Iida T, Adachi T, Tabeya T, Nakagaki S, Yabana T, Goto A, Kondo Y, Kasai K. Rare type of pancreatitis as the first presentation of anti-neutrophil cytoplasmic antibody-related vasculitis. World J Gastroenterol 2016; 22(7): 2383-2390 [PMID: 26900301 DOI: 10.3748/wjg.v22.i7.2383]
Corresponding Author of This Article
Tomoya Iida, MD, Department of Gastroenterology, Otaru City General Hospital, 1-1 1-chome, Wakamatu-cho, Otaru, Hokkaido 047-8550, Japan. tomoya.iida.0306@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Tomoya Iida, Takeya Adachi, Suguru Nakagaki, Takashi Yabana, Akira Goto, Yoshihiro Kondo, Department of Gastroenterology, Otaru City General Hospital, Otaru, Hokkaido 047-8550, Japan
Tetsuya Tabeya, Department of Internal Medicine of Connective Tissue Disease, Otaru City General Hospital, Otaru, Hokkaido 047-8550, Japan
Kiyoshi Kasai, Department of Diagnostic Pathology, Otaru City General Hospital, Otaru, Hokkaido 047-8550, Japan
Author contributions: All authors helped to perform the research; Iida T wrote the paper; all authors have approved the final draft of the manuscript.
Supported by Otaru City General Hospital, Otaru, Hokkaido, Japan
Institutional review board statement: Otaru City General Hospital Institutional Review Board for Conduction and Submission of the study.
Informed consent statement: The patient provided informed consent prior to study enrollment.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest, financial or other, exists for any authors listed in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tomoya Iida, MD, Department of Gastroenterology, Otaru City General Hospital, 1-1 1-chome, Wakamatu-cho, Otaru, Hokkaido 047-8550, Japan. tomoya.iida.0306@gmail.com
Telephone: +81-134-251211 Fax: +81-134-326424
Received: July 22, 2015 Peer-review started: July 30, 2015 First decision: August 28, 2015 Revised: September 11, 2015 Accepted: December 12, 2015 Article in press: December 12, 2015 Published online: February 21, 2016 Processing time: 192 Days and 19.7 Hours
Abstract
A pancreatic tumor was suspected on the abdominal ultrasound of a 72-year-old man. Abdominal computed tomography showed pancreatic enlargement as well as a diffuse, poorly enhanced area in the pancreas; endoscopic ultrasound-guided fine needle aspiration biopsy and endoscopic retrograde cholangiopancreatography failed to provide a definitive diagnosis. Based on the trend of improvement of the pancreatic enlargement, the treatment plan involved follow-up examinations. Later, he was hospitalized with an alveolar hemorrhage and rapidly progressive glomerulonephritis; he tested positive for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA) and was diagnosed with ANCA-related vasculitis, specifically microscopic polyangiitis. It appears that factors such as thrombus formation caused by the vasculitis in the early stages of ANCA-related vasculitis cause abnormal distribution of the pancreatic blood flow, resulting in non-uniform pancreatitis. Pancreatic lesions in ANCA-related vasculitis are very rare. Only a few cases have been reported previously. Therefore, we report our case and a review of the literature.
Core tip: Pancreatic lesions in anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis are very rare. Only few cases of pancreatic lesions in ANCA-related vasculitis have been reported previously. We encountered a case presenting with pancreatic enlargement and a diffuse, poorly enhanced area in the pancreas during the early stages of ANCA-related vasculitis. In light of the clinical course, it appears that factors such as thrombus formation caused by the vasculitis during the early stages of ANCA-related vasculitis cause abnormal distribution of pancreatic blood flow, resulting in non-uniform pancreatitis manifested in the imaging findings.
