A case of autoimmune pancreatitis with sclerosing cholangitis

A 56-year-old man was admitted to our department because of increased levels of serum hepato-biliary enzymes and dilatation of intrahepatic bile ducts on abdominal CT image. ERCP showed stricture of the main pancreatic duct and dilatation of its branches in the head of the pancreas. Lower common bile duct was also narrow and multiple strictures of intrahepatic bile ducts were seen. Serum IgG and IgG4 levels were high and histological examination of pancreatic biopsy specimen obtained by EUS-FNA showed infiltration of lymphocytes and plasma cells, and interlobular fibrosis. Therefore, we diagnosed autoimmune pancreatitis, but the cholangiogram was difficult to discriminate from primary sclerosing cholangitis. Oral steroid therapy was commenced after the diagnosis of autoimmune pancreatitis. Increased levels of hepatobiliary enzymes and IgG4 went down after starting steroid therapy, and cholangiogram was also improved markedly.