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My 7 Year Old Had 2 Incidents Of Pancreatitis In
Question: My 7 year old had 2 incidents of pancreatitis in January coupled with a finding of a syrinx, scoliosis, and development of urinary incontinence. Her GI assumed a viral cause for pancreatitis because MRI and ultrasound revealed nothing abnormal with the pancreas, bile ducts, or gallbladder. Her lipase was in excess of 900 at the last incident falling to 475 2 weeks after. 4 months later the lipase is back up to 450. Her erythrocyte sedimentation rate has consistently been above 60. Her c reactive protein 2 months after was .2 mg/dL and has climbed to 1.5 mg/dL over the last two months. Her red blood cell count fluctuates between 3.74 to 4.17, and she has had trace leukocytes in her 2 urinalysis. She has had eczema and poor tooth health her whole life. She is under medical care between a neurosurgeon, GI, and pediatrician but no one has any idea what is going on.
Brief Answer:
Could be autoimmune pancreatitis
Detailed Answer:
Thanks for using the Ask a Doctor service.
I have gone carefully through your query and understand your concerns. I have checked the attached reports. You have confirmed that the child has been having eczema all throughout her life. Eczema is an autoimmune reaction. It means that due to incorrect marking of suspicious targets the body lands up attacking ownself and causing damage. The same thing can involve the pancreas as well and lead to what is known as autoimmune pancreatitis (AIP) and involves chronic inflammation of the pancreas. Since the attack is at microscopic level, the macroscopic or overall structures remain unaffected and therefore MRI is likely to remain unaffected. Sometimes enlargement of the pancreas may be seen. Since it has a distinctive appearance easily recognized under a microscope, an endoscopic core biopsy can be helpful but is often not conclusive. Increased IgG4+ plasma cells is observed and serum IgG4 levels usually are elevated but only the type 1 variant of the disease. Detecting these can aid the diagnosis. However, no single test or characteristic feature identifies autoimmune pancreatitis.
Symptoms of autoimmune pancreatitis often improve after a short course of prednisolone. Many people respond quickly, even dramatically so I would insist you to discuss with your treating physician about this modality of treatment. Take precautions against infections like drink cleaner water.
Feel free to write back.
Regards
Could be autoimmune pancreatitis
Detailed Answer:
Thanks for using the Ask a Doctor service.
I have gone carefully through your query and understand your concerns. I have checked the attached reports. You have confirmed that the child has been having eczema all throughout her life. Eczema is an autoimmune reaction. It means that due to incorrect marking of suspicious targets the body lands up attacking ownself and causing damage. The same thing can involve the pancreas as well and lead to what is known as autoimmune pancreatitis (AIP) and involves chronic inflammation of the pancreas. Since the attack is at microscopic level, the macroscopic or overall structures remain unaffected and therefore MRI is likely to remain unaffected. Sometimes enlargement of the pancreas may be seen. Since it has a distinctive appearance easily recognized under a microscope, an endoscopic core biopsy can be helpful but is often not conclusive. Increased IgG4+ plasma cells is observed and serum IgG4 levels usually are elevated but only the type 1 variant of the disease. Detecting these can aid the diagnosis. However, no single test or characteristic feature identifies autoimmune pancreatitis.
Symptoms of autoimmune pancreatitis often improve after a short course of prednisolone. Many people respond quickly, even dramatically so I would insist you to discuss with your treating physician about this modality of treatment. Take precautions against infections like drink cleaner water.
Feel free to write back.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your reply Dr. Diptanshu XXXXXXX
Her IgG was pulled and had abnormal range for subclass 1; however, this was over a month after the pancreatic incident. Is it possible that IgG 4 dropped since the incident? I have attached those results.
Her IgG was pulled and had abnormal range for subclass 1; however, this was over a month after the pancreatic incident. Is it possible that IgG 4 dropped since the incident? I have attached those results.
Brief Answer:
The steroid treatment should definitely be tried
Detailed Answer:
Thanks for the response. I have checked the attached IgG 4 report (including the other subtypes). As mentioned earlier, it is possible that in her type the IgG4 is not raised at all (so the question of dropping does not arise, although it is possible). I would insist on trying the steroid treatment no matter what. Discuss with your treating physician.
Regards
The steroid treatment should definitely be tried
Detailed Answer:
Thanks for the response. I have checked the attached IgG 4 report (including the other subtypes). As mentioned earlier, it is possible that in her type the IgG4 is not raised at all (so the question of dropping does not arise, although it is possible). I would insist on trying the steroid treatment no matter what. Discuss with your treating physician.
Regards
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Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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