Autoimmune pancreatitis (AIMP) - a clinical entity of its own?

History and admission findings: A 34-year-old man with chronic inflammation of both tear glands for 10 years was admitted because of severe upper abdominal pain and jaundice. Investigations: Transaminase and cholestasis parameters were raised, as were gamma -globulins on electrophoresis. Ultrasound revealed an echo-poor diffusely enlarged pancreas with hypervascularity on colour-Doppler. Endoscopic retrograde cholangiopancreatography (ERCP) indicated chronically changed pancreatic ducts of varying diameter and stenosis, as well as a filiform distal stenosis of the common bile duct. A pancreatic biopsy showed chronic sclerosing pancreatitis with broad periductal lymphocytic infiltration. Treatment and course: ERCP and a guide-wire papillotomy were performed, followed by placement of a nasobiliary catheter. All findings markedly improved on oral prednisone. Conclusion: This case supports the supposition that in idiopathic chronic pancreatitis autoimmune processes may be responsible for the changes in the pancreatic ducts. Immunosuppressive treatment is thus recommended in these cases.