case_images: PMC10315465_01
case_images: Single-shot fast spin-echo MRI sequence showing diffuse inflammatory infiltration of the pancreas (A). Endosonographic image showing massive hypoechoic swelling, multiple interlobular septa, and diameter changes (B).
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case_images: PMC10315465_01_fimmu-14-1201363-g001.jpg
case_images: f1
case_images: An abdominal MRI ordered by the patient's general practitioner was performed two weeks before presentation and revealed diffuse inflammatory infiltration of the pancreas, without exudates, necrosis, or focal lesions ( Figure 1 ). Figure 1 ). Fine-needle biopsy revealed unspecific chronic inflammatory infiltrates without signs of fibrosis or malignancy.
case_images: PMC10315465_02
case_images: Timeline of immunosuppressive treatment regimen and associated glutamate pyruvate transaminase (GPT) and lipase levels. Dashed lines indicate respective upper limits.
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case_images: PMC10315465_02_fimmu-14-1201363-g002.jpg
case_images: f2
case_images: We responded by adding supportive immunosuppression through azathioprine, which eventually had to be discontinued due to a rise in liver enzymes ( Figure 2 ) as well as abdominal pain and nausea. Unfortunately, the patient then had another flare of steatorrhea associated with a dramatic increase in lipase ( Figure 2 ).
case_images: PMC10315465_03
case_images: PMC10315465_04
case_images: Sonographic images of the pancreatic body showing diffuse hypoechoic swelling upon admission (A), which decreased under steroid treatment (B) and 11 months after the first dose of vedolizumab (C).
case_images: fimmu-14-1201363-g003.jpg
case_images: PMC10315465_04_fimmu-14-1201363-g003.jpg
case_images: f3
case_images: Follow-up sonography was unremarkable for signs of inflammation as seen upon initial presentation ( Figure 3 ).