Autoimmune Pancreatitis Associated with Pancreatic Pseudocyst: A Case Report
Keywords:
Autoimmune pancreatitis; IgG4 related disease; PseudocystAbstract
Autoimmune pancreatitis is a sub-type of chronic pancreatitis. It has 2 further types; type I and II. Type I is associated with IgG4 disease. We describe a case of chronic pancreatitis that ultimately turned out to be having IgG4 disease.
A 45 years old female with no co-morbids presented with epigastric pain, left hypochondrium pain, vomiting and fever for 5 days. She had previously been admitted twice in the hospital with similar complaints and was diagnosed as acute pancreatitis.
Examination revealed tenderness in epigastrium and left hypochondrium. Laboratory investigations revealed serum Lipase: 405 U/L, serum Amylase: 178 U/L, Lipid profile: cholesterol: 242 mg/dL triglycerides: 218 mg/dL HDL: 42 mg/dL LDL: 169 mg/dL. HbA1c: 9.53%. and IgG4 level: 1657mg/liter. CT abdomen with pancreatic protocol showed a cystic lesion in the body and tail of pancreas suggestive of infected pseudocyst or localized acute pancreatitis.
The patient was diagnosed as type 1 autoimmune pancreatitis and multidisciplinary team (MDT) was taken on board for further management. The patient was not deemed appropriate for percutaneous or endoscopic drainage of the pseudocyst. She therefore underwent distal pancreatectomy and splenectomy. The biopsy showed features favoring mucinous cystic neoplasm of pancreas with no evidence of malignancy. On immunohistochemical stains the reactivity pattern was positive for ER, inhibin and CD 10 which highlighted the ovarian stroma and cytokeratin.
The patient was discharged on supportive treatment.
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Copyright (c) 2025 Aliena Badshah, Hammad Naeem, Iqbal Haider, Sidra Bibi
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