Eosinophilic Pancreatitis with Psoriasis Vulgaris
Pp. 438-446 (9)
Masashi Inoue, Masahiro Tanemura, Toshimitsu Irei, Nobutaka Hatanaka, Yuki Matsuzaka and Kazuya Kuraoka
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.
Distal pancreatectomy, Eosinophilic pancreatitis, Pancreatic pseudocyst,
Psoriasis vulgaris, Steroid.
Department of Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure737-0023, Japan.