Autoimmune pancreatitis with evolution to cholangitis : a case report

We report the case of a 47-year-old Caucasian male patient who presented with obstructive jaundice and mild epigastric pain. Autoimmune pancreatitis was diagnosed based on magnetic reso- nance imaging, biopsy and clinical evolution, and the patient was successfully treated with corticosteroids. However, a few months later ERCP showed an image compatible with sclerosing cholan- gitis. Again, treatment with corticosteroids was given, after which the bile ducts became normal. A few months later, again there was a relapse and azathioprine was started. After decreasing the dose of immunesuppression, we saw relapses of cholangitis and pancre- atitis, with eventually evolution to chronic calcifying pancreatitis. The aim of this report is to describe autoimmune pancreatitis as a cause of obstructive jaundice, and to illustrate that evolution to an immunesuppression-responsive cholangitis, with evolution to chronic calcifying pancreatitis is possible. AlsO. our patient had a small fluid collection, possibly a pseudocyst, an unusual finding in autoimmune pancreatitis, which disappeared during treatment. (Acta gastroenterol. belg., 2004, 67, 346-350).