Eosinophilic pancreatitis K86.1

Eosinophilic pancreatitis (EP) is a rare form of chronic pancreatitis, of unknown aetiology, characterised by localised or diffuse eosinophilic infiltration of the pancreas and elevated serum immunoglobulin E levels, excluding reactive and otherwise known causes of tissue or haematoeosinophilia. The diagnosis is often made only after pancreatic resection for suspected pancreatic tumor (Euscher E et al 2000). It may occur in the setting of eosinophilic gastroenteritis or hypereosinophilic syndrome (Manohar M et al. 2020).

The cause of eosinophilic pancreatitis (EP) is not clear. The usual triggers of eosinophilia are not present as causes. They must be excluded (e.g. worm diseases).

It mostly affects younger and middle-aged people and both sexes.

The symptoms are non-specific and may indicate both (non-eosinophilic) chronic pancreatitis and pancreatic carcinoma. In the foreground are nausea, weight loss, abdominal pain, icterus.

The starting point for diagnosis is the "tumor mass" (tumor-like enlargement of the organ), which is detected sonographically or on CT. Often, pancreatic carcinoma is the first suspected diagnosis. The bile duct is compressed by the pancreatic tissue, so that an icterus can develop due to bile stasis (cholestatic icterus, occlusive icterus).

An increase in eosinophilic leukocytes in the blood is common. IgE is also found to be elevated (Manohar M et al 2020).

Other organs especially of the gastrointestinal tract may also be involved in the eosinophilic inflammatory process. In a review that included 45 patients, 20 sufferers with eosinophilic gastroenteritis developed pancreatitis, 20/45 had isolated eosinophilic pancreatitis. In 5/45, hypereosinophilic syndrome with pancreatic involvement was detectable (Pinte L et al 2019). In this respect, endoscopic examinations of the gastrointestinal tract (gastroduodenoscopy, colonoscopy) should be included in the diagnosis.

Diffuse, periductal, acinar and septal inflammatory infiltrates consisting of a pure or predominant population of eosinophils. Furthermore, eosinophilic phlebitis and arteritis as well as localized eosinophilic infiltrates with pseudocyst formation (Reppucci J et al. 2017).

Final diagnosis by histological examination

Often pancreatic carcinoma is the most important differential diagnosis

Inmany cases a surgical resection is performedbecause of a pancreatic carcinoma which cannot be excluded. A conservative therapy would be sufficient. It is carried out by a systemically applied glucocorticoid. However, the diagnosis must be ensured by a representative fine needle biopsy. Mild icterus is regressive under this therapy.

Chronic recurrent course.

1. Euscher E et al. (2000) Eosinophilic pancreatitis: a rare entity that can mimic a pancreatic neoplasm. Ann Diagn Pathol 4:379-385.
2. Manohar M et al (2020) Eosinophilic pancreatitis: a rare or unexplored disease entity? Prz Gastroenterol 15:34-38.
3. Pinte L et al.(2019) Eosinophilic pancreatitis versus pancreatitis associated with eosinophilic gastroenteritis - a systematic review regarding clinical features and diagnosis. Rome J Intern Med. 57: 284-295
4. Reppucci J et al (2017) Eosinophilic pancreatitis: A Rare Cause of Recurrent Acute Pancreatitis. Case Rep Gastroenterol 11:120-126.
5. Tian L et al. (2016) Eosinophilic pancreatitis: Three case reports and literature review. Mol Clin Oncol 4:559-562.