Autoimmune pancreatitis: a report from India.
BACKGROUND
Autoimmune pancreatitis is characterized by immune-mediated inflammation, prominent lymphocytic infiltration and fibrosis of pancreas. It accounts for 4.6-6% of chronic pancreatitis but only a few cases from India have been reported.


OBJECTIVE
Evaluation of cases of autoimmune pancreatitis diagnosed between July 2006 and June 2009.


METHODS
Retrospective analysis of the clinical records of all patients diagnosed as autoimmune pancreatitis between July 2006 and June 2009.


METHODS
Tertiary care centre, northern India.


METHODS
Clinical records of all patients with autoimmune pancreatitis were analyzed with respect to their initial diagnosis and treatment, imaging, cytology, serology, presence of other organ involvement and response to treatment.


RESULTS
The 5 cases of autoimmune pancreatitis included 4 men and one woman ranging in age from 48 to 60 years. The interval between initial consultation and diagnosis ranged from 3 months to 7 years. Symptoms included obstructive jaundice (5/5), abdominal pain (3/5) and weight loss (3/5). In 3 cases a presumptive diagnosis of a pancreatic mass with a biliary stricture was made and, in one patient, the diagnosis of primary sclerosing cholangitis was considered. These four patients had received a biliary stent and it was only on follow-up and review of the repeat CT scan that a diagnosis of autoimmune pancreatitis was suggested. In one patient, a diagnosis of autoimmune pancreatitis was considered in the first instance. Radiologically, all 5 patients showed a bulky pancreas with loss of lobulations.


CONCLUSIONS
In this report from India, we highlight the need for a high index of suspicion in diagnosing autoimmune pancreatitis because it responds dramatically to steroids.
Noor
Mohd T
MT
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Lal
Anupam
A
Kochhar
Rakesh
R
Singhal
Manphool
M
Sidhu
Gurbakshish S
GS
Srinivasan
Radhika
R
Rawat
Amit
A
Dutta
Usha
U
Dhiman
Radha K
RK
Chawla
Yogesh K
YK
Singh
Kartar
K
D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D044963:Biopsy, Fine-Needle; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007194:India; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005938:Glucocorticoids; D007074:Immunoglobulin G; D011239:Prednisolone