Autoimmune pancreatitis with different clinical manifestations and imaging findings: a series of three cases

Abstract

Autoimmune pancreatitis (AIP) is a rare and emerging immune-mediated pancreatitis. The involvement of the pancreas with lymphoplasmacytic infiltration and fibrosis on histology is the most common features and has been well studied in the literature. It is characterized by a nonspecific presentation that mimics a malignant process. The purpose of this report is to explore the different clinical and paraclinical aspects of this disease, as well as the challenges posed by its management. The series are made up of three different cases of patients with elevated serum IgG4 levels and pancreatic changes. The first case initially revealed cholestatic jaundice with extrahepatic and intrahepatic cholangitis, and ultrasound reflected multiple occupying changes in the pancreas. The elevated serum IgG4 level was brilliant. Patient improved under the influence of corticosteroids. The second case was clinically asymptomatic, just found weight loss. Magnetic resonance revealed a round mass in the head of the pancreas and was considered as a neuroendocrine tumor. The patient showed slightly elevated serum IgG4 level, but was sensitive to hormone therapy. The third case concerned epigastric pain and enlarged lymph nodes. It was initially diagnosed as pancreatic cancer with distant metastasis, but also finally resolved by corticosteroid treatment. The clinical presentation of AIP is heterogeneous, as evidenced by our three clinical cases. Further observational and interventional studies are needed to better identify and manage this disease.