title: A case of autoimmune pancreatitis effectively treated with an immunosuppressant (azathioprine).
abstract: The patient was a 42-year-old man who presented at our hospital with obstructive jaundice. Although antinuclear antibody test results were negative, and immunoglobulin G4 (IgG4) was not elevated, endoscopic ultrasound revealed a mixed internal hyperechoic and diffuse hypoechoic pattern, a finding consistent with autoimmune pancreatitis. Endoscopic retrograde cholangiopancreatography further revealed irregular narrowing of the main pancreatic duct and sclerosing cholangitis with distal biliary stricture. In addition, endoscopic ultrasound with fine needle aspiration cytology resulted in a diagnosis of type 1 autoimmune pancreatitis. Oral prednisolone treatment was initiated at 30 mg/day, and the dosage was gradually decreased. However, in accordance with the patient's wishes, maintenance treatment was discontinued once dosage reached 5 mg/day. Despite this, relapse of obstructive jaundice occurred 1 month post discontinuation, and was treated with methyl-prednisolone pulse therapy (500 mg/day) followed by oral prednisolone. However, computed tomography, magnetic resonance imaging, and endoscopic ultrasound did not reveal sufficient improvement after 6 months of treatment. Therefore, an immunosuppressant (azathioprine) was introduced. Subsequent imaging analyses and endoscopic ultrasound fine needle aspiration revealed clear improvements in pathology.
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan. yamaaka0110@yahoo.co.jp.
authors.forename: Akane
authors.identifier: http://orcid.org/0000-0002-5413-9636
authors.initials: A
authors.lastname: Yamabe
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
authors.affiliation: Department of Pathology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Notohara
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Shibukawa
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Fujisawa
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Arakawa
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Igarashi
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Maki
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001379:Azathioprine / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine
keywords: Autoimmune pancreatitis; Azathioprine; Immunosuppressant