title: Autoimmune pancreatitis complicated by spontaneous subcapsular splenic haemorrhage.
abstract: BACKGROUND
  Autoimmune pancreatitis is a rare but increasingly recognised condition with unique clinical, immunological and histological features. We report the first case of autoimmune pancreatitis associated with spontaneous splenic haemorrhage.
  
  
  METHODS
  A 75-year-old man presented with severe epigastric pain radiating to the back associated with nausea and vomiting. A CT-scan of his abdomen showed a large pseudocyst within the pancreatic tail as well as a subcapsular splenic haemorrhage. His IgG4 levels were elevated and clinical history and investigations were consistent with severe acute pancreatitis, but were negative for other known causes of pancreatic disease. The patient was started on steroid therapy and improved dramatically clinically, immunologically and radiologically thus confirming the diagnosis of autoimmune pancreatitis. His splenic haemorrhage was managed conservatively in view of his haemodynamic stablity and eventually self-resolved.
  
  
  CONCLUSIONS
  Autoimmune pancreatitis should not be overlooked in cases of acute pancreatitis without other obvious etiology. Furthermore, superimposed splenic haemorrhage is a rare but important complication of autoimmune pancreatitis.
authors.affiliation: Department of Gastroenterology, Frenchay Hospital, North Bristol NHS Trust. Bristol, United Kingdom. mina.hanna@nhs.net.
authors.forename: Mina S
authors.initials: MS
authors.lastname: Hanna
authors.forename: Ana
authors.initials: A
authors.lastname: Terlevich
authors.forename: Robert
authors.initials: R
authors.lastname: Przemioslo
authors.forename: Peter
authors.initials: P
authors.lastname: Marden
mesh_terms: D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D010192:Pancreatic Pseudocyst / Q000150:complications; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D013158:Splenic Diseases / Q000150:complications*; D014057:Tomography, X-Ray Computed
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G; D011239:Prednisolone