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Editor’s quiz: GI snapshot
Focal pancreatic lesions in autoimmune pancreatitis and weight loss
  1. Ali Aghdassi1,
  2. Quang Trung Tran1,
  3. Thomas Bulla1,
  4. Robin Bülow2,
  5. Silvia Ribback3,
  6. Markus M Lerch1,
  7. Tilman Pickartz1
  1. 1 Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
  2. 2 Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
  3. 3 Institute of Pathology, Ernst-Moritz-Arndt Universitat Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
  1. Correspondence to Dr Ali Aghdassi, Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany; ali.aghdassi{at}med.uni-greifswald.de

https://doi.org/10.1136/gutjnl-2020-321987

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    Clinical presentation

    A 67-year-old male patient was admitted to hospital with upper abdominal pain, jaundice and pale stool for 2 weeks. Laboratory investigation showed highly elevated cholestatic parameters and transaminases but no increase of serum IgG4. MRI (figure 1) and endoscopic ultrasound (EUS) demonstrated a diffuse enlargement of the pancreas. Parenchymal biopsy taken by EUS-guided fine needle aspiration (FNA) contained storiform fibrosis with increased plasma cells expressing IgG4 (>30 cells/HPF) compatible with autoimmune pancreatitis type I. A steroid pulse therapy was initiated followed by maintenance therapy (prednisolone 5 mg/kg p.o.) and the patient recovered. One year later, the patient presented again with weight …

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    Footnotes

    • Contributors AA, TB, SR, MML and TP drafted the manuscript. QTT and RB made critical revisions for important intellectual content. All authors reviewed and approved the final article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.