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Hara S, Yoshida M, Sanada H, Suzuki Y, Sato Y, Mizushima I, Kawano M. Pediatric IgG4-related disease: a descriptive review. Expert Rev Clin Immunol 2024; 20:97-119. [PMID: 37874048 DOI: 10.1080/1744666x.2023.2274358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION IgG4-related disease (IgG4-RD) is an immune-mediated systemic fibroinflammatory condition characterized by serum IgG4 elevation and IgG4-positive plasma cell infiltration into various organs. It generally occurs in elderly males. Pediatric cases have been reported, albeit rarely, accordingly lack of recognition of such cases could delay therapeutic intervention leading to poorer outcomes. AREAS COVERED The present review is a descriptive review of all published case reports, cohort studies, and reviews of pediatric IgG4-RD listed in PubMed. Characteristics of pediatric IgG4-RD were clarified, including sex, organ involvement, serological and histological findings, and treatment. We assessed how many published cases met current classification and comprehensive diagnostic criteria. EXPERT OPINION The characteristics of pediatricIgG4-RD differed from adult IgG4-RD in terms of sex and involved organs. There was no clear male dominance in numbers of cases, and surface organ involvement such as ophthalmic diseases were more common in the pediatric IgG4-RD. Organ involvement tended to be indolent and unilateral, causing difficulty in definitively diagnosing pediatric IgG4-RD. Only about 20% of published cases met IgG4-RD classification or comprehensive diagnostic criteria. Physicians should be careful in diagnosing pediatric IgG4-RD after excluding mimickers. International collaboration toward high-quality evidence to support diagnosis and treatment of pediatric IgG4-RD is advised.
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Affiliation(s)
- Satoshi Hara
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Misaki Yoshida
- Department of Nephrology and Urology, Fukui Red Cross Hospital, Fukui, Fukui, Japan
| | - Hajime Sanada
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Yasunori Suzuki
- Department of Nephrology and Urology, Fukui Red Cross Hospital, Fukui, Fukui, Japan
| | - Yasuharu Sato
- Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Kita-ku, Okayama, Okayama, Japan
| | - Ichiro Mizushima
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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Kersten R, Trampert DC, Herta T, Hubers LM, Maillette de Buy Wenniger LJ, Verheij J, van de Graaf SFJ, Beuers U. IgG4-related cholangitis - a mimicker of fibrosing and malignant cholangiopathies. J Hepatol 2023; 79:1502-1523. [PMID: 37598939 DOI: 10.1016/j.jhep.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
IgG4-related cholangitis (IRC) is the major hepatobiliary manifestation of IgG4-related disease (IgG4-RD), a systemic fibroinflammatory disorder. The pathogenesis of IgG4-RD and IRC is currently viewed as multifactorial, as there is evidence of a genetic predisposition while environmental factors, such as blue-collar work, are major risk factors. Various autoantigens have been described in IgG4-RD, including annexin A11 and laminin 511-E8, proteins which may exert a partially protective function in cholangiocytes by enhancing secretion and barrier function, respectively. For the other recently described autoantigens, galectin-3 and prohibitin 1, a distinct role in cholangiocytes appears less apparent. In relation to these autoantigens, oligoclonal expansions of IgG4+ plasmablasts are present in patients with IRC and disappear upon successful treatment. More recently, specific T-cell subtypes including regulatory T cells, follicular T helper 2 cells, peripheral T helper cells and cytotoxic CD8+ and CD4+ SLAMF7+ T cells have been implicated in the pathogenesis of IgG4-RD. The clinical presentation of IRC often mimics other biliary diseases such as primary sclerosing cholangitis or cholangiocarcinoma, which may lead to inappropriate medical and potentially invalidating surgical interventions. As specific biomarkers are lacking, diagnosis is made according to the HISORt criteria comprising histopathology, imaging, serology, other organ manifestations and response to therapy. Treatment of IRC aims to prevent or alleviate organ damage and to improve symptoms and consists of (i) remission induction, (ii) remission maintenance and (iii) long-term management. Glucocorticosteroids are highly effective for remission induction, after which immunomodulators can be introduced for maintenance of remission as glucocorticosteroid-sparing alternatives. Increased insight into the pathogenesis of IRC will lead to improved diagnosis and novel therapeutic strategies in the future.
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Affiliation(s)
- Remco Kersten
- Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, AGEM, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - David C Trampert
- Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, AGEM, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Toni Herta
- Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, AGEM, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Lowiek M Hubers
- Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, AGEM, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Joanne Verheij
- Department of Pathology, Amsterdam University Medical Centers, the Netherlands
| | - Stan F J van de Graaf
- Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, AGEM, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology & Hepatology, Tytgat Institute for Liver and Intestinal Research, AGEM, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
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IgG4 related pericardium and lung disease in pediatric patient complicated with fatal massive hemoptysis: a case report and review of literature. Pediatr Rheumatol Online J 2023; 21:16. [PMID: 36782218 PMCID: PMC9926825 DOI: 10.1186/s12969-023-00799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a progressive and sometimes fatal disease that rarely affects pediatric age group. It may affect the orbits, lacrimal and salivary glands, pancreas, kidneys, peritoneum and other organs. Lung and pleura are not commonly reported in IgG4-RD. We here present a rare case of pediatric IgG4-RD with rare involvement of pericardium, pleura and lungs. CASE PRESENTATION A 13-year-old girl presented with intrathoracic IgG4-RD with pleuropericardial involvement. She showed initial improvement on prednisolone. Azathioprine and then mycophenolate failed to control relapses during steroid tapering. Her last relapse was treated by rituximab however, the patient developed acute fatal massive hemoptysis. CONCLUSIONS Pediatric IgG4-RD is a rare entity with pericardio-pulmonary affection as the rare of the rare. Usual treatment of prednisolone and steroid sparing agents should be used, with rituximab used as a rescue therapy, but fatal complications may occur.
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Becker EC, Kumar R, Altaf A, Yu Z, Lawrence T, Palle S. Pediatric Autoimmune Pancreatitis: A Single-Center Retrospective Case Series. Pancreas 2023; 52:e144-e150. [PMID: 37523606 DOI: 10.1097/mpa.0000000000002224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Autoimmune pancreatitis (AIP) is a rare form of a chronic, immune-mediated, inflammatory pancreatic condition. There is limited data regarding presentation and outcome in the pediatric population. We described a single-center case series of 4 pediatric patients with AIP to better understand the presentation, symptoms, and outcomes of this rare condition. METHODS Data collected included demographics, serology markers, symptoms at presentation, imaging, additional organ involvement, histology, treatment methods, and outcomes. The diagnosis of AIP was made by a combination of serology, pancreatic imaging, histology, extrapancreatic manifestations, and steroid response. RESULTS All patients were diagnosed with type 2 AIP. Abdominal pain, emesis, and obstructive jaundice were the most common symptoms at presentation. Autoimmune markers were negative. Cross-sectional abdominal imaging showed diffuse/focal pancreatic gland enlargement and common bile duct stricture universally and main pancreatic duct irregularity in half of the patients. Biopsies showed lymphoplasmacytic infiltration with associated pancreatic fibrosis and atrophy. Treatment with an 8-week tapering course of prednisone showed prompt response with resolution of symptoms and normalization of laboratory test results. CONCLUSIONS Our case series shows that AIP in children is a rare entity with a distinct clinical presentation, classical radiographic and histological features with good long-term prognosis.
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Affiliation(s)
- Erica C Becker
- From the Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT
| | - Rakesh Kumar
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Adnan Altaf
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Zhongxin Yu
- Department of Pediatric Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Tony Lawrence
- Department of Pediatric Radiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sirish Palle
- Department of Pediatric Gastroenterology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Bu F, Koo SC. Clinicopathologic Characterization of IgG4-Rich Pediatric Head and Neck Lesions. Arch Pathol Lab Med 2021; 146:611-618. [PMID: 34473213 DOI: 10.5858/arpa.2021-0041-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Immunoglobulin G4 (IgG4)-related disease is rare but well characterized in adults; however, the clinical and histologic manifestations in children may differ. OBJECTIVE.— To review the clinical and histologic features of IgG4-rich head and neck lesions in a pediatric population. DESIGN.— Retrospective search for cases with IgG4 immunohistochemical staining performed at our institution from 2011 to 2019. Review of clinical courses, serology profiles, histologic patterns, and immunohistochemical staining patterns. RESULTS.— Four pediatric IgG4-rich lesions were identified and showed distinct histologic patterns from adult IgG4-related disease, including absence of pathognomonic findings associated with the latter. One case showed intralesional immunoglobulin light-chain restriction. Clinical review showed serum IgG4 elevation in 2 of 4 cases, presence of additional autoantibody positivity, and a generally benign/treatment-responsive clinical course. CONCLUSIONS.— Pediatric IgG4-related disease shows distinct clinical, serologic, and histologic features from its adult counterpart. Pediatric IgG4-related disease involving the orbit has unique clinical characteristics, including frequently normal serum IgG4 levels and female predominance. Awareness and evaluation for these features may improve diagnosis and treatment.
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Affiliation(s)
- Fang Bu
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Bu, Koo).,the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio (Bu, Koo).,Bu is currently at the Department of Pathology and Laboratory Medicine, Children's Minnesota, Minneapolis
| | - Selene C Koo
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Bu, Koo).,the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio (Bu, Koo).,Koo is currently at the Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases. Genes (Basel) 2021; 12:genes12091372. [PMID: 34573354 PMCID: PMC8465218 DOI: 10.3390/genes12091372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel diseases (IBDs) are chronic relapsing inflammatory conditions of the gastrointestinal tract, encompassing Crohn’s disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBD-U). They are currently considered as systemic disorders determined by a set of genetic predispositions, individual susceptibility and environmental triggers, potentially able to involve other organs and systems than the gastrointestinal tract. A large number of patients experiences one or more extraintestinal manifestations (EIMs), whose sites affected are mostly represented by the joints, skin, bones, liver, eyes, and pancreas. Pancreatic abnormalities are not uncommon and are often underestimated, encompassing acute and chronic pancreatitis, autoimmune pancreatitis, exocrine pancreatic insufficiency and asymptomatic elevation of pancreatic enzymes. In most cases they are the result of environmental triggers. However, several genetic polymorphisms may play a role as precipitating factors or contributing to a more severe course. The aim of this paper is to provide an updated overview on the available evidence concerning the etiology, pathogenesis and clinical presentation of pancreatic diseases in IBD pediatric patients.
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Autoimmune pancreatitis in children: A single centre experience in diagnosis, management and long term follow up. Pancreatology 2019; 19:169-176. [PMID: 30455055 DOI: 10.1016/j.pan.2018.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis and data is limited in the paediatric population. We aim to describe in detail a cohort of paediatric patients with AIP including their presentation, investigations that led to their diagnosis, management and long-term follow up. METHODS We retrospectively reviewed the data of 6 patients diagnosed with AIP over an 10-year period. Data including demographics, clinical information, laboratory parameters, serological markers, radiological and histological findings as well as longitudinal follow up were collected. RESULTS Out of the six patients, one was diagnosed with definitive Type 1 AIP, two with definitive Type 2 AIP, two with probable Type 2 AIP and one with suspected Type 2 AIP. Median time of follow up was 3.9 years (range 2.6-10.1). 4 patients had pancreatic biopsies with 2 of these patients showing granulocytic epithelial lesions (GELs). 4 patients received steroids and two of them developed ulcerative colitis. Azathioprine was commenced on the patient with Type 1 AIP to help her wean off steroids that caused significant side effects on her. Only two patients developed exocrine insufficiency. CONCLUSIONS The long term follow up of our cohort of paediatric AIP shows good prognosis. More follow up data on patients with AIP is needed to help further characterize and define the disease.
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Gouveia CI, Oliveira L, Campos AP, Cabral J. Autoimmune pancreatitis with associated ulcerative colitis in a teenager. BMJ Case Rep 2018; 11:11/1/e227888. [PMID: 30567253 DOI: 10.1136/bcr-2018-227888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Autoimmune pancreatitis (AIP) is a rare entity that is extremely uncommon in children. Its diagnosis is also a clinical challenge. This form of chronic pancreatitis often presents itself with obstructive jaundice and/or a pancreatic mass and it is sometimes misdiagnosed as pancreatic cancer. We describe the case of a 13-year-old boy with obstructive jaundice and a 4 cm mass in the head of the pancreas that was diagnosed as AIP with associated ulcerative colitis.
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Affiliation(s)
| | - Laura Oliveira
- Department of Paediatric Gastroenterology Unit, Hospital Dona Estefania, Lisboa, Portugal
| | - António P Campos
- Department of Paediatric Gastroenterology Unit, Hospital Dona Estefania, Lisboa, Portugal
| | - José Cabral
- Department of Paediatric Gastroenterology Unit, Hospital Dona Estefania, Lisboa, Portugal
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Gui H, You J, Liu D, Liu S, Wang X, Liu L. IgG4 positive autoimmune pancreatitis: report of a case and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:2160-2164. [PMID: 31938327 PMCID: PMC6958195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/25/2017] [Indexed: 06/10/2023]
Abstract
Autoimmune pancreatitis (AIP) is a rare chronic pancreatitis and the incidence is increasing recently. However, the formal report of this disease is still rare in literatures. Here, we reported a rare case of IgG4 positive autoimmune pancreatitis to make the awareness of this type of disease. The patient was a 58-year-old Chinese male who was suffered from epigastric pain accompanied by nausea and vomiting. An occupying lesion was detected in the body of the pancreas tail with the ultrasound examination. The serum IgG4 levels, white blood cells, blood amylase and the γ-globulin fraction were all increased. After operation, the following pathological detection with immunochemistry test confirmed the diagnosis of autoimmune pancreatitis.
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Affiliation(s)
- Huawei Gui
- Department of Pathology, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Jian You
- Department of General Surgery, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Dongling Liu
- Department of Pathology, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Song Liu
- Department of Radiology, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Xuming Wang
- Department of Histopathology, Jiangda Pathology Institute, Jianghan UniversityWuhan, Hubei Province, P. R. China
| | - Lijiang Liu
- Department of Histopathology, Jiangda Pathology Institute, Jianghan UniversityWuhan, Hubei Province, P. R. China
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Cousin E, Cousin I, Aziz K, Chailloux P, Breton E. Autoimmune Pancreatitis and Ulcerative Rectocolitis in an Adolescent. Pediatrics 2018; 141:S456-S461. [PMID: 29610171 DOI: 10.1542/peds.2016-0765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/24/2022] Open
Abstract
Autoimmune pancreatitis (AIP) is rare in teenagers and difficult to diagnose. There are no clear and established diagnostic criteria in the pediatric population to distinguish subtype 1 and subtype 2. Here, we report the case of a 16-year-old white French teenager admitted to the pediatric emergency service with more than 1 year's history of pain originating from the epigastric and the right hypochondriac regions, with bloody diarrhea. After exclusion of pancreatic cancer and other common causes of acute pancreatitis, the diagnosis of AIP was suspected. Biological analyses revealed acute pancreatitis with severe cholestasis and an elevated level of serum immunoglobulin G4. Magnetic resonance cholangiography revealed a voluminous pancreas presenting a typical "sausage-like" aspect. Anatomopathological analyses of the liver biopsy specimen revealed a biliary obstruction due to pancreatic involvement without the typical aspect of chronic destructive cholangitis. Corticotherapy and immunosuppressive treatment proved effective after 1 week of treatment. Without a pancreatic biopsy specimen, the distinction between AIP type 1 and 2 could not be made clearly in this case. The succession of clinical observations could allow clinicians to recognize, treat, and manage AIP in children.
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Affiliation(s)
| | - Ianis Cousin
- Department of Pediatric Surgery, Brest University Hospital, Brest, France
| | - Karim Aziz
- Gastroenterology, Saint-Brieuc Hospital, Saint-Brieuc, France; and
| | - Pascal Chailloux
- Gastroenterology, Saint-Brieuc Hospital, Saint-Brieuc, France; and
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Scheers I, Palermo JJ, Freedman S, Wilschanski M, Shah U, Abu-El-Haija M, Barth B, Fishman DS, Gariepy C, Giefer MJ, Heyman MB, Himes RW, Husain SZ, Lin TK, Liu Q, Lowe M, Mascarenhas M, Morinville V, Ooi CY, Perito ER, Piccoli DA, Pohl JF, Schwarzenberg SJ, Troendle D, Werlin S, Zimmerman B, Uc A, Gonska T. Autoimmune Pancreatitis in Children: Characteristic Features, Diagnosis, and Management. Am J Gastroenterol 2017; 112:1604-1611. [PMID: 28374818 PMCID: PMC5908471 DOI: 10.1038/ajg.2017.85] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Autoimmune pancreatitis (AIP) is an increasingly recognized disease entity, but data in children are limited. AIP presentation and outcome in children might differ from the adult experience. We aim to determine the characteristic features of AIP in children. METHODS Data about clinical symptoms, imaging, histology, and treatment were collected using two sources: (i) a systematic literature search and (ii) the INSPPIRE database, the largest international multicenter study of pancreatitis in children and the Cliniques Universitaires St-Luc (CUSL) registry. RESULTS We identified 48 AIP cases: 30 from literature review, 14 from INSPPIRE, and 4 from CUSL. The median age at diagnosis was 13 years (range 2-17 years). Abdominal pain (43/47, 91%) and/or obstructive jaundice (20/47, 42%) were the most common symptoms at diagnosis. Elevated serum IgG4 levels were only observed in 9/40 (22%) children. Cross-sectional imaging studies were abnormal in all children including hypointense global or focal gland enlargement (39/47, 83%), main pancreatic duct irregularity (30/47, 64%), and common bile duct stricture (26/47, 55%). A combination of lymphoplasmacytic inflammation, pancreatic fibrosis, and ductal granulocyte infiltration were the main histological findings (18/25, 72%). Children with AIP had a prompt clinical response to steroids. Complications of AIP included failure of exocrine (4/25, 16%) and endocrine (3/27, 11%) pancreas function. CONCLUSIONS Pediatric AIP has a distinct presentation with features similar to type 2 AIP in adults. This comprehensive report on the largest group of children with AIP to date is expected to help with the diagnosis and management of this disease and pave the way for future research studies.
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Affiliation(s)
- Isabelle Scheers
- Hospital for Sick Children, Toronto, Ontario, Canada,Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Joseph J. Palermo
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Steven Freedman
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Uzma Shah
- Harvard Medical School, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | | | - Bradley Barth
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | | | | | | | - Melvin B. Heyman
- University of California at San Francisco, San Francisco, California, USA
| | | | - Sohail Z. Husain
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Tom K. Lin
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Quin Liu
- Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mark Lowe
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Maria Mascarenhas
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Chee Y. Ooi
- Discipline of Paediatrics, School of Women’s and Children’s Health, Medicine, University of New South Wales and Sydney Children’s Hospital Randwick, Sydney, New South Wales, Australia
| | - Emily R. Perito
- University of California at San Francisco, San Francisco, California, USA
| | - David A. Piccoli
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - David Troendle
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Steven Werlin
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Aliye Uc
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tanja Gonska
- Hospital for Sick Children, Toronto, Ontario, Canada
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12
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Thompson A, Whyte A. Imaging of IgG4-related disease of the head and neck. Clin Radiol 2017; 73:106-120. [PMID: 28501095 DOI: 10.1016/j.crad.2017.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
IgG4-related disease is a systemic, inflammatory disorder typically involving multiple organ systems. Several eponymous conditions described previously in the clinical and radiology literature are now recognised to be part of the IgG4-related disease spectrum. This includes multiple manifestations in the head and neck region, which are the subject of this review. Imaging can occasionally suggest the specific diagnosis of IgG4 disease. More commonly, it will be included in a limited differential diagnosis that requires clarification with the aid of image-guided biopsy. There are strict histopathological criteria for the diagnosis of IgG4-related disease.
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Affiliation(s)
- A Thompson
- Neurological Intervention and Imaging Service Western Australia, Level 1, G Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Neurological Intervention and Imaging Service Western Australia, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia; Princess Margaret Hospital for Children, Roberts Road, Subiaco, WA 6008, Australia.
| | - A Whyte
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, WA 6008, Australia; School of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; Department of Medicine and Radiology, University of Melbourne, Parkville, VIC 3010, Australia
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13
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Martín-de-Carpi J, Moriczi M, Pujol-Muncunill G, Navas-López VM. Pancreatic Involvement in Pediatric Inflammatory Bowel Disease. Front Pediatr 2017; 5:218. [PMID: 29075621 PMCID: PMC5641548 DOI: 10.3389/fped.2017.00218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/25/2017] [Indexed: 12/26/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic condition that includes two clinical entities: Crohn's disease and ulcerative colitis. Although both entities mainly affect the gastrointestinal tract are considered multisystemic diseases and may present extraintestinal manifestations involving other organs and systems. Pancreatic involvement in Pediatric IBD includes a heterogeneous group of clinical entities like acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, asymptomatic exocrine pancreatic insufficiency, increased pancreatic enzyme levels, structural abnormalities, and granulomatous inflammation. Although the mechanism for pancreatic involvement in IBD is not clearly elucidated, is important to keep in mind the association of these two entities in order to perform a prompt diagnosis and establish an appropriate treatment. The objective of this review is to update the available evidence on pancreatic involvement in children with IBD.
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Affiliation(s)
- Javier Martín-de-Carpi
- Unit for the Comprehensive Care of Paediatric Inflammatory Bowel Disease, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Melinda Moriczi
- Pediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain
| | - Gemma Pujol-Muncunill
- Unit for the Comprehensive Care of Paediatric Inflammatory Bowel Disease, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Victor M Navas-López
- Pediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain.,IBIMA, Biomedical Institute of Málaga, Málaga, Spain
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