Steroid-resistant Relapse of Autoimmune Pancreatitis with Marked Main Pancreatic Duct Dilatation Mimicking Multifocal Pancreatic Cancer
Abstract
A 67-year-old man with type 1 autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis experienced a relapse, while presenting with pancreatic head swelling and distal bile duct stenosis. Despite an increase in the prednisolone dosage (from 7.5 to 20 mg/day), the disease worsened. A significant dilatation of the main pancreatic duct (8 mm) and new stenosis of the pancreatic tail duct were observed. Malignancy was ruled out by repeated endoscopic ultrasound-guided fine-needle aspiration biopsies. A further escalation of the prednisolone dose to 40 mg/day led to clinical and radiological improvements. This case underscores the difficulty in distinguishing a steroid-resistant AIP relapse from pancreatic cancer, and the importance of ruling out malignancy before intensifying immunosuppressive therapy.
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BibTeX
@article{hirano2026steroidresistant,
title = {{Steroid-resistant Relapse of Autoimmune Pancreatitis with Marked Main Pancreatic Duct Dilatation Mimicking Multifocal Pancreatic Cancer}},
author = {Kenji Hirano and Kanami Kondo and Toshifumi Saito and Keigo Takahashi and Shinji Ono and Sohei Abe and Tomoji Kato and Katsuya Kobayashi and Kenichiro Sekigawa and Hiroshi Mitsui},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.6704-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/17/65_6704-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Steroid-resistant Relapse of Autoimmune Pancreatitis with Marked Main Pancreatic Duct Dilatation Mimicking Multifocal Pancreatic Cancer
AU - Kenji Hirano
AU - Kanami Kondo
AU - Toshifumi Saito
AU - Keigo Takahashi
AU - Shinji Ono
AU - Sohei Abe
AU - Tomoji Kato
AU - Katsuya Kobayashi
AU - Kenichiro Sekigawa
AU - Hiroshi Mitsui
PY - 2026
DA - 2026/09/01
JO - Internal Medicine
DO - 10.2169/internalmedicine.6704-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/17/65_6704-25/_article
AB - A 67-year-old man with type 1 autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis experienced a relapse, while presenting with pancreatic head swelling and distal bile duct stenosis. Despite an increase in the prednisolone dosage (from 7.5 to 20 mg/day), the disease worsened. A significant dilatation of the main pancreatic duct (8 mm) and new stenosis of the pancreatic tail duct were observed. Malignancy was ruled out by repeated endoscopic ultrasound-guided fine-needle aspiration biopsies. A further escalation of the prednisolone dose to 40 mg/day led to clinical and radiological improvements. This case underscores the difficulty in distinguishing a steroid-resistant AIP relapse from pancreatic cancer, and the importance of ruling out malignancy before intensifying immunosuppressive therapy.
SN - 1349-7235
SN - 0918-2918
ER -