Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer

Introduction: Autoimmune pancreatitis (AIP) is a rare extraintestinal manifestation of inflammatory bowel disease (IBD) which is typically responsive to corticosteroid treatment.Case Presentation: We report a case of a 17-year-old male diagnosed with ulcerative colitis who subsequently developed acu...

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Autores principales:	Sujin Choi, Hae Jeong Lee, An Na Seo, Han Ik Bae, Hyung Jun Kwon, Chang Min Cho, So Mi Lee, Byung-Ho Choe, Ben Kang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	autoimmune pancreatitis ulcerative colitis inflammatory bowel disease pancreatic cancer IgG4 Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/52d90b34e6ab4ff2ad5d07afdaebf661
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spelling	oai:doaj.org-article:52d90b34e6ab4ff2ad5d07afdaebf6612021-12-01T08:04:10ZCase Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer2296-236010.3389/fped.2021.791840https://doaj.org/article/52d90b34e6ab4ff2ad5d07afdaebf6612021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.791840/fullhttps://doaj.org/toc/2296-2360Introduction: Autoimmune pancreatitis (AIP) is a rare extraintestinal manifestation of inflammatory bowel disease (IBD) which is typically responsive to corticosteroid treatment.Case Presentation: We report a case of a 17-year-old male diagnosed with ulcerative colitis who subsequently developed acute pancreatitis. Blood tests demonstrated elevated pancreatic enzyme levels of amylase (1319 U/L) and lipase (809 U/L). Abdominal computed tomography revealed peripancreatic fat stranding and the presence of a perisplenic pseudocyst. Azathioprine and mesalazine were stopped as possible causes of drug-induced pancreatitis. However, pancreatic enzymes remained elevated and corticosteroid treatment was started. Despite corticosteroid therapy, amylase and lipase levels continued to increase. Infliximab was started due to a flare in gastrointestinal symptoms of ulcerative colitis. Follow-up abdominal ultrasonography revealed a pancreatic tail mass. Tumor markers, including CA 19-9, were elevated and atypical cells were seen on histological examination of an endoscopic ultrasonography-guided fine needle aspiration biopsy. Surgical pancreaticosplenectomy was performed for suspected pancreatic neoplasm. Surprisingly, histology revealed chronic pancreatitis with storiform fibrosis and infiltration of IgG4-positive cells, compatible with AIP type 1. Thereafter, pancreatic enzymes gradually decreased to normal levels and the patient has been in remission for 9 months on infliximab monotherapy.Conclusion: Pediatric gastroenterologists should keep in mind that AIP may develop during the natural course of pediatric IBD. Moreover, the development of pancreatic fibrosis may be non-responsive to corticosteroid treatment and mimic pancreatic neoplasia.Sujin ChoiHae Jeong LeeAn Na SeoHan Ik BaeHyung Jun KwonChang Min ChoSo Mi LeeByung-Ho ChoeBen KangFrontiers Media S.A.articleautoimmune pancreatitisulcerative colitisinflammatory bowel diseasepancreatic cancerIgG4PediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	autoimmune pancreatitis ulcerative colitis inflammatory bowel disease pancreatic cancer IgG4 Pediatrics RJ1-570
spellingShingle	autoimmune pancreatitis ulcerative colitis inflammatory bowel disease pancreatic cancer IgG4 Pediatrics RJ1-570 Sujin Choi Hae Jeong Lee An Na Seo Han Ik Bae Hyung Jun Kwon Chang Min Cho So Mi Lee Byung-Ho Choe Ben Kang Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer
description	Introduction: Autoimmune pancreatitis (AIP) is a rare extraintestinal manifestation of inflammatory bowel disease (IBD) which is typically responsive to corticosteroid treatment.Case Presentation: We report a case of a 17-year-old male diagnosed with ulcerative colitis who subsequently developed acute pancreatitis. Blood tests demonstrated elevated pancreatic enzyme levels of amylase (1319 U/L) and lipase (809 U/L). Abdominal computed tomography revealed peripancreatic fat stranding and the presence of a perisplenic pseudocyst. Azathioprine and mesalazine were stopped as possible causes of drug-induced pancreatitis. However, pancreatic enzymes remained elevated and corticosteroid treatment was started. Despite corticosteroid therapy, amylase and lipase levels continued to increase. Infliximab was started due to a flare in gastrointestinal symptoms of ulcerative colitis. Follow-up abdominal ultrasonography revealed a pancreatic tail mass. Tumor markers, including CA 19-9, were elevated and atypical cells were seen on histological examination of an endoscopic ultrasonography-guided fine needle aspiration biopsy. Surgical pancreaticosplenectomy was performed for suspected pancreatic neoplasm. Surprisingly, histology revealed chronic pancreatitis with storiform fibrosis and infiltration of IgG4-positive cells, compatible with AIP type 1. Thereafter, pancreatic enzymes gradually decreased to normal levels and the patient has been in remission for 9 months on infliximab monotherapy.Conclusion: Pediatric gastroenterologists should keep in mind that AIP may develop during the natural course of pediatric IBD. Moreover, the development of pancreatic fibrosis may be non-responsive to corticosteroid treatment and mimic pancreatic neoplasia.
format	article
author	Sujin Choi Hae Jeong Lee An Na Seo Han Ik Bae Hyung Jun Kwon Chang Min Cho So Mi Lee Byung-Ho Choe Ben Kang
author_facet	Sujin Choi Hae Jeong Lee An Na Seo Han Ik Bae Hyung Jun Kwon Chang Min Cho So Mi Lee Byung-Ho Choe Ben Kang
author_sort	Sujin Choi
title	Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer
title_short	Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer
title_full	Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer
title_fullStr	Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer
title_full_unstemmed	Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer
title_sort	case report: development of type 1 autoimmune pancreatitis in an adolescent with ulcerative colitis mimicking pancreatic cancer
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/52d90b34e6ab4ff2ad5d07afdaebf661
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Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer

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