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Acute pancreatitis associated with immunoglobulin A vasculitis: report of fifteen cases

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Abstract

Objective

Immunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis common in children. Pancreatic involvement in IgAV is rare. The purpose of this study was to analyze the clinical characteristics of IgAV-related acute pancreatitis in children.

Methods

Records of patients with IgAV-related acute pancreatitis admitted to our institution between January 2016 and December 2019 were reviewed. We summarized the clinical characteristics, laboratory characteristics, imaging findings, treatment, and outcomes of 15 children with IgAV-related acute pancreatitis.

Results

The patients’ median age was 9.6 years. Pancreatitis was the initial manifestation of IgAV in 3 patients. All patients had abdominal manifestations, including abdominal pain (15/15), vomiting (10/15), and gastrointestinal bleeding (7/15). Serum amylase and lipase levels were elevated in all patients. Serum amylase in 4 cases reached more than three-fold elevation and serum lipase in 14 cases reached more than three-fold elevation. Morphological abnormalities and abnormal signals of the pancreas were observed in 13 cases by magnetic resonance imaging. Pancreaticobiliary maljunction was seen in 3 cases by magnetic resonance cholangiopancreatography. Glucocorticoid therapy and intravenous immunoglobulins were used to treat acute pancreatitis in IgAV. All patients showed clinical improvement after treatment. During the follow-up period of 6–12 months, all 15 cases with pancreatitis were cured without recurrence.

Conclusions

Pancreatic involvement is rare in IgAV; however, this should be considered in IgAV patients with severe abdominal pain. The timely application of steroid therapy is important for IgAV-associated pancreatitis.

Key Points

• Acute pancreatitis is a rare complication of immunoglobulin A vasculitis (IgAV).

• Acute pancreatitis can be the initial manifestation of IgAV. It is important to evaluate for pancreatitis while IgAV patients with severe abdominal pain.

• A common image finding of IgAV-associated pancreatitis was swelling of the pancreas.

• Glucocorticoid therapy and intravenous immunoglobulins is helpful in alleviating acute pancreatitis in IgAV.

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Funding

This work was funded by the Beijing Natural Science Foundation (7212169).

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Authors and Affiliations

  1. Department of Chinese Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China

    Lina Du, Chang Liu, Xintai Wang, Jing Mu & Yan Yang

Authors
  1. Lina Du
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  2. Chang Liu
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  3. Xintai Wang
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  4. Jing Mu
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  5. Yan Yang
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Contributions

Lina DU contributed to the overall ideas and drafted the manuscript. Chang Liu, Xintai Wang, and Jing Mu contributed to data collection of the patients. Yan Yang revised the manuscript for intellectual content and had full responsibility for the study. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yan Yang.

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Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Consent to participate

The study protocol was approved by the Research Ethics Commission of Beijing Children’s Hospital, Capital Medical University (2022-E-177-R).

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Du, L., Liu, C., Wang, X. et al. Acute pancreatitis associated with immunoglobulin A vasculitis: report of fifteen cases. Clin Rheumatol 42, 839–847 (2023). https://doi.org/10.1007/s10067-022-06398-3

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  • DOI: https://doi.org/10.1007/s10067-022-06398-3

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