PMC10315465_01
Single-shot fast spin-echo MRI sequence showing diffuse inflammatory infiltration of the pancreas (A). Endosonographic image showing massive hypoechoic swelling, multiple interlobular septa, and diameter changes (B).
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An abdominal MRI ordered by the patient's general practitioner was performed two weeks before presentation and revealed diffuse inflammatory infiltration of the pancreas, without exudates, necrosis, or focal lesions ( Figure 1 ). Figure 1 ). Fine-needle biopsy revealed unspecific chronic inflammatory infiltrates without signs of fibrosis or malignancy.
PMC10315465_02
Timeline of immunosuppressive treatment regimen and associated glutamate pyruvate transaminase (GPT) and lipase levels. Dashed lines indicate respective upper limits.
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We responded by adding supportive immunosuppression through azathioprine, which eventually had to be discontinued due to a rise in liver enzymes ( Figure 2 ) as well as abdominal pain and nausea. Unfortunately, the patient then had another flare of steatorrhea associated with a dramatic increase in lipase ( Figure 2 ).
PMC10315465_03
PMC10315465_04
Sonographic images of the pancreatic body showing diffuse hypoechoic swelling upon admission (A), which decreased under steroid treatment (B) and 11 months after the first dose of vedolizumab (C).
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Follow-up sonography was unremarkable for signs of inflammation as seen upon initial presentation ( Figure 3 ).