The Korean Journal of Medicine

  • 제93권2호
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  • Pages.206-210
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  • 2018
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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급성췌장염 양상을 보였던 궤양성대장염을 동반한 2형 자가면역췌장염

Type 2 Autoimmune Pancreatitis with Ulcerative Colitis Manifesting as Acute Pancreatitis

  • 김하일 (울산대학교 의과대학 서울아산병원 내과) ;
  • 정혜민 (울산대학교 의과대학 서울아산병원 내과) ;
  • 이정환 (울산대학교 의과대학 서울아산병원 내과) ;
  • 노수민 (울산대학교 의과대학 서울아산병원 내과) ;
  • 형례창 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김명환 (울산대학교 의과대학 서울아산병원 내과)
  • Kim, Ha Il (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Hye Min (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jung Hwan (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Noh, Soo Min (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hsing, Li Chang (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Myung-Hwan (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2017.05.30
  • 심사 : 2017.06.28
  • 발행 : 2018.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

2형 자가면역췌장염은 급성췌장염의 임상 양상으로 발현 할 수 있다. 특히 젊은 환자에서 원인미상의 췌장염으로 확인된 경우, 췌장 영상 소견을 특히 주의 깊게 관찰하여 이미 알려진 자가면역췌장염 소견과 합당한지 따져보는 것이 중요하다. 특히 궤양성대장염 환자에서 췌장염이 동반되는 경우, 한 번쯤은 2형 자가면역췌장염의 동반 유무를 감별해 보아야 할 것이다. 이와 같은 경우라면 췌장 조직 검사를 적극적으로 시행함으로서 자가면역췌장염을 진단할 수 있겠고, 스테로이드 투여를 통해 효과적으로 치료를 기대해 볼 수 있겠다.

Autoimmune pancreatitis (AIP) occurs in two forms. Type 1 AIP is an IgG4-related systemic fibro-inflammatory disease. Type 2 AIP is not associated with altered levels of IgG4, and involves only the pancreas. Here, we report a case of type 2 AIP manifesting as acute pancreatitis in a 20-year-old male with ulcerative colitis. The patient was definitely diagnosed with type 2 AIP based on typical pancreatic imaging, supportive histology, history of ulcerative colitis, and steroid responsiveness.

키워드

참고문헌

  1. Kim JY, Chang HS, Kim MH, et al. A case of autoimmune chronic pancreatitis improved with oral steroid therapy. Korean J Gastroenterol 2002;39:304-308.
  2. Kamisawa T, Shimosegawa T, Okazaki K, et al. Standard steroid treatment for autoimmune pancreatitis. Gut 2009;58:1504-1507. https://doi.org/10.1136/gut.2008.172908
  3. Sugumar A, Kloppel G, Chari ST. Autoimmune pancreatitis: pathologic subtypes and their implications for its diagnosis. Am J Gastroenterol 2009;104:2308-2310; quiz 2311. https://doi.org/10.1038/ajg.2009.336
  4. Chun YJ, Chang JH, Lee IS, et al. Steroid responsive pancreatic mass-forming type 2 autoimmune pancreatitis. Korean J Gastroenterol 2011;58:53-57. https://doi.org/10.4166/kjg.2011.58.1.53
  5. Kamisawa T, Chari ST, Lerch MM, Kim MH, Gress TM, Shimosegawa T. Recent advances in autoimmune pancreatitis: type 1 and type 2. Gut 2013;62:1373-1380. https://doi.org/10.1136/gutjnl-2012-304224
  6. Sah RP, Chari ST, Pannala R, et al. Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis. Gastroenterology 2010;139:140-148; quiz e12-13. https://doi.org/10.1053/j.gastro.2010.03.054
  7. Hart PA, Kamisawa T, Brugge WR, et al. Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut 2013;62:1771-1776. https://doi.org/10.1136/gutjnl-2012-303617
  8. Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011;40:352-358. https://doi.org/10.1097/MPA.0b013e3182142fd2
  9. Kamisawa T, Tu Y, Egawa N, et al. Can MRCP replace ERCP for the diagnosis of autoimmune pancreatitis? Abdom Imaging 2008;34:381-384.
  10. Moon SH, Kim MH. The role of endoscopy in the diagnosis of autoimmune pancreatitis. Gastrointest Endosc 2012;76:645-656. https://doi.org/10.1016/j.gie.2012.04.458