Zhang BB, Huo JW, Yang ZH, Wang ZC, Jin EH. Spontaneous remission of autoimmune pancreatitis: Four case reports . World J Clin Cases 2022; 10(23): 8232-8241 [PMID: 36159515 DOI: 10.12998/wjcc.v10.i23.8232]
Corresponding Author of This Article
Er-Hu Jin, Doctor, Chief Doctor, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing 100050, China. drerhujin@163.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/
World J Clin Cases. Aug 16, 2022; 10(23): 8232-8241 Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8232
Spontaneous remission of autoimmune pancreatitis: Four case reports
Bin-Bin Zhang, Jian-Wei Huo, Zheng-Han Yang, Zhen-Chang Wang, Er-Hu Jin
Bin-Bin Zhang, Zheng-Han Yang, Zhen-Chang Wang, Er-Hu Jin, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Bin-Bin Zhang, Jian-Wei Huo, Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
Author contributions: Zhang BB and Jin EH conceived the idea of the study; Zhang BB and Huo JW collected and analysed the data; Yang ZH and Wang ZC interpreted the results; Zhang BB wrote the paper; all authors discussed the results and revised the manuscript.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Er-Hu Jin, Doctor, Chief Doctor, Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xicheng District, Beijing 100050, China. drerhujin@163.com
Received: November 10, 2021 Peer-review started: November 10, 2021 First decision: December 2, 2021 Revised: December 13, 2021 Accepted: July 11, 2022 Article in press: July 11, 2022 Published online: August 16, 2022
Abstract
BACKGROUND
Autoimmune pancreatitis (AIP) is a particular type of chronic pancreatitis, and steroid treatment of AIP is effective. Spontaneous remission (SR) of AIP without steroids is relatively rare. The international consensus for the treatment of autoimmune pancreatitis suggests that patients with AIP with obstructive jaundice, abdominal pain, and back pain related to the pancreas or the bile duct should be treated with steroids; most asymptomatic patients with AIP may improve without steroids. However, in our clinical work, we found that the clinical characteristics of AIP patients with SR vary. Four of these cases are described here. In addition, to our knowledge, there is no previously published report of dynamic imaging before and after SR of AIP at present.
CASE SUMMARY
We present the cases of four patients with AIP (two females and two males) in which the AIP improved spontaneously without steroid treatment. Two patients were asymptomatic, one patient had abdominal pain with obstructive jaundice, and one patient had intermittent right upper abdominal pain. Three patients presented with localized pancreatic enlargement and one with diffuse pancreatic enlargement. In addition to the pancreatic lesions, bile duct involvement was seen in two patients, and no extra-pancreatic organ involvement was found in the other two patients. The serum IgG4 level of all patients was more than twice the normal level. After SR in the four patients, the affected pancreases exhibited three types of image features: Return to normal, progressive fibrosis, and atrophy and calcification.
CONCLUSION
The clinical features of SR in our four patients with AIP differ, but the imaging findings share some characteristics. After SR, in some cases the affected pancreas could return to normal, although some patients suffer from progressive fibrosis and atrophy as well as calcification.
Core Tip: We focus on spontaneous remission (SR) in patients with autoimmune pancreatitis due to the high risks and contraindications of steroid treatment. As with asymptomatic patients, some symptomatic patients may also have SR. Patients with localized or diffuse enlargement of the pancreas (the former may be more prone to SR), with or without involvement of the bile ducts, may have SR. After SR, the affected pancreases may return to normal, or exhibit progressive fibrosis and atrophy as well as calcification.
