Newly developed autoimmune cholangitis without relapse of autoimmune pancreatitis after discontinuing prednisolone

Figure 1 Initial abdominal computed tomography scan revealed an ill-defined enhancing mass-like lesion in the uncinate process of the pancreas with a dilatation of common bile duct. A: The uncinate process of the pancreas (white arrow) measuring 5.7 cm × 3.2 cm with regional infiltrations; B: In addition to this, there is small amounts of fluid collections around the pancreas head (white arrows).

Figure 2 Magentic resonance cholangiopancreatography and endoscopic retrograde cholangiography. A: Magentic resonance cholangiopancreatography showed moderate dilatation of the intrahepatic and common bile duct. The distal common bile duct had an abrupt narrowing. The pancreatic duct was unremarkable; B: Endoscopic retrograde cholangiography revealed a beak shaped stricture of the distal common bile duct with biliary dilatation above it.

Figure 3 Photomicrograph of cytologic specimen obtained by endoscopic ultrasound-fine needle aspiration, showing lymphocytes (arrows) and irregular sheets of bland ductal epithelial cells on the bloody background (hematoxylin and eosin, × 400).

Figure 4 Follow up abdominal computed tomography scan. A: Coronal image revealed a stenosis of the common hepatic and the proximal common bile duct (white arrow) with significant thickening and inner wall enhancement of the bile duct; B: There was no pancreatic relapse (white arrow).

Figure 5 Abdominal computed tomography scan after retreatment with prednisolone showed resolution of the thickening of the bile duct (white arrow).