Introduction: Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis that has recently been subcategorized over the last two decades. It is an inflammatory and fibrosing disease marked by pancreatic immune infiltrates. This is categorized as autoimmune due to the profound response to steroid therapy and interaction with immune cells which is a different mechanism than chronic pancreatitis. This case connects the association between autoimmune pancreatitis and newly diagnosed Sjogren's Syndrome.
Case Description/Methods: A 46 year old woman with a past medical history of seronegative rheumatoid arthritis, reiter's syndrome, collagenous colitis, vertigo, fibromyalgia, achalasia, Hashimoto’s Thyroiditis presents with 6 months of watery diarrhea without relief. She had accompanied abdominal cramping, loose stools, and dysphagia. Endoscopy and colonoscopy revealed an unremarkable esophagus and duodenal biopsies favored collagenous enteritis. Colonoscopy revealed mild left-sided diverticulosis. MRCP revealed diffuse fatty atrophy of the pancreas without mass. Pancreatic Elastase returned at 25 (Reference: < 100 severe insufficiency, 100- 199 moderate, >200 normal). During the exam it was noted that the patient kept taking sips of her water and having to wet her mouth and lips. She notes that she has always suffered from dental caries and has had most of her adult teeth pulled. Endorses dry eyes in which she uses artificial tears daily. Sjogren's anti La and anti Ro returned positive. Sjorgen’s was diagnosed and prescribed eye drops and saliva production stimulators.
Discussion: Autoimmune pancreatitis can be diagnosed in a variety of ways including measurement of serum IgG4 levels. Other imaging modalities such as MRCP, showing widespread spreading of the pancreas, as well as endoscopic ultrasound with tissue biopsy can also be used to diagnose this disease. Diagnosis of autoimmune pancreatitis should increase awareness to other autoimmune conditions due to the overlap in immune cell interactions. Our patient presented presented with new diagnosis Sjorgen’s Syndrome. It is the second most common autoimmune rheumatic disorder after rheumatoid arthritis, exceeding the prevalence for systemic lupus erythematosus, yet remains underdiagnosed. This association between autoimmune pancreatitis and Sjorgen’s Syndrome will reveal accurate awareness and diagnosis in people suffering with this condition.
Disclosures: Ganesh Arun indicated no relevant financial relationships. Nedal Darwish indicated no relevant financial relationships. Khurram Khalid indicated no relevant financial relationships. Lorrie Pennfield indicated no relevant financial relationships.
Ganesh Arun, DO, Nedal Darwish, MD, Khurram Khalid, MD, Lorrie Pennfield, MD. P1151 - Autoimmune Pancreatitis 1st Relative to Sjorgen's Syndrome, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.