A case of advanced-stage sclerosing cholangitis with autoimmune pancreatitis not responsive to steroid therapy.
BACKGROUND
Autoimmune pancreatitis and sclerosing cholangitis associated with autoimmune pancreatitis respond well to steroid therapy. Some criteria used for the differential diagnosis of autoimmune pancreatitis and sclerosing cholangitis with autoimmune pancreatitis include the response to a steroid trial.


METHODS
A 68-year-old woman was diagnosed as having type 3 sclerosing cholangitis with autoimmune pancreatitis four years after clinical onset. Seven years after clinical onset, imaging findings revealed multiple pancreatic stones in an atrophic pancreas, stenosis of the main pancreatic duct in the head of the pancreas and upstream dilatation and a longer stretch of stenosis in the hilar hepatic region. We tried steroid therapy in an attempt to ameliorate stenosis of both the bile duct and the pancreatic duct and prevent further progression. Neither lesion responded to steroid therapy.


CONCLUSIONS
Advanced-stage sclerosing cholangitis with autoimmune pancreatitis may sometimes be unresponsive to steroid therapy, and this should be borne in mind when attempting a steroid trial for the diagnosis of sclerosing cholangitis with autoimmune pancreatitis. Early administration of steroid is important for the prevention of disease progression.
Nakazawa
Takahiro
T
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. tnakazaw@med.nagoya-cu.ac.jp
Naitoh
Itaru
I
Ando
Tomoaki
T
Hayashi
Kazuki
K
Okumura
Fumihiro
F
Miyabe
Katsuyuki
K
Yoshida
Michihiro
M
Ohara
Hirotaka
H
Joh
Takashi
T
D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D010195:Pancreatitis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013256:Steroids / Q000627:therapeutic use*; D017211:Treatment Failure
D013256:Steroids