Biliary Involvement in Type 2 Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP) is a rare condition classified in 2 subtypes. Their distinction relies on a combination of clinical, serological, morphological and histological features. Type 1 is a pancreatic manifestation of IgG4-related disease characterized by multiorgan infiltration by IgG4 plasmocytes. In this condition, hepatobiliary infiltration is frequent and often mimics cholangiocarcinoma or primary sclerosing cholangitis. On the other hand, type 2 is commonly limited to the pancreas. Herein, we describe the case of a patient who presented a type 2 AIP associated with cholangiopathy, a condition not described in the established criteria. He first developed a pancreatitis identified as type 2 by the typical histopathological features and lack of IgG4 in the serum and tissue. Despite a good clinical response to steroids, cholestasis persisted, identified by MR cholangiography as a stricture of the left hepatic duct with dilatation of the intrahepatic bile duct in segments 2 and 3. Biliary cytology was negative. Evolution was favorable but after steroid tapering a few months later, the patient suffered from recurrence of the pancreatitis as well as progression of biliary attempt, suspicious for cholangiocarcinoma. As the investigations again ruled out neoplastic infiltration or primary sclerosing cholangitis, azathioprine was initiated with resolution of both pancreatic and biliary attempts

Clinical Course and Management of Iatrogenic Cushing’s Syndrome after Co-Administration of Injected-Triamcinolone and Ritonavir: a Systematic Review

Iatrogenic Cushing Syndrome (ICS) has been reported after co-administration of injectedtriamcinolone and ritonavir. Clinical evolution is however poorly described and recommendations on how to manage this drug-drug interaction are lacking. Methods: We performed a systematic review of all reported cases of ICS exploring Pubmed, Embase, Cochrane library, and articles references. Time to Hypothalamic-Pituitary-Adrenal (HPA) axis recovery for patients with or without ritonavir interruption, was compared in a Cox model adjusted for confounding factors