Autoimmune Pancreatitis Novelty as Triggered by Sunlight Exposure in a Patient with Verified Causality by Unintentional Re-exposure as Diagnostic Gold Standard: A Case Report

Teschke R, Eickhoff A and Bangard C

^*Correspondance to: Teschke Rolf 

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Abstract:

This report describes as novelty the unique case of a patient with painless jaundice due to Autoimmune Pancreatitis (AIP) related to significant sunshine exposure as a triggering factor never described before in the literature. The causal association was confirmed by positive unintentional re-exposure results viewed as a gold standard in clinical diagnostics: (1) male gender aged 76 years and of European ethnicity (Germany); (2) normal serum IgG4 levels exclude attribution of the case to the large group of IgG4-related disorders; (3) association with secondary sclerosing cholangitis characterized by prestenotic dilatations above stenoses of the hepatic fork and within intrahepatic bile ducts; (4) treatment with prednisolone and azathioprine was unsuccessful in preventing cellular pancreatic disruption with exocrine pancreatic insufficiency due to organ burn-out and organ atrophy, associated with persistent xerostomia likely due to hyposalivation from exocrine salivary gland insufficiency; and (5) avoidance of direct sunlight exposure prevents disease recurrence. In essence, this AIP case with novelty features in the form of sunshine exposure as the culprit is well established regarding causality through a positive unintentional re-exposure result and differs from current AIP-1 and AIP-2, both lacking an established culprit, and from AIP-3 caused by immune checkpoint inhibitors (ICIs), representing a new AIP type that may be termed a fourth AIP type observed first in Europe, specifically Germany. This finding may call for refinement of existing AIP guideline recommendations in Japan and Europe based on a mandatory reevaluation of current AIP classifications incorporating the details provided by this novel case.  

Keywords:

Sunlight exposure; Autoimmunity; Pancreatic disruption; Autoimmune Pancreatitis (AIP); Secondary Sclerosing Cholangitis (SSC); AIP guidelines

Cite the Article:

Teschke R, Eickhoff A, Bangard C. Autoimmune Pancreatitis Novelty as Triggered by Sunlight Exposure in a Patient with Verified Causality by Unintentional Re-exposure as Diagnostic Gold Standard: A Case Report. Clin Case Rep Int. 2026; 10:1751..