IgG4 negative sclerosing cholangitis associated with autoimmune pancreatitis.
BACKGROUND
Sclerosing pancreatitis is an autoimmune condition characterized by periductal lymphocytic infiltration on histology, and elevated serum auto-antibodies and IgG4. Bile duct involvement is often associated with sclerosing pancreatitis but it is rarely the dominant feature.


METHODS
We report a patient with dominant biliary stricture and obstructive jaundice associated with IgG4 negative autoimmune pancreatitis. Due to uncertainties regarding the preoperative diagnosis, the patient underwent bilio-enteric bypass with an intraoperative pancreatic and bile duct biopsy. Post operatively, due to disease recurrence, the patient was started on steroids with consequent remission of the disease.


CONCLUSIONS
Sclerosing pancreatitis may sometimes present with biliary stricture due to bile duct involvement due to the inflammatory process. The condition is often recognized after surgical exploration for a suspected malignancy. Preoperative diagnosis permits treatment with steroids and endoscopic biliary decompression, and avoids unnecessary surgery.
Sewkani
Ajit
A
Department of Surgical Gastroenterology, Bhopal Memorial Hospital and Research Center, Bhopal, MP, India.
Kapoor
Sorabh
S
Sharma
Sandesh
S
Naik
Saleem
S
Debbarma
Manash K
MK
Varshney
Subodh
S
D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications* / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D041781:Jaundice, Obstructive / Q000150:complications / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D007582:Jejunostomy; D008297:Male; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use
D007074:Immunoglobulin G; D013256:Steroids