年長女性以難治性胰臟炎及嚴重腹痛為表現的第一型自體免疫胰臟炎

Immunoglobulin G4 Pancreatitis with the Manifestations of Severe Abdominal Pain and Refractory Pancreatitis in an Old Woman: A Case Report

陳俊昌(Chun-Chang Chen) ； 方姿蓉(Tzu-Jung Fang)

《台灣老年醫學暨老年學會雜誌》 16卷2期 (2021/05) Pp. 153-164

https://doi.org/10.29461/TGGa.202105_16(2).0006

摘要

78歲女性，因右髖關節壞死住院進行髖關節全關節置換術。術後病患有持續性腹痛現象，經診斷為胰臟炎，在標準治療後仍有反覆性腹痛、噁心、嘔吐等情形。後續更形成胰臟假性囊腫及嚴重敗血症，需放置引流管治療。探究其反覆難治性胰臟炎原因，發現疑似為免疫球蛋白G4胰臟炎（IgG4 pancreatitis），但因病人拒絕切片診斷，給予類固醇治療後，胰臟炎症狀改善出院。後續追蹤，病患沒有腹痛或胰臟炎再復發的情形。免疫球蛋白G4胰臟炎患者的表現非常多樣化。常見的臨床表現為阻塞性黃疸及輕微的腹痛，有時也被誤認為胰臟癌，但是典型的急性胰臟炎表現及嚴重腹部疼痛則非常少見。此個案表現出嚴重腹痛及典型的急性胰臟炎，伴隨血清中的免疫球蛋白G4指數升高，電腦斷層顯示胰臟瀰漫性及局部病灶腫大。胰臟炎是可以醫治的，絕大多數免疫球蛋白G4相關性疾病對類固醇的反應都相當好。然而，免疫球蛋白G4胰臟炎是個較為罕見的疾病而不易診斷，因此盡可能早期診斷是有機會改善患者的疼痛及降低後續因胰臟反覆發炎而造成胰臟癌的風險。

關鍵字

自體免疫胰臟炎 ； 免疫球蛋白G4 ； 免疫球蛋白G4相關性疾病

並列摘要

We herein report a rare case. A 78-year-old woman who suffered from severe abdominal pain after right hip arthroplasty for avascular necrosis. Pancreatitis persisted for more than one week even with standard treatment, complicated with intra-abdominal infection and severe sepsis. Focal pancreatic enlargement and acute peripancreatic fluid accumulation were noted in abdominal computed tomography. Serum immunoglobulin G4 (IgG4) elevated. The patient underwent a pigtail tube drainage for peripancreatic fluid, antibiotics treatment for intraabdominal infection, and steroid later for IgG4 pancreatitis. Abdominal pain and amylase/lipase improved rapidly after steroid use. IgG4 pancreatitis is treatable and often responds quite well to steroid therapy. Earlier diagnosis and treatment help reduce suffering. However, in this elderly patient with poor renal function, liver cancer, and liver cirrhosis, early diagnosis is more difficult because contrasted image and tissue proof could not be obtained. We provide some suggestions to patients in a similar situation.

並列關鍵字

autoimmune pancreatitis ； immunoglobulin G4 ； immunoglobulin G4 related disease