Pancreatite autoimune tipo 1
recidiva com abscesso hepático
DOI:
https://doi.org/10.11606/issn.2176-7262.v53i1p81-87Palavras-chave:
Imunoglobulina G, Doenças Autoimunes, Pancreatite, Colangite Esclerosante, Abscesso HepáticoResumo
A pancreatite autoimune tipo 1 é uma causa de pancreatite crônica relacionada à doença sistêmica conhecida como Doença Esclerosante relacionada à IgG4. Relato do caso: Relatamos o caso de um paciente do sexo masculino, 64 anos, que apresentou quadros recorrentes de dor epigástrica com irradiação para as costas, associada com icterícia, xerostomia, náuseas e vômitos desde 2014, diagnosticado após 2 anos com adenocarcinoma pancreático irressecável. O diagnóstico foi questionado após alguns meses de acompanhamento sem deterioração clínica, quando aventaram a possibilidade de forma pseudotumoral da pancreatite autoimune tipo 1. Realizou tratamento com glicocorticoides, obtendo melhora clínica importante. Após dois anos de acompanhamento, retorna assintomático com imagens sugestivas de colangite esclerosante e volumoso abscesso hepático. Importância do problema: O presente caso denota uma dificuldade encontrada no diagnóstico dessa entidade devido a semelhanças clínico-radiológicas com o adenocarcinoma pancreático. Além disso, apresenta uma complicação pouco descrita da doença, o abscesso hepático.
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Referências
1. Shimosegawa T, Chari S, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas. April 2011;40(3):352-358.
2. Kamisawa T, Shimosegawa T. Epidemiology of Autoimmune Pancreatitis. In: Beger HG, Warshaw AL, Hruban RH, Büchler MW, Lerch MM, Neoptolemos JP, Shimosegawa T, Whitcomb DC and Groß C. The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery.3rd edition. Japan: John Wiley & Sons Ltd. 2018. 503-509.
3. O'Reilly DA, Malde DJ, Duncan T, Rao M, Filobbos R. Review of the diagnosis, classification and management of autoimmune pancreatitis. World J Gastrointest Pathophysiol. 2014;5(2):71-81.
4. Shakov R, DePasquale JR, Elfarra H, Spira RS. Autoimmune pancreatitis: case series and review of the literature. Ann Clin Lab Sci. 2009;39(2):167-75.
5. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001 Mar 8;344(10):732-8.
6. Martins C, Lago P, Sousa P, et al. Type 2 Autoimmune Pancreatitis: A Challenge in the Differential Diagnosis of a Pancreatic Mass. GE Port J Gastroenterol. 2017;24(6):296-300.
7. Chari ST, Smyrk CT, Levy MJ, Topazian MD, Takahashi N, Zhang L, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clinical Gastroenterology and Hepatology. 2016;4(8):1010-1016.
8. ZHANG L, Notohara K, Levy MJ, Chari ST, Smyrk TC. IgG4-positive plasma cell infiltration in the diagnosis of autoimmune pancreatitis. Modern Pathology. 2007;20(1):23-28.
9. Hsu WL, Chang SM, Wu PY, Chang CC. Localized autoimmune pancreatitis mimicking pancreatic cancer: Case report and literature review. J Int Med Res. 2018;46(4):1657-1665.
10. Choi SY, Kim SH, Kang TW, Song KD, Hyun Jeong Park HJ, Choi YH. Differentiating Mass-Forming Autoimmune Pancreatitis From Pancreatic Ductal Adenocarcinoma on the Basis of Contrast-Enhanced MRI and DWI Findings. American Journal of Roentgenology. 2016;206(2):291-300.
11. Adsay NV, Basturk O, Thirabanjasak D. Diagnostic features and differential diagnosis of autoimmune pancreatitis. Seminars in diagnostic pathology. 2005;22(4):309-317.
12. Gunasekara TNKW, Di Palma S, Bagwan IN. IgG4 related sclerosing sialadenitis-a retrospective analysis. The Malaysian journal of pathology. 2016;38(2):111-115.
13. Miyabe K, Zen Y, Cornell LD, Rajagopalan G, Chowdhary VR, Roberts LR, Chari ST. Gastrointestinal and Extra-Intestinal Manifestations of IgG4–Related Disease. Gastroenterology. 2018;155(4):990-1003.
14. Tanaka A. IgG4-Related Sclerosing Cholangitis and Primary Sclerosing Cholangitis. Gut Liver. 2019;13(3):300–307. doi:10.5009/gnl18085
15. Fernandes DA, Kido RYZ, Barros RHO, Martins DL, Penachim TJ, Caserta NMG. Immunoglobulin G4-related disease: autoimmune pancreatitis and extrapancreatic manifestations. Radiol Bras. 2016;49(2):122–125.
16. Tokala A, Khalili K, Menezes R, Hirschfield G, Jhaveri KS. Comparative MRI analysis of morphologic patterns of bile duct disease in IgG4-related systemic disease versus primary sclerosing cholangitis. AJR 2014; 202:536–543
17. Ohara H, Okasaki K, Tsubouchi H, Inui K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of IgG4‐related sclerosing cholangitis 2012. Journal of Hepato‐Biliary‐Pancreatic Sciences. 2012;19(5):536-542.
18. Khandelwal A, Inoue D, Takahashi N. Autoimmune pancreatitis: an update. Abdominal Radiology. 2019: 1-12.
19. Huang CJ, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL, Zuidema GD. Pyogenic hepatic abscess: changing trends over 42 years. Annals of surgery. 1996;223(5):600-609.
20. Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O, Waldron R. Modern management of pyogenic hepatic abscess: a case series and review of the literature. BMC research notes. 2011;4(1):80-88.
21. Shibata M, Matsubayashi H, Aramaki T, Uesaka K, Tsutsumi N, Sasaki K, Ono H. A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment. BMC gastroenterology.2016;16(1):89-95.
22. Saito M, Shimura T, Hashimoto Y, Ishigame T, Yashima R, Koyama Y, Takenoshita S. IgG4-related intrahepatic sclerosing cholangitis resulting in sepsis caused by secondary suppurative inflammation: report of a case. Surgery Today. 2012;43(10):175–1179.
2. Kamisawa T, Shimosegawa T. Epidemiology of Autoimmune Pancreatitis. In: Beger HG, Warshaw AL, Hruban RH, Büchler MW, Lerch MM, Neoptolemos JP, Shimosegawa T, Whitcomb DC and Groß C. The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery.3rd edition. Japan: John Wiley & Sons Ltd. 2018. 503-509.
3. O'Reilly DA, Malde DJ, Duncan T, Rao M, Filobbos R. Review of the diagnosis, classification and management of autoimmune pancreatitis. World J Gastrointest Pathophysiol. 2014;5(2):71-81.
4. Shakov R, DePasquale JR, Elfarra H, Spira RS. Autoimmune pancreatitis: case series and review of the literature. Ann Clin Lab Sci. 2009;39(2):167-75.
5. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001 Mar 8;344(10):732-8.
6. Martins C, Lago P, Sousa P, et al. Type 2 Autoimmune Pancreatitis: A Challenge in the Differential Diagnosis of a Pancreatic Mass. GE Port J Gastroenterol. 2017;24(6):296-300.
7. Chari ST, Smyrk CT, Levy MJ, Topazian MD, Takahashi N, Zhang L, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clinical Gastroenterology and Hepatology. 2016;4(8):1010-1016.
8. ZHANG L, Notohara K, Levy MJ, Chari ST, Smyrk TC. IgG4-positive plasma cell infiltration in the diagnosis of autoimmune pancreatitis. Modern Pathology. 2007;20(1):23-28.
9. Hsu WL, Chang SM, Wu PY, Chang CC. Localized autoimmune pancreatitis mimicking pancreatic cancer: Case report and literature review. J Int Med Res. 2018;46(4):1657-1665.
10. Choi SY, Kim SH, Kang TW, Song KD, Hyun Jeong Park HJ, Choi YH. Differentiating Mass-Forming Autoimmune Pancreatitis From Pancreatic Ductal Adenocarcinoma on the Basis of Contrast-Enhanced MRI and DWI Findings. American Journal of Roentgenology. 2016;206(2):291-300.
11. Adsay NV, Basturk O, Thirabanjasak D. Diagnostic features and differential diagnosis of autoimmune pancreatitis. Seminars in diagnostic pathology. 2005;22(4):309-317.
12. Gunasekara TNKW, Di Palma S, Bagwan IN. IgG4 related sclerosing sialadenitis-a retrospective analysis. The Malaysian journal of pathology. 2016;38(2):111-115.
13. Miyabe K, Zen Y, Cornell LD, Rajagopalan G, Chowdhary VR, Roberts LR, Chari ST. Gastrointestinal and Extra-Intestinal Manifestations of IgG4–Related Disease. Gastroenterology. 2018;155(4):990-1003.
14. Tanaka A. IgG4-Related Sclerosing Cholangitis and Primary Sclerosing Cholangitis. Gut Liver. 2019;13(3):300–307. doi:10.5009/gnl18085
15. Fernandes DA, Kido RYZ, Barros RHO, Martins DL, Penachim TJ, Caserta NMG. Immunoglobulin G4-related disease: autoimmune pancreatitis and extrapancreatic manifestations. Radiol Bras. 2016;49(2):122–125.
16. Tokala A, Khalili K, Menezes R, Hirschfield G, Jhaveri KS. Comparative MRI analysis of morphologic patterns of bile duct disease in IgG4-related systemic disease versus primary sclerosing cholangitis. AJR 2014; 202:536–543
17. Ohara H, Okasaki K, Tsubouchi H, Inui K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of IgG4‐related sclerosing cholangitis 2012. Journal of Hepato‐Biliary‐Pancreatic Sciences. 2012;19(5):536-542.
18. Khandelwal A, Inoue D, Takahashi N. Autoimmune pancreatitis: an update. Abdominal Radiology. 2019: 1-12.
19. Huang CJ, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL, Zuidema GD. Pyogenic hepatic abscess: changing trends over 42 years. Annals of surgery. 1996;223(5):600-609.
20. Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O, Waldron R. Modern management of pyogenic hepatic abscess: a case series and review of the literature. BMC research notes. 2011;4(1):80-88.
21. Shibata M, Matsubayashi H, Aramaki T, Uesaka K, Tsutsumi N, Sasaki K, Ono H. A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment. BMC gastroenterology.2016;16(1):89-95.
22. Saito M, Shimura T, Hashimoto Y, Ishigame T, Yashima R, Koyama Y, Takenoshita S. IgG4-related intrahepatic sclerosing cholangitis resulting in sepsis caused by secondary suppurative inflammation: report of a case. Surgery Today. 2012;43(10):175–1179.
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— Atualizado em 2020-04-27
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Copyright (c) 2020 Gustavo Mesquita de Oliveira, Lia de Freitas Araújo Alves, Paloma Lucena Cabral, Ana Luiza Viana Pequeno, Clóvis Rêgo Coelho, Rodrigo Vieira Costa Lima
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
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1.
Oliveira GM de, Alves L de FA, Cabral PL, Pequeno ALV, Coelho CR, Lima RVC. Pancreatite autoimune tipo 1: recidiva com abscesso hepático. Medicina (Ribeirão Preto) [Internet]. 27º de abril de 2020 [citado 17º de abril de 2024];53(1):81-7. Disponível em: https://www.revistas.usp.br/rmrp/article/view/158792
