title: An autopsy case of acute pancreatitis with a high serum IgG4 complicated by amyloidosis and rheumatoid arthritis.
abstract: We report an autopsy case of acute pancreatitis with a high serum IgG4 concentration complicated by systemic amyloid A amyloidosis and rheumatoid arthritis (RA). The patient was a 42-year-old Japanese female with a 22-year history of rheumatoid arthritis. She was diagnosed with myasthenia gravis when she was 31-year old. At the onset of pancreatitis, the patient was anti-nuclear antibody-positive, and had high serum gamma globulin and IgG4 levels. Dexamethasone and conventional therapy induced clinical remission and significantly decreased the serum IgG4 and gamma globulin. However, despite the decreased disease parameters, the patient developed a bleeding pseudocyst and died of cardiac failure. In the autopsy examination, it was determined that pancreatitis was probably caused by ischemia due to vascular obstruction caused by amyloid deposition in the pancreas. Even though acute pancreatitis is a rare complication in RA patients, we speculate that an autoimmune pancreatitis-related mechanism and ischemia due to vascular obstruction by amyloid deposition might be attributable to a single source that leads to acute pancreatitis in our particular case.
authors.affiliation: The First Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. ichikawa@net.nagasaki-u.ac.jp
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hamasaki
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Ohkubo
authors.forename: Kan
authors.initials: K
authors.lastname: Toriyama
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000686:Amyloidosis / Q000150:complications* / Q000276:immunology / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000276:immunology / Q000473:pathology; D001344:Autopsy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D010195:Pancreatitis / Q000150:complications* / Q000276:immunology / Q000473:pathology
chemical_list: D007074:Immunoglobulin G