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Reply to the comment on “Atypical retroperitoneal fibrosis associated with biliary stricture: IgG4-related sclerosing disease?” by Matsushita et al.

Reply to the comment on “Atypical retroperitoneal fibrosis associated with biliary stricture: IgG4-related sclerosing disease?” by Matsushita et al.

Abstract

Scandinavian Journal of Gastroenterology, 2009; 44: 1152 CORRESPONDENCE Reply to the comment on ‘‘Atypical retroperitoneal fibrosis associated with biliary stricture: IgG4-related sclerosing disease?’’ by Matsushita et al. MICHAEL QUANTE1, HUI ZHOU2 & TILMAN SAUERBRUCH1 1 Department of Medicine I and 2Department of Pathology, University Hospital Bonn, Germany TO THE EDITOR: We appreciate the interesting comments made by Matsushita et al. and their reasonable suggestion that autoimmune pancreatitis (AIP) should be considered in the differential diagnoses, as this would require steroid therapy rather than Tamoxifen treatment. This is certainly of interest to all readers. As we mentioned in the case report, we initially considered steroid therapy, as it is recommended for the treatment of retroperitoneal fibrosis. However, owing to our patient having recurrent urinary tract infections, being overweight, and having early signs of osteoporosis, we chose to treat her with Tamoxifen instead. Indeed, together with autoimmune cholangitis, autoimmune pancreatitis could be an alternative diagnosis. Nevertheless, several factors are not consistent with the diagnosis of AIP in our patient. As we discussed in the article, apart from an elevated erythrocyte sedimentation rate (ESR), all laboratory tests were within normal limits. With regard to any autoimmune disease, rheumatoid factor and antibodies
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