scholarly journals Focal Autoimmune Pancreatitis: A Simple Flow Chart for a Challenging Diagnosis

2020 ◽  
Vol 06 (03) ◽  
pp. E67-E75
Author(s):  
Clara Benedetta Conti ◽  
Fabrizio Cereatti ◽  
Andrea Drago ◽  
Roberto Grassia
Keyword(s):  
Autoimmune Pancreatitis ◽  
Diagnostic Workup ◽  
Laboratory Findings ◽  
Clinical Criteria ◽  
Ca 19.9 ◽  
Painless Jaundice ◽  
Upper Abdominal ◽  
Segmental Involvement ◽  
Simple Flow ◽  
Rule Out

AbstractAutoimmune pancreatitis is a chronic fibroinflammatory autoimmune mediated disease of the pancreas. Clinically, obstructive painless jaundice and upper abdominal pain are the main symptoms. Focal AIP is characterized by segmental involvement of pancreatic parenchyma and it is often radiologically represented by a pancreatic mass. In these cases, the diagnosis can be very challenging, since it may be easily confused with pancreatic cancer. Therefore, we suggest a combined approach of imaging tests as the diagnostic workup. EUS study combined with CEUS and elastography, if available, increases the accuracy of the method to rule out cancer. Moreover, the lesion should always be sampled under EUS guidance to obtain a cyto/histological diagnosis. The diagnostic workup should also include the use of diagnostic clinical criteria (extrapancreatic lesions, steroid response) and laboratory findings (CA 19.9 and IgG4 evaluations).

scholarly journals Guillain –Barrè Syndrome following Hepatitis E

2014 ◽  
Vol 2 (1) ◽  
pp. 48-49
Author(s):  
Poly Sengupta ◽  
Rama Biswas ◽  
Hasan Shahrear Ahmed ◽  
Kaniz Fatema
Keyword(s):  
Motor Nerve ◽  
Electrophysiological Study ◽  
Hepatitis E ◽  
Immunoglobulin M ◽  
Guillain Barre Syndrome ◽  
Limb Weakness ◽  
Laboratory Findings ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Upper Abdominal

Guillain- Barrè Syndrome is characterized by acute progressive symmetric limb weakness and areflexia. A 32 year old female presented with progressive ascending areflexic muscular weakness and bilateral lower motor neuron type of facial palsy. She had anorexia, nausea and upper abdominal pain for 2 weeks. The findings of motor nerve conduction study are consistent with acute inflammatory demyelinating polyradiculoneuropathy. She had elevated liver enzyme and positive immunoglobulin M antibody against hepatitis E in blood. Based on clinical features, laboratory findings and electrophysiological study, she was diagnosed as Guillain- Barrè Syndrome following hepatitis E. She was treated with intravenous immunoglobulin and recovered fully. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19973 Bangladesh Crit Care J March 2014; 2 (1): 48-49

scholarly journals Lupus-like nephritis with positive anti-neutrophil cytoplasmic antibodies and negative antinuclear antibodies

2020 ◽  
Author(s):  
Joana Eugénio Santos ◽  
Rita Vicente ◽  
Beatriz Malvar ◽  
Iolanda Santos ◽  
Miguel Coimbra ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Steroid Treatment ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Small Vessel Vasculitis ◽  
Laboratory Findings ◽  
Clinical Criteria ◽  
Immunological Markers

Abstract Antineutrophil cytoplasmic antibodies (ANCAs) are associated with small vessel vasculitis but their prevalence is not rare in other immune diseases. In lupus nephritis (LN), their pathological role and clinical relevance have been the target of controversial views. We present a case of acute kidney injury and nephrotic syndrome in a young woman with diffuse global proliferative and membranous nephritis on her kidney biopsy, showing a full-house immunofluorescence pattern, very allusive of class IV + V LN, but lacking associated clinical criteria and laboratory findings to support the diagnosis of systemic lupus erythematosus (SLE). Furthermore, the patient presented with high titers of ANCA, steadily decreasing alongside the renal function and proteinuria improvements, with mycophenolate mofetil (MMF) and steroid treatment. The authors believe this is a case of lupus-like nephritis, in which ANCAs are immunological markers, although they are not directly involved in the pathogenesis.

Autoimmune Pancreatitis

2018 ◽  
Author(s):  
Allison L Yang ◽  
Julia McNabb-Baltar
Keyword(s):  
Chronic Pancreatitis ◽  
Obstructive Jaundice ◽  
Autoimmune Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Imaging Findings ◽  
Laboratory Findings ◽  
Related Disease

Autoimmune pancreatitis (AIP) is a subcategory of chronic pancreatitis that is highly responsive to steroids. The term was first proposed in 1995 by Yoshida and colleagues, and since its discovery, the diagnosis of AIP has dramatically increased. AIP is a chronic fibroinflammatory disease characterized by lymphoplasmacytic infiltrates and fibrosis on histology. There are two distinct subtypes: type 1 AIP is the pancreatic manifestation of a systemic serum immunoglobulin G subtype 4–related disease (IgG4-RD) and type 2 AIP is described clinically as idiopathic duct-centric pancreatitis and has no association with IgG4. Clinically, AIP presents most commonly as obstructive jaundice in type 1 AIP and can present as acute pancreatitis in type 2 AIP. The diagnostic criteria include histology, imaging findings, and responsiveness to steroids as well as laboratory findings and other organ involvement. The mainstay of treatment is steroid therapy, with immunomodulators such as rituximab used for maintenance or relapsing disease. Long-term complications of AIP include pancreatic insufficiency and are often associated with relapsing disease. This review contains 45 references, 1 figure, and 2 tables. Key Words: autoimmune pancreatitis, chronic pancreatitis, EUS-guided biopsy, IgG4, immunomodulatory, obstructive jaundice, pancreas mass, steroid

scholarly journals Sacroiliac Pain: A Clinical Approach for the Neurosurgeon

2017 ◽  
Vol 08 (04) ◽  
pp. 622-627 ◽  
Author(s):  
Luis Rafael Moscote-Salazar ◽  
Hernando Raphael Alvis-Miranda ◽  
Andrei Fernandes Joaquim ◽  
Jessica Amaya-Quintero ◽  
Huber S. Padilla-Zambrano ◽  
...  
Keyword(s):  
Public Health Problem ◽  
Diagnostic Techniques ◽  
Unknown Etiology ◽  
Clinical Approach ◽  
Clinical Criteria ◽  
Positive Data ◽  
Health Related ◽  
Important Amount ◽  
Rule Out

ABSTRACTPain originating from sacroiliac joint may also cause pain in the lumbar and gluteal region in 15% of the population. The clinical manifestation represents a public health problem due to the great implications on the quality of life and health-related costs. However, this is a diagnosis that is usually ignored in the general clinical practice; probably because of the unknown etiology, making harder to rule out the potential etiologies of this pathology, or maybe because the clinical criteria that support this pathology are unknown. By describing several diagnostic techniques, many authors have studied the prevalence of this pathology, finding more positive data than expected; coming to the conclusion that even though there is no diagnostic gold standard yet, an important amount of cases might be detected by properly applying several tests at the physical examination. Thus, it is necessary to have knowledge of the physiopathology and clinical presentation so that diagnosis can be made to those patients that manifest this problem. We present a clinical approach for the neurosurgeon.

Endoscopic Ultrasonography-Guided Fine Needle Aspiration Can Be Used to Rule Out Malignancy in Autoimmune Pancreatitis Patients

2017 ◽  
Vol 36 (11) ◽  
pp. 2237-2244 ◽  
Author(s):  
Mitsuru Sugimoto ◽  
Tadayuki Takagi ◽  
Rei Suzuki ◽  
Naoki Konno ◽  
Hiroyuki Asama ◽  
...  
Keyword(s):  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Autoimmune Pancreatitis ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Rule Out

How to diagnose autoimmune pancreatitis by the revised Japanese clinical criteria

2007 ◽  
Vol 42 (S18) ◽  
pp. 32-38 ◽  
Author(s):  
Kazuichi Okazaki ◽  
Kazushige Uchida ◽  
Mitsunobu Matsushita ◽  
Makoto Takaoka
Keyword(s):  
Autoimmune Pancreatitis ◽  
Clinical Criteria

scholarly journals Diagnostic workup of patients with acute transverse myelitis: spectrum of clinical presentation, neuroimaging and laboratory findings

Spinal Cord ◽  
2008 ◽  
Vol 47 (4) ◽  
pp. 312-317 ◽  
Author(s):  
J Sellner ◽  
N Lüthi ◽  
W M M Schüpbach ◽  
A Gebhardt ◽  
O Findling ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Transverse Myelitis ◽  
Diagnostic Workup ◽  
Laboratory Findings ◽  
Acute Transverse Myelitis

scholarly journals A Case of Pancreatic Cancer in the Setting of Autoimmune Pancreatitis with Nondiagnostic Serum Markers

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Manju D. Chandrasegaram ◽  
Su C. Chiam ◽  
Nam Q. Nguyen ◽  
Andrew Ruszkiewicz ◽  
Adrian Chung ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Portal Vein ◽  
Autoimmune Pancreatitis ◽  
Squamous Metaplasia ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Serum Markers ◽  
Normal Serum ◽  
Serum Igg4 ◽  
Ca 19.9

Background. Autoimmune pancreatitis (AIP) often mimics pancreatic cancer. The diagnosis of both conditions is difficult preoperatively let alone when they coexist. Several reports have been published describing pancreatic cancer in the setting of AIP.Case Report. The case of a 53-year-old man who presented with abdominal pain, jaundice, and radiological features of autoimmune pancreatitis, with a “sausage-shaped” pancreas and bulky pancreatic head with portal vein impingement, is presented. He had a normal serum IgG4 and only mildly elevated Ca-19.9. Initial endoscopic ultrasound-(EUS-) guided fine-needle aspiration (FNA) of the pancreas revealed an inflammatory sclerosing process only. A repeat EUS guided biopsy following biliary decompression demonstrated both malignancy and features of autoimmune pancreatitis. At laparotomy, a uniformly hard, bulky pancreas was found with no sonographically definable mass. A total pancreatectomy with portal vein resection and reconstruction was performed. Histology revealed adenosquamous carcinoma of the pancreatic head and autoimmune pancreatitis and squamous metaplasia in the remaining pancreas.Conclusion. This case highlights the diagnostic and management difficulties in a patient with pancreatic cancer in the setting of serum IgG4-negative, Type 2 AIP.

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