Painless Jaundice and Bilaterally Enlarged Sub-mandibular Glands in an Elderly Man
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Case Presentation and Evolution
An otherwise robust 81-year-old Japanese-American male presented to his primary care physician for painless jaundice that was first noticed by his barber. He denied any abdominal pain, but upon further questioning reported an unintentional 15-lb weight loss over the previous year and reduced energy while exercising. He had no major co-morbidities and took only omeprazole for mild gastroesophageal reflux symptoms. He denied significant use of alcohol or tobacco and had no family history of pancreatic disorders or cancer. His physical examination was remarkable only for bilaterally enlarged sub-mandibular glands.
Notable laboratory values were serum creatinine of 1.2 mg/dl, ALT 77 IU/l, AST 69 IU/l, total bilirubin 0.6 mg/dl, alkaline phosphatase 250 IU/l, total protein 8.9 g/dl, and an erythrocyte sedimentation rate of 82 mm/h. Computed tomography revealed a 2 × 2.5 cm hypodense pancreatic head mass (Fig. 1). Endoscopic retrograde cholangiopancreatography s ...
- Sarles H, Sarles JC, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas–an autonomous pancreatic disease? Am J Dig Dis. 1961;6:688–698. doi:10.1007/BF02232341. CrossRef
- Pearson RK, Longnecker DS, Chari ST, et al. Controversies in clinical pancreatology: autoimmune pancreatitis: does it exist? Pancreas. 2003;27:1–13. doi:10.1097/00006676-200307000-00001. CrossRef
- Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–738. doi:10.1056/NEJM200103083441005. CrossRef
- Beger H, Warshaw A, Buchler M, et al. The Pancreas. An Integrated Textbook of Basic Science, Medicine, and Surgery. 2nd ed. Malden: Blackwell Publishing; 2008.
- Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. 2006;4:1010–1016. doi:10.1016/j.cgh.2006.05.017. quiz 934. CrossRef
- Finkelberg DL, Sahani D, Deshpande V, Brugge WR. Autoimmune pancreatitis. N Engl J Med. 2006;355:2670–2676. doi:10.1056/NEJMra061200. CrossRef
- Zandieh I, Byrne MF. Autoimmune pancreatitis: a review. World J Gastroenterol. 2007;13:6327–6332. doi:10.3748/wjg.13.6327. CrossRef
- Church NI, Pereira SP, Deheragoda MG, et al. Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series. Am J Gastroenterol. 2007;102:2417–2425. doi:10.1111/j.1572-0241.2007.01531.x. CrossRef
- Matsushita M, Ikeura T, Fukui T, Uchida K, Okazaki K. Refractory autoimmune pancreatitis: azathioprine or steroid pulse therapy? Am J Gastroenterol. 2008;103:1834. Author reply 1834–5.
- Painless Jaundice and Bilaterally Enlarged Sub-mandibular Glands in an Elderly Man
Digestive Diseases and Sciences
Volume 54, Issue 3 , pp 488-490
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 300 Pasteur Drive, MC: 5187, Stanford, CA, 94305-5187, USA
- 2. Department of Pathology and Laboratory Medicine, Stanford University Medical Center, Stanford, CA, USA
- 3. Department of Radiology, Stanford University Medical Center, Stanford, CA, USA