An atypical case with recurrent episodes of pancreatitis: is eosinophilic pancreatitis a diagnosis or a mimic in the spectrum of IgG4-related diseases? A case-based review : Eosinophilic pancreatitis or IGG4-releated disease.

Authors

Burak Okyar, Süha Göksel, Ceren Korkmaz, Okan Dilek, Çağla Okyar, Zeynep Tüzün, Servet Yüce, Emine Duygu Ersözlü

Published in

Clinical journal of gastroenterology. Sep 06, 2026. Epub Sep 06, 2026.

Abstract

Eosinophilic pancreatitis (EP) is a rare disorder characterized by prominent pancreatic eosinophilic infiltration and often associated with peripheral eosinophilia and elevated IgE. IgG4-related disease (IgG4-RD) may involve the pancreas as type 1 autoimmune pancreatitis, with lymphoplasmacytic infiltration, storiform fibrosis, and increased IgG4-positive plasma cells. Both can mimic pancreatic malignancy. We report a 43-year-old man who underwent distal pancreatectomy in 2016 for suspected cancer and later experienced three episodes of acute pancreatitis. In 2024, modest serum IgG4 elevation (304 mg/dL; reference range, 3-201 mg/dL) and persistent monocytosis prompted re-evaluation of the surgical specimen. Histology showed dense, patchy eosinophilic infiltration with microabscesses and non-storiform fibrosis, while IgG4-positive plasma cells were sparse. These findings favored EP over type 1 autoimmune pancreatitis. This case highlights that EP may occur without peripheral eosinophilia, mimic malignancy and IgG4-RD, and require re-examination of archival tissue. Careful clinicopathological correlation is therefore essential to avoid diagnostic delay and misclassification.

PMID:
42701935
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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