The Diagnosis And Treatment Of Autoimmune Pancreatitis, A Case Report

Objective:Autoimmune pancreatitis (autoimmune pancreatitis, AIP) used to be a kind of idiopathic pancreatitis. With the recent development of molecular biology, its characteristics are being gradually realized. AIP has been issued as a separate sub-type existed. The main clinical manifestations is no or mild abdominal pain, accompanied by pancreatic exocrine manifestations (Such as renal masses, nephritis, pulmonary masses, or common bile duct stenosis), and associated with typeⅡdiabetes. The international community has not yet worked out an unified diagnostic criteria. It is more difficult to giving an accurate diagnosis. So the clinical misdiagnosis often occurs. The author described a case of autoimmune pancreatitis treated with prednisone therapy in patient and a follow-up results.Case presentation and treatment:Patient, female,64y, repeated anorexia, fatigue two months, with skin itching for four days. She had a poor appetite, worse after a meal umbilical discomfort, and felt tired weakness. After admission, she received some more checks. WBC 3.7×109/L,RBC 4.13X1012/L, Liver function:Globulin 35.8g/L,GPT 435U/L,AST 213U/L, ALP 481U/L, TB 34μmol/L, DB 17μmol/L, fasting plasma glucose 7.97 mmol/L.CA19-9 108.8U/L.B ultrasound:diffuse swelling of the pancreas with low and uneven echo (Pancreatic cancer considered first); dialatation of intra-and extrahepatic bile duct with expansion of the gallbladder. CT scan:diffuse pancreatic space-occupying; obstructive biliary dilatation with two kidneys multiple space occupied lesion; first consider the metastasis associated with pancreatic cancer. MRI showed that pancreatic duct was not clear, dialatation of intra-and extrahepatic bile duct, autoimmune pancreatitis considered first. Pancreatic biopsy showed pancreatic fibrosis with lymphocyte infiltration, morphology consistent with autoimmune pancreatitis. After one month treatment with prednisone diagnostic, the patient resumed eating, jaundice, upper abdominal discomfort disappeared, recovery in weight than before; CT examination revealed renal masses reduced, no enlargement of liver and extrahepatic bile duct.Conclusion:Patients with autoimmune pancreatitis has a higher sensitivity to prednisone therapy. Involvement of organs outside the pancreas can be able to mitigate or improve or even cure after medication.