[Eosinophilic pancreatitis and autoimmune pancreatitis: comparison, differential diagnosis, and treatment]

Mauro Turrin, Sergio Martinelli

DOI: https://doi.org/10.7175/cmi.v11i1.1295


Among the rarest causes of acute pancreatitis, there are eosinophilic pancreatitis (EP) and autoimmune pancreatitis (AIP). They share some features, such as the low frequency and the association with systemic disorders. Their diagnostic criteria, mainly clinical and laboratory, are different, but both require histological confirmation in most cases: in fact, pancreas is enlarged at CT scan, with tumor-like appearance.

Here we discuss the importance of hypereosinophilia in EP and IgG increase in type 1 AIP (included in IgG-related systemic diseases). Differential diagnosis with pancreatic neoplasms and therapy schedules are discussed as well.


Acute pancreatitis; Eosinophilic pancreatitis; Autoimmune pancreatitis; IgG4-related disease

Full Text



  • Orphanet. I quaderni di Orphanet, Dicembre 2016. http://www.orpha.net (ultimo accesso marzo 2017)
  • Sheikh RA, Prindiville TP, Pecha RE, et al. Unusual presentations of eosinophilic gastroenteritis: case series and review of literature. World J Gastroenterol 2009; 15: 2156-61; https://doi.org/10.3748/wjg.15.2156
  • Cay A, Imamoglu M, Cobanoglu U. Eosinophilic pancreatitis mimicking pancreatic neoplasia. Can J Gastroenterol 2006, 20: 361-4; https://doi.org/10.1155/2006/386918
  • Euscher E, Vaswani K, Frankel W. Eosinophilic pancreatitis: a rare entity that can mimic a pancreatic neoplasm. Ann Diagn Pathol 2000; 4: 379-85; https://doi.org/10.1053/adpa.2000.19371
  • Christopher V, Thompson MH, Hughes S. Eosinophilic gastroenteritis mimicking pancreatic cancer. Postgrad Med J 2002; 78: 498-9; https://doi.org/10.1136/pmj.78.922.498
  • Rakesh K, Banerjee R, Gupta R, et al. Eosinophilic pancreatitis with pseudocyst. Indian J Gastroenterol 2007; 26: 136-7
  • Polyak S, Smith TA, Mertz H. Eosinophilic gastroenteritis causing pancreatitis and pancreaticobiliary ductal dilation. Dig Dis Sci 2002; 47: 1091-5; https://doi.org/10.1023/A:1015046309132
  • Abraham SC, Leach S, Yeo CJ, et al. Eosinophilic pancreatitis and increased eosinophils in the pancreas. Am J Surg Pathol 2003; 27: 334-42; https://doi.org/10.1097/00000478-200303000-00006
  • Barthet M, Hastier P, Buckley MJ, et al. Eosinophilic pancreatitis mimicking pancreatic neoplasia: EUS and ERCP findings - is non-surgical diagnosis possible? Pancreas 1998; 17: 419-22; https://doi.org/10.1097/00006676-199811000-00014
  • Sah RP, Pannala R, Zhang L, et al. Eosinophilia and allergic disorders in autoimmune pancreatitis. Am J Gastroenterol 2010; 105: 2485-91; https://doi.org/10.1038/ajg.2010.236
  • Bastid C, Sahel J, Choux R, et al. Eosinophilic pancreatitis: report of a case. Pancreas 1990; 5: 104-7; https://doi.org/10.1097/00006676-199001000-00016
  • Tokoo M, Oguchi H, Kawa S, et al. Eosinophilia associated with chronic pancreatitis: an analysis of 122 patients with definite chronic pancreatitis. Am J Gastroenterol 1992; 87: 455-60
  • Song JW, Kim MH, Seo WJ, et al. A case of eosinophilic pancreatitis. Korean J Gastroenterol 2003; 42: 444-49
  • Stevens T, Mackey R, Falk GW, et al. Eosinophilic pancreatitis presenting as a pancreatic mass with obstructive jaundice. Gastrointest Endosc 2006; 63: 525-7; https://doi.org/10.1016/j.gie.2005.10.005
  • Kakodkar S, Omar H, Cabrera J, et al. Eosinophilic pancreatitis diagnosed with endoscopic ultrasound. ACG Case Reports Journal 2015; 2: 240-1; https://doi.org/10.14309/crj.2015.71
  • Tian L, Fu P, Dong X, et al. Eosinophilic pancreatitis: three case reports and literature review. Mol Clin Oncol 2016; 4: 559-62; https://doi.org/10.3892/mco.2016.760
  • Caglar E, Karismaz K, Dobrucali A. A case of eosinophilic gastroenteritis mimicking gastric lymphoma associated with pancreatitis due to duodenal involvement. Turk J Gastroenterol 2012; 23: 585-9; https://doi.org/10.4318/tjg.2012.0436
  • Lyngbaek S, Adamsen S, Aru A, et al. Recurrent acute pancreatitis due to eosinophilic gastroenteritis. Case report and literature review. JOP 2006; 7: 211-7
  • Le Connie D, Nguyen H. Eosinophilic gastroenteritis, ascites, and pancreatitis: a case report and review of the literature. South Med J 2004; 905-6; https://doi.org/10.1097/01.SMJ.0000139403.55785.1C
  • Maeshima A, Murakami H, Sadkata H, et al. Eosinophilic gastroenteritis presenting with acute pancreatitis. J Med 1997; 28: 265-72
  • Baek MS, Mok YM, Han W-C, et al. A patient with eosinophilic gastroenteritis presenting with acute pancreatitis and ascites. Gut Liver 2014; 8: 224-7; https://doi.org/10.5009/gnl.2014.8.2.224
  • Zhu B, Bai H, Wu Y. A patient with eosinophilic gastroenteritis presenting with acute pancreatitis. Zhonghua Er Ke Za Zhi (Chinese Journal of Pediatrics) 2015; 53: 542-3; doi.med.wanfangdata.com.cn/10.3760/cma.j.issn.0578-1310.2015.07.015
  • Wang Q, Lu CM, Guo T, et al. Eosinophilia associated with chronic pancreatitis. Pancreas 2009; 38: 149-53
  • Tilkemeier P, Thompson RD. Acute pancreatitis possibly related to enalapril. N Engl J Med 1988; 12: 1275-6
  • Martin T, Taupignon A, Graf E, et al. Pancreatitis and hepatitis in a patient treated with enalapril maleate. A case report. Therapie 1989; 44: 449-50
  • Gonzalèz Ramallo VJ, Muiňo Miguez A, Torre Segovia FJ. Necrotizing pancreatitis and enalapril. Eur J Med 1992; 1: 123
  • Maringhini A, Termini A, Patti R, et al. Enalapril-associated acute pancreatitis: recurrence after rechallenge. Am J Gastroenterol 1997; 92: 166-7
  • Carnovale A, Esposito P, Bassano P, et al. Enalapril-induced acute recurrent pancreatitis. Dig Liver Dis 2003; 35: 55-7; https://doi.org/10.1016/S1590-8658(02)00012-9
  • Kanbay M, Selcuk H, Yilmaz U, et al. Recurrent acute pancreatitis probably secondary to lisinopril. South Med J 2006; 99: 1388-9; https://doi.org/10.1097/01.smj.0000251413.20573.ad
  • Maliekal J, Drake CF. Acute pancreatitis associated with the use of lisinopril. Ann Pharmacother 1993; 27: 1465-6; https://doi.org/10.1177/106002809302701211
  • Gershon T, Olshaker JS. Acute pancreatitis following lisinopril rechallenge. Am J Emerg Med 1998; 16: 523-4; https://doi.org/10.1016/S0735-6757(98)90009-2
  • Kanbay M, Korkimaz M, Yimaz U, et al. Acute pancreatitis due to ramipril therapy. Postgrad Med J 2004; 80: 617-8; https://doi.org/10.1136/pgmj.2003.018119
  • Famularo G, Minisola G, Nicotra GD, et al. Acute pancreatitis associated with irbesartan therapy. Pancreas 2005; 13: 294-5; https://doi.org/10.1097/01.mpa.0000178281.58158.64
  • Fisher AA, Bassett ML. Acute pancreatitis associated with angiotensin II receptor antagonists. Ann Pharmacother 2002; 36: 1883-6; https://doi.org/10.1345/1542-6270(2002)036<1883:APAWAI>2.0.CO;2; https://doi.org/10.1345/aph.1C099
  • Cann B, Sali M, Batman A, et al. Valsartan-induced acute pancreatitis. Inter Med 2014; 53: 703-5; https://doi.org/10.2169/internalmedicine.53.0667
  • Kaurich T. Drug-induced acute pancreatitis. Proc (Bayl Univ Med Cent) 2008; 21: 77-81
  • Kuoppala J, Pulkkinen J, Kastannen H, et al. Use of statins and the risk of acute pancreatitis: a population-based case-control study. Pharmacoepidemiol Drug Saf 2015; 24: 1085-92; https://doi.org/10.1002/pds.3858
  • DeVries JH, Rosenstok J. DPP-4 inhibitor-related pancreatitis: rare but real! Diabetes Care 2017; 40: 163-4; https://doi.org/10.2337/dci16-0035
  • Badalov N, Baradarian R, Iswara K, et al. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol 2007; 5: 648-61
  • Bosch X. Losartan-induced acute pancreatitis. Ann Intern Med 1997; 127: 1043-4; https://doi.org/10.7326/0003-4819-127-11-199712010-00031
  • Birck R, Keim V, Fiedler F, et al. Pancreatitis after losartan. Lancet 1998; 351: 1178; https://doi.org/10.1016/S0140-6736(05)79122-4
  • Arellano L, Altaba A, Santamaria C, et al. Acute pancreatitis in a patient treated with losartan. Aten Primaria 2014; 46: 316-7; https://doi.org/10.1016/j.aprim.2014.02.003
  • Tkàč I, Raz I. Combined analysis of three large interventional trials with gliptins indicates increased incidence of acute pancreatitis in patients with type 2 diabetes. Diabetes Care 2017; 40: 284-6; https://doi.org/10.2337/dc15-1707
  • Guler S, Cimen S, MacDonald F, et al. Eosinophilic pancreatitis. In: Di Giovanni G, Marcoz P (a cura di). Rare Diseases. New York (NY): Nova Science Publishers, 2014
  • Gullo L, Golfieri R, Orcioni GE, et al. Multivisceral eosinophilic fibrosis: a new clinical presentation. Eur J Gastroenterol Hepatol 2000; 12: 1037-9; https://doi.org/10.1097/00042737-200012090-00014
  • Stone JH, Khosroshahi A, Deshpande V, et al. Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations. Arthritis Rheum 2012; 64: 3061-7; https://doi.org/10.1002/art.34593
  • Chari ST, Takahashi N, Levy MJ, et al. A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol 2009; 7: 1097-103
  • Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 2011; 40: 352-8
  • Rana A, Yadav D, Kresinskas AM, et al. Evaluation and management of autoimmune pancreatitis: experience at a large US center. Am J Gastroenterol 2009; 104: 2295-306; https://doi.org/10.1038/ajg.2009.325
  • Kanno A, Masamune A, Fujishima F, et al. Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study. Gastrointest Endosc 2016; 84: 797-804; https://doi.org/10.1016/j.gie.2016.03.1511
  • Ghazale A, Chari S. Is autoimmune pancreatitis a risk factor for pancreatic cancer? Pancreas 2007; 35: 376; https://doi.org/10.1097/MPA.0b013e318073ccb8
  • Frulloni L, Lunardi C, Simone R, et al. Identification of a novel antibody associated with autoimmune pancreatitis. N Engl J Med 2009; 361: 2135-42; https://doi.org/10.1056/NEJMoa0903068
  • Hirano K, Tada M, Isayama H, et al. Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment. Gut 2007; 56: 1719-24; https://doi.org/10.1136/gut.2006.115246
  • Moon SH, Kim HM, Park DH, et al. Is a 2-week steroid trial after initial negative investigation for malignancy useful in differentiating autoimmune pancreatitis from pancreatic cancer? A prospective outcome study. Gut 2008; 57: 1704; https://doi.org/10.1136/gut.2008.150979
  • Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology 2008; 134: 706-15; http://dx.doi.org/10.1053/j.gastro.2007.12.009
  • Hart PA, Topazian MD, Witzig TE, et al. Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience. Gut 2013; 62: 1607-15; https://doi.org/10.1136/gutjnl-2012-302886
  • Okazaki K, Chari ST, Frulloni L, et al. International consensus for the treatment of autoimmune pancreatitis. Pancreatology 2017; 17: 1-6; https://doi.org/10.1016/j.pan.2016.12.003
  • Khosroshahi A, Wallace ZS, Crowe JL, et al. International consensus guidance statement on the management and treatment of IgG4-related disease. Arthritis Rheum 2015; 67: 1688-99; https://doi.org/10.1002/art.39132
  • Della-Torre E, Campochiaro C, Bozzolo EP, et al. Methotrexate for maintenance of remission in IgG4-related disease. Rheumatology 2015; 54; 1934-6; https://doi.org/10.1093/rheumatology/kev244


Abstract: 1849 views
HTML: 3581 views
PDF: 1830 views


  • There are currently no refbacks.