Advances in Modern Medicine

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Advances in Modern Medicine introduces recent advanced medical practices performed at the Kure Medical Center and Chugoku Cancer Center (KMCCCC) - one of the leading hospitals in Japan - to those ...
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Eosinophilic Pancreatitis with Psoriasis Vulgaris

Pp. 438-446 (9)

Masashi Inoue, Masahiro Tanemura, Toshimitsu Irei, Nobutaka Hatanaka, Yuki Matsuzaka and Kazuya Kuraoka

Abstract

Eosinophilic pancreatitis (EP) is a rare disease characterized by eosinophilic infiltration of pancreatic parenchyma. Although the etiology of EP is not fully understood, there may be some allergic mechanisms related to the disease. Here we report on an EP patient with psoriasis vulgaris.

A 47-year-old man was admitted with cardiac space pain and a feeling of abdominal compression. He had a history of psoriasis vulgaris treated with steroid ointment for the past 30 years. Laboratory findings revealed elevated serum titers amylase. An abdominopelvic computed tomography scan showed a cystic lesion 45 mm in diameter localized in the pancreatic tail. He was diagnosed with pancreatic pseudocyst and conservative medical treatment was initiated with antimicrobial drugs and gabexate mesilate. Whenever meals were taken, pancreatitis aggravation returned. Eosinophilic leukocytosis occurred during steroid administration. Pseudoaneurysm in the splenic artery solution part occurred and a splenic artery embolism was performed in interventinal radiology. The patient underwent distal pancreatectomy. The operation specimen revealed eosinophilic infiltration.

Despite the unusual occurrence of EP, it should be considered in the differential diagnosis of patients with allergic disease or with an eosinophillia group presenting pancreatitis. In such cases, EUS-FNA or laparoscopic biopsy should be mandatory to avoid unnecessary surgical operation.

Keywords:

Distal pancreatectomy, Eosinophilic pancreatitis, Pancreatic pseudocyst, Psoriasis vulgaris, Steroid.

Affiliation:

Department of Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure737-0023, Japan.