Autoimmune Disease

Scientists at University of Tennessee release new data on autoimmune disease

Autoimmune Disease Library Library Home This article was published in Immunotherapy Weekly, which you can subscribe to online.

"She complained of occasional early satiety and had lost 10 lbs since the onset of symptoms. There was no history of jaundice, fever, chills, or night sweats. Upper and lower endoscopies were unremarkable. Five months before this evaluation, a laparoscopic cholecystectomy was performed without relief of symptoms. Past medical history was significant only for hypertension with no history of any autoimmune disorder. The patient did not smoke or consume alcohol. On physical exam, the patient was afebrile with normal vital signs. There was no evidence of cachexia. The sclera were anicteric. No peripheral adenopathy was noted. The abdomen was soft with no palpable mass. Computed tomography (CT) of the abdomen demonstrated a diffuse, isohomogenous mass of the pancreas predominantly involving the pancreatic head with encasement of the mesenteric vessels and surrounding adenopathy (Fig. 1). Liver function tests were normal except for a mildly elevated alkaline phosphatase of 153 U/I (normal, 30100). CA19-9 and CEA levels were normal. Given the atypical presentation for pancreatic adenocarcinoma and the CT findings, a preliminary diagnosis of pancreatic lymphoma was entertained. Fine needle aspiration (FNA) of the pancreas was performed and returned consistent with chronic pancreatitis. Because of a continued concern of an underlying neoplasm, a core biopsy was obtained and pathologic analysis was consistent with lymphoplasmacytic sclerosing pancreatitis (LPSP) (Fig. 2). In retrospect, features consistent with LPSP were present on fine needle biopsy but were not recognized by the initial pathologist. Total IgG [1,140 mg/dl (normal, 600-1500)] and IgG4 [120 mg/dl (normal 8-140)] levels were unremarkable. The patient was started at 40 mg of prednisone daily. Because of significant side effects of weight gain and mental status changes, the dose was decreased after 2 weeks to 5 mg per day. Six months after initiation of steroid therapy, the patient was completely asymptomatic. A repeat CT scan demonstrated significant resolution of the pancreatic mass. The encasement of the mesenteric vessels noted on the initial survey had nearly completely resolved (Fig. 3)," wrote S.W. Behrman and colleagues, University of Tennessee.

The researchers concluded: "The patient remains on 5 mg of prednisone daily."

Behrman and colleagues published their study in the Journal of Gastrointestinal Surgery (Clinical and radiologic resolution of IgG 4 normal, nonoperatively diagnosed lymphoplasmacytic sclerosing pancreatitis (LPSP) after initiation of steroid therapy. Journal of Gastrointestinal Surgery, 2007;11(9):1194-1196).

For additional information, contact S.W. Behrman, University of Tennessee, Center Health Science, Dept. of Surgery, 956 Court Avenue, Suite G218, Memphis, TN 38163, USA.

The publisher of the Journal of Gastrointestinal Surgery can be contacted at: Springer, 233 Spring Street, New York, NY 10013, USA.

Keywords: United States, Memphis, Autoimmune Disease, Autoimmune Disorder, Immunology, University of Tennessee.

This article was prepared by Immunotherapy Weekly editors from staff and other reports. Copyright 2007, Immunotherapy Weekly via NewsRx.com.