A Case of Advanced-Stage Sclerosing Cholangitis with Autoimmune Pancreatitis not Responsive to Steroid Therapy

  • Takahiro Nakazawa Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Itaru Naitoh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Tomoaki Ando Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Kazuki Hayashi Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Fumihiro Okumura Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Katsuyuki Miyabe Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Michihiro Yoshida Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Hirotaka Ohara Department of Community-Based Medical Education, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
  • Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences. Nagoya, Japan
Keywords: Autoimmune Diseases, Cholangitis, Sclerosing, Pancreatitis, Steroids

Abstract

Context Autoimmune pancreatitis and sclerosing cholangitis associated with autoimmune pancreatitis respond well to steroid therapy. Some criteria used for the differential diagnosis of autoimmune pancreatitis and sclerosing cholangitis with autoimmune pancreatitis include the response to a steroid trial. Case report A 68-year-old woman was diagnosed as having type 3 sclerosing cholangitis with autoimmune pancreatitis four years after clinical onset. Seven years after clinical onset, imaging findings revealed multiple pancreatic stones in an atrophic pancreas, stenosis of the main pancreatic duct in the head of the pancreas and upstream dilatation and a longer stretch of stenosis in the hilar hepatic region. We tried steroid therapy in an attempt to ameliorate stenosis of both the bile duct and the pancreatic duct and prevent further progression. Neither lesion responded to steroid therapy. Conclusion Advanced-stage sclerosing cholangitis with autoimmune pancreatitis may sometimes be unresponsive to steroid therapy, and this should be borne in mind when attempting a steroid trial for the diagnosis of sclerosing cholangitis with autoimmune pancreatitis. Early administration of steroid is important for the prevention of disease progression.

Image: ERCP by using a balloon catheter showing a longer stretch of stenosis in the hilar hepatic region.

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References

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ERCP by using a balloon catheter showing a longer stretch of stenosis in the hilar hepatic region
Published
2016-07-13
How to Cite
NakazawaT., NaitohI., AndoT., HayashiK., OkumuraF., MiyabeK., YoshidaM., OharaH., & JohT. (2016). A Case of Advanced-Stage Sclerosing Cholangitis with Autoimmune Pancreatitis not Responsive to Steroid Therapy. JOP. Journal of the Pancreas, 11(1), 58-60. https://doi.org/10.6092/1590-8577/3873
Section
CASE REPORTS

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