Anonymous User
Login / Registration

Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2022; 76(5): 392–398. doi: 10.48095/ccgh2022392.

A rare cause of painless obstructive jaundice in the elderly – a case series

Tomáš Koller Orcid.org  1, Petra Vrbová1, Viliam Gál2, Iveta Mečiarová2

+ Affiliation

Summary

A series of two case reports discusses the differential diagnosis of painless jaundice in the elderly and points to autoimmune pancreatitis as one of its rarer causes. In search for the cause, the first step is to rule out the malignant origin of the obstruction using the clinical picture, imaging examinations, and EUS-guided biopsy. An imaging examination can initially point to the possibility of autoimmune pancreatitis, but in the case of focal pancreatic involvement the distinction from cancer is unreliable. Elevated concentration of IgG4 antibodies can further increase the probability of IgG4-associated pancreatitis. Histological examination of the pancreas will help reveal typical features of autoimmune pancreatitis such as lymphoplasmacytic infiltrate, storiform fibrosis, obliterating phlebitis and increased number of IgG4 positive plasma cells. Once the diagnosis is probable, it is advisable to start a treatment with steroids. A quick decrease in cholestatic markers and bilirubin is typical. Patients with autoimmune pancreatitis require long-term follow-up, to adjust the treatment in case of relapses, the risk of developing exocrine or endocrine insufficiency, and in case of IgG4 associated disease due to the risk of other organ systems involvement. The risk of pancreatic cancer is still a matter of discussion.

Keywords

autoimmune pancreatitis, IgG4, obstructive jaundice, case report

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users

Literature

1. Zhang L, Sanagapalli S, Stoita A. Challenges in diagnosis of pancreatic cancer. World J Gastroenterol 2018; 24(19): 2047–2060. doi: 10.3748/wjg.v24.i19.2047.
2. Blaho M, Dítě P, Kunovský L et al. Autoimmune pancreatitis – An ongoing challenge. Adv Med Sci 2020; 65(2): 403–408. doi: 10.1016/j.advms.2020.07.002.
3. Schneider A, Michaely H, Weiss C et al. Prevalence and Incidence of Autoimmune Pancreatitis in the Population Living in the Southwest of Germany. Digestion 2017; 96(4): 187–198. doi: 10.1159/000479316.
4. Maruyama M, Watanabe T, Kanai K et al. International Consensus Diagnostic Criteria for Autoimmune Pancreatitis and Its Japanese Amendment Have Improved Diagnostic Ability over Existing Criteria. Gastroenterol Res Pract 2013; 2013: 456965. doi: 10.1155/2013/456965.
5. Schneider A, Michaely H, Rückert F et al. Diagnosing autoimmune pancreatitis with the Unifying-Autoimmune-Pancreatitis-Criteria. Pancreatology 2017; 17(3): 381–394. doi: 10.1016/j.pan.2017.03.005.
6. Löhr JM, Beuers U, Vujasinovic M et al. European guideline on IgG4-related digestive disease – UEG and SGF evidence-based recommendations. United European Gastroenterol J 2020; 8(6): 637–666. doi: 10.1177/2050640620934911.
7. Backhus J, Neumann C, Perkhofer L et al. A Follow-Up Study of a European IgG4-Related Disease Cohort Treated with Rituximab. J Clin Med 2021; 10(6): 1329. doi: 10.3390/jcm10061329.
8. Kunovský L, Dítě P, Blaho M et al. Is autoimmune pancreatitis a risk factor for pancreatic adenocarcinoma? Vnitr Lek 2021; 67(1): 9–13. doi: 10.36290/vnl.2021.011.
9. Macinga P, Bajer L, del Chiaro M et al. Pancreatic cancer in patients with autoimmune pancreatitis: A scoping review. Pancreatology 2021; 21(5): 928–937. doi: 10.1016/j.pan.2021.03.007.
10. Löhr JM, Vujasinovic M, Rosendahl J et al. IgG4-related diseases of the digestive tract. Nat Rev Gastroenterol Hepatol 2022; 19(3): 185–197. doi: 10.1038/s41575-021-00529-y.

Credited self-teaching test