Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2016; 22(7): 2383-2390
Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2383
Rare type of pancreatitis as the first presentation of anti-neutrophil cytoplasmic antibody-related vasculitis
Tomoya Iida, Takeya Adachi, Tetsuya Tabeya, Suguru Nakagaki, Takashi Yabana, Akira Goto, Yoshihiro Kondo, Kiyoshi Kasai
Tomoya Iida, Takeya Adachi, Suguru Nakagaki, Takashi Yabana, Akira Goto, Yoshihiro Kondo, Department of Gastroenterology, Otaru City General Hospital, Otaru, Hokkaido 047-8550, Japan
Tetsuya Tabeya, Department of Internal Medicine of Connective Tissue Disease, Otaru City General Hospital, Otaru, Hokkaido 047-8550, Japan
Kiyoshi Kasai, Department of Diagnostic Pathology, Otaru City General Hospital, Otaru, Hokkaido 047-8550, Japan
Author contributions: All authors helped to perform the research; Iida T wrote the paper; all authors have approved the final draft of the manuscript.
Supported by Otaru City General Hospital, Otaru, Hokkaido, Japan
Institutional review board statement: Otaru City General Hospital Institutional Review Board for Conduction and Submission of the study.
Informed consent statement: The patient provided informed consent prior to study enrollment.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest, financial or other, exists for any authors listed in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tomoya Iida, MD, Department of Gastroenterology, Otaru City General Hospital, 1-1 1-chome, Wakamatu-cho, Otaru, Hokkaido 047-8550, Japan. tomoya.iida.0306@gmail.com
Telephone: +81-134-251211 Fax: +81-134-326424
Received: July 22, 2015
Peer-review started: July 30, 2015
First decision: August 28, 2015
Revised: September 11, 2015
Accepted: December 12, 2015
Article in press: December 12, 2015
Published online: February 21, 2016
Abstract

A pancreatic tumor was suspected on the abdominal ultrasound of a 72-year-old man. Abdominal computed tomography showed pancreatic enlargement as well as a diffuse, poorly enhanced area in the pancreas; endoscopic ultrasound-guided fine needle aspiration biopsy and endoscopic retrograde cholangiopancreatography failed to provide a definitive diagnosis. Based on the trend of improvement of the pancreatic enlargement, the treatment plan involved follow-up examinations. Later, he was hospitalized with an alveolar hemorrhage and rapidly progressive glomerulonephritis; he tested positive for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA) and was diagnosed with ANCA-related vasculitis, specifically microscopic polyangiitis. It appears that factors such as thrombus formation caused by the vasculitis in the early stages of ANCA-related vasculitis cause abnormal distribution of the pancreatic blood flow, resulting in non-uniform pancreatitis. Pancreatic lesions in ANCA-related vasculitis are very rare. Only a few cases have been reported previously. Therefore, we report our case and a review of the literature.

Keywords: Pancreas, Pancreatitis, Antibodies, Anti-neutrophil cytoplasmic, Vasculitis, Microscopic polyangiitis

Core tip: Pancreatic lesions in anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis are very rare. Only few cases of pancreatic lesions in ANCA-related vasculitis have been reported previously. We encountered a case presenting with pancreatic enlargement and a diffuse, poorly enhanced area in the pancreas during the early stages of ANCA-related vasculitis. In light of the clinical course, it appears that factors such as thrombus formation caused by the vasculitis during the early stages of ANCA-related vasculitis cause abnormal distribution of pancreatic blood flow, resulting in non-uniform pancreatitis manifested in the imaging findings.