 2010; 39(5): 555−60.
Kamisawa T, Okazaki K, Shigeyuki K, Shimosegawa T, Tanaka M. Japanese consensus guidelines for management of autoimmune pancreatitis: III. Treatment and prognosis of AIP. J Gastroenterol 2010; 45(5): 471−7.
Kubota K, Watanabe S, Uchiyama T, Kato S, Sekino Y, Suzuki K, et al. Factors predictive of relapse and spontaneous remission of autoimmune pancreatitis patients treated/not treated with corticosteroids. J Gastroenterol 2011; 46(6): 834−42.
Kalaitzakis E, Webster GJ. Review article: autoimmune pancreatitis: Management of an emerging disease. Aliment Pharmacol Ther 2011; 33(3): 291−303.
Takuma K, Kamisawa T, Gopalakrishna R, Hara S, Tabata T, Inaba Y, et al. Strategy to differentiate autoimmune pancreatitis from pancreas cancer. World J Gastroenterol 2012; 18(10): 1015−20.
Kim JH, Kim MH, Byun JH, Lee SS, Lee SJ, Park SH, et al. Diagnostic Strategy for Differentiating Autoimmune Pancreatitis From Pancreatic Cancer: Is an Endoscopic Retrograde Pancreatography Essential. Pancreas 2012; 41(4): 639−47.