A 43-year-old man, born in Morocco, was admitted to our service due to a 4-day history of painless mucocutaneous jaundice, choluria and generalized pruritus.
The only antecedents of interest were treated tuberculosis, hypercholesterolemia in dietary treatment and mild smoking.
Analytical analysis showed the following data: bilirubin 19.44 mg/dl, AST 110 IU/ml, ALT 371 IU/ml, GGT 632 IU/ml, AP 787 IU/ml, LDH 394
Amylase and lipase were normal at all times.
He also had hypergammaglobulinemia (1.56% gammaglobulin), with IgG 1840 IU/ml (751-1.560 IU/ml).
CA 19-9 marker was 82 IU/ml.
Autoantibodies (ANA, AMA, AMA-2, ANCA, LKM1, SMA, SLA and F-actina) and serology for viruses and bacteria (VHA, EBV19, virus
Abdominal ultrasound showed dilation of the intrahepatic and extrahepatic bile ducts and endoscopic ultrasound (EUS) showed an enlarged pancreas with a focal lesion of 3 cm in the head and mild posterior dilation of the pancreatic duct.
retroperitoneal adipose tissue showed extension with an enlarged pancreas, hypodense, with a hypodense peripancreatic halo, with smooth edge, without involvement of peripancreatic fat, and a bilateral peripancreatic
Persistence of pruritus and manifest biliary stasis was performed percutaneous drainage showing cholangiography a stenosing lesion in distal bile duct suggestive of pancreatic neoplasia.
This possibility as the first differential diagnosis was made by EUS guided needle aspiration with negative cytology for malignant cells and negative Zielh staining.
Given the absence of confirmation of neoplasia and suspected autoimmune pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP) was performed, revealing dilation of the main bile duct with a regular stenoses in the authenticated aspect of 3 cm.
Corticosteroid treatment was initiated (methylprednisolone at a dose of 32 mg/day) and percutaneous drainage was removed.
With the diagnosis of probable IAP, the patient was discharged and followed up on an outpatient basis with evidence of normalization of all analytical parameters and resolution in the control abdominal CT scan, one month later and four months later the pancreatic fibrosis disappeared.
The corticosteroid dose was progressively decreased until complete withdrawal at 4 months, with biliary stent removal.
To date, after 24 months of follow-up, the asymptomatic patient had asymptomatic pancreatitis without recurrence of autoimmune pancreatitis or retroperitoneal fibrosis.
