Immune Checkpoint Inhibitor-induced Pancreatitis with Pancreatic Enlargement Mimicking Autoimmune Pancreatitis: A Case Report and Review of the Literature

Intern Med. 2024 Mar 15;63(6):791-798. doi: 10.2169/internalmedicine.1943-23. Epub 2023 Aug 2.

Abstract

A 61-year-old woman was administered 35 cycles of pembrolizumab for the treatment of recurrent endometrial cancer, achieving a complete response. She presented with asymptomatic pancreatic enlargement and elevated hepatobiliary enzymes, but amylase and lipase levels were within the normal ranges. Intrapancreatic bile duct stenosis due to pancreatic enlargement was present, mimicking autoimmune pancreatitis on computed tomography performed before the onset of clinical manifestations. A histological examination of a biopsy specimen showed lymphocyte and plasma cell infiltration with dense fibrosis in the stroma. The patient was successfully treated with oral prednisolone. There were no manifestations of recurrent pancreatitis after tapering the prednisolone dose.

Keywords: ICI-induced pancreatitis; autoimmune pancreatitis; immune checkpoint inhibitors; pancreatitis; pembrolizumab.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Autoimmune Diseases* / chemically induced
  • Autoimmune Diseases* / diagnosis
  • Autoimmune Diseases* / drug therapy
  • Autoimmune Pancreatitis*
  • Female
  • Humans
  • Hypertrophy
  • Immune Checkpoint Inhibitors
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Pancreatitis* / diagnosis
  • Pancreatitis* / diagnostic imaging
  • Prednisolone / therapeutic use

Substances

  • Immune Checkpoint Inhibitors
  • Prednisolone