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Non‐alcoholic sclerosing pancreatitis with Sjögren's syndrome and tubulointerstitial nephritis
Author(s) -
Yamada Masahiko,
Ichikawa Masafumi,
Tamai Hirofumi,
Fu Kyo,
Ishikawa Shigeto,
Ozeki Masayasu,
Suzuki Satoshi,
Ishiguro Yoshihiro,
Matsunaga Kazuya,
Yokoi Syunpei
Publication year - 2001
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1046/j.1443-1661.2001.00102.x
Subject(s) - medicine , autoimmune pancreatitis , pathology , pancreatitis , endoscopic retrograde cholangiopancreatography , renal biopsy , biopsy , nephritis , gastroenterology , anti nuclear antibody , pancreas , autoantibody , antibody , immunology
We recently encountered a 56‐year‐old Japanese man with pancreatitis who had hyperglobulinemia, was autoantibody‐positive and responded to steroid therapy. The patient had been found to have asymptomatic proteinuria at an annual medical check‐up and had experienced a dry mouth for several years. He was diagnosed as having Sjögren's syndrome indicated by the dry mouth and positive findings from a lip biopsy and a Schirmer's test. Tubulointerstitial nephritis, causing proteinuria, was verified by percutaneous renal biopsy. Antinuclear antibody was positive at the 1 : 160 titer. Serum γ‐globulin and IgG values were markedly increased, whereas complement components C3 and C4 were lowered. Abdominal computed tomography and ultrasonography demonstrated a diffusely enlarged pancreas without localized pancreatic mass or para‐aortic lymphadenopathy. Neither calcification nor cysts were detected in the pancreas. Endoscopic retrograde cholangiopancreatography revealed a diffuse narrowing of the main pancreatic duct with an irregular wall. Wedged biopsy specimens of the pancreas by an exploration of the abdomen showed prominent lymphocytic infiltrates including some plasmacytes, as well as decreased exocrine parenchyma and inter‐ and intralobular fibrosis. These findings suggested a diagnosis of autoimmune‐related pancreatitis. Steroid therapy was carried out with a marked improvement of his clinical symptoms and laboratory data.