Autoimmune Pancreatitis Accompanied by Tubulointerstitial Nephritis

Yu Hwa Lee, Hye Jin Tae, Jin Ok Kim, Jeong Im Choi, Dong Chan Kim, Won Sohn, Ho Soon Choi
2012 Korean Journal of Medicine  
Autoimmune pancreatitis (AIP) is type of chronic pancreatitis characterized by an autoimmune inflammatory process. IgG4-positive plasma cells can be found in both the pancreas and at extrapancreatic sites of involvement. A 60-year-old man presented with abdominal discomfort. Computed tomography revealed enlargement of the pancreas and kidneys as well as low-attenuated lesions in both kidneys. MRCP showed narrowing of the distal common bile duct and the proximal pancreatic duct. The serum IgG
more » ... t. The serum IgG level was elevated, but IgG4 was normal. Histologic examination revealed lymphoplasma infiltration in the renal tubulointerstitium associated with fibrosis along with many IgG4-positive plasma cells, thereby confirming the diagnosis of tubulointerstitial nephritis-associated AIP. The abnormalities in the clinical, laboratory, and radiological findings improved after oral steroid treatment. This is a case of autoimmune pancreatitis accompanied by tubulointerstitial nephritis diagnosed by renal biopsy. Clinicians should suspect the possibility of extrapancreatic organ involvement in autoimmune pancreatitis, especially when abnormalities in other organs are suggested. Proper examinations must be performed. ( Korean J Med 2012;83:775-780) Keywords: Autoimmune pancreatitis; Tubulointerstitial nephritis 서 론 자가면역성 췌장염은 만성 췌장염의 한 형태로 자가면역 기전에 의해 형질 임파구의 췌관 침윤과 췌장 섬유화로 췌장 기능의 상실을 초래하는 질환이다. 미만성 췌장 비대, 불규칙적인 췌관 협착 소견 및 고감 마글로불린혈증과 자가면역 항체 양성이 특징인 이 질환은 1995년 Yoshida 등[1]에 의해 처음 보고되었다. 전세계적으로 공통된 진단기준은 없으나 일본에서 2002년 진단기준을 제시하였고, 우리나라에서는 2007년 자가면역성 췌장염의 진단기준을 제시하였다[2]. 자가면역성 췌장염은 만성췌장염의 원인 중 빈도는 높지 않으나 황달, 복통, 체중 감소 및 CA 19-9 상승 등이 특징인 췌장암 혹은 원발성 경화성 담도염과 임상양상이 유사하여
doi:10.3904/kjm.2012.83.6.775 fatcat:aomb563xvvhs3iieozqzunnw7e