A 33-year-old woman with no previous history of interest.
She presented with a 3-week history of severe pruritus, asthenia, anorexia and weight loss, associated with jaundice, choluria and acholia in the last days.
Physical examination revealed jaundice of the skin and mucous membranes, the rest of the physical examination being normal.
Laboratory tests showed Hb 11.2 mg/d, platelets 286.000 x 103/μl, leukocytes 9.460 x 103/μl (normal formula).
105% prothrombin.
Glucose 89 mg/dl; Urea 45 mg/dl; Creatinine 1.2 mg/dl; Total bilirubin 12.4 mg/dl; Direct bilirubin 53GT 60 mg/dl
Serology negative hepatotropic virus.
Tumor markers within the normal range (alphafetoprotein: 2 ng/ml, CEA: 4 ng/ml, Ca: 19.9 0.6 U/ml)
Abdominal ultrasound showed dilation of the intrahepatic and extrahepatic bile duct, so an abdominal CAT scan showed the presence of a mass in the head and uncinate pancreatic process and dilatation of the intrahepatic and extrahepatic bile duct.
Endoscopic retrograde cholangiopancreatography showed the following: pancreatic mass suspect as well as neoplasm, which produces proximal stenosis of the pancreatic duct of Wirsung of 23 mm in length distal cholangiopancreatography.
Sphincterotomy and placement of a 7F flexime prosthesis were performed.
A hard exploratory laparotomy was performed and a tumor of 3-4 cm consistency was reported in the head of the pancreas that was biopsied intraoperatively as lymphoplasmacytic pancreatitis.
Pancreatic lesion resection was not performed due to the absence of data compatible with pancreatic neoplasia, establishing the diagnostic suspicion of autoimmune pancreatitis.
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The definitive pathological study was reported as pancreatic tissue with chronic pancreatitis, fibrosis and predominantly ductal inflammatory infiltrate, compatible with lymphoplasmacytic pancreatitis.
These results, together with the above mentioned findings, confirmed the diagnosis of P.A.
Treatment was initiated with prednisone 40 mg daily, with complete resolution of clinical data and normalization of laboratory findings after two months of treatment.
