Rare type of pancreatitis as the first presentation of anti-neutrophil cytoplasmic antibody-related vasculitis - PubMed (original) (raw)

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Tomoya Iida et al. World J Gastroenterol. 2016.

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.

Keywords: Anti-neutrophil cytoplasmic; Antibodies; Microscopic polyangiitis; Pancreas; Pancreatitis; Vasculitis.

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Figures

Figure 1

Figure 1

Contrast-enhanced abdominal/pelvic computed tomography showing pancreatic enlargement with a diffuse, poorly enhanced area in the uncinate process (arrow) and pancreatic body tail (A-C).

Figure 2

Figure 2

On endoscopic ultrasound, a hypoechoic mass in a form in which the pancreatic lobe structure was maintained in the uncinate process and from the pancreatic body to the tail.

Figure 3

Figure 3

Endoscopic retrograde pancreatography. A: A slight disparity of the opening diameter in the main pancreatic duct, but no localized stenosis or diffuse narrowing observed; B: No abnormality in the papilla of Vater (arrow); C: The biopsy reveals thrombus formation (arrow).

Figure 4

Figure 4

Contrast-enhanced abdominal/pelvic computed tomography performed in May 2014 showing a trend of improvement in the pancreatic enlargement.

Figure 5

Figure 5

Chest computed tomography demonstrating an alveolar hemorrhage and pneumonia.

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References

    1. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, Hagen EC, Hoffman GS, Hunder GG, Kallenberg CG. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. 1994;37:187–192. - PubMed
    1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, Flores-Suarez LF, Gross WL, Guillevin L, Hagen EC, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65:1–11. - PubMed
    1. Villiger PM, Guillevin L. Microscopic polyangiitis: Clinical presentation. Autoimmun Rev. 2010;9:812–819. - PubMed
    1. Kallenberg CG, Heeringa P, Stegeman CA. Mechanisms of Disease: pathogenesis and treatment of ANCA-associated vasculitides. Nat Clin Pract Rheumatol. 2006;2:661–670. - PubMed
    1. Vamvakopoulos J, Savage CO, Harper L. ANCA-associated vasculitides-lessons from the adult literature. Pediatr Nephrol. 2010;25:1397–1407. - PubMed

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