A case of IgG4-related sclerosing cholangitis with autoimmune pancreatitis that the bile duct stricture replased at different sites in metachronous during steroid therapy

Abstract

A 80-year-old man was diagnosed with autoimmune pancreatitis and IgG4-related sclerosing cholangitis in 201X. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture of the lower common bile duct. we performed endoscopic biliary stenting (EBS), steroid therapy was started. The bile duct stricture and diffuse swelling of pancreas improved after administration of prednisolone (30mg daily). The prednisolone dose decreased gradually to 3mg daily. He was admitted to our hospital because of evaluation of total bilirubin, transaminase, alkaline phosphatase and γ-glutamyl transferase. ERCP showed a stricture of the upper common bile duct differing from the findings in the first attack. We performed EBS and the prednisolone dose increased to 30mg daily again. The postoperative course is uneventful. In this case, the bile duct stricture relapsed at different sites in metachronous during steroid maintenance therapy. We present this case, with a review of the literature.