Faculty Bibliography

We report a case of autoimmune pancreatitis in a 9-year-old female who presented with persistent epigastric pain for 3 weeks. Magnetic resonance cholangiopancreatography (MRCP) showed both intrahepatic and extrahepatic biliary ductal dilatation. The common bile duct, along with the pancreatic duct, was noted to be dilated. Labs showed normal IgG and IgG4 levels and negative for autoimmune antibodies. Endoscopic ultrasound revealed the pancreatic head to be enlarged and surrounded by hypoechoic and lobulated lymph nodes. Biopsy of the pancreatic head showed chronic mildly active inflammation with fibrosis, acinar atrophy, and lymphocytic infiltrate. A diagnosis of autoimmune pancreatitis (AIP) was made, and she was treated with prednisone. The patient's symptoms improved quickly, and follow-up MRCP showed resolution of inflammatory changes and intrahepatic and pancreatic ductal dilatation.

The production of acid by the stomach is a tightly controlled physiological process that involves neural and hormonal mechanisms and the input of several epithelial cell types. The past several years have seen significant advances in our understanding of the molecular ontogenesis of the stomach and the factors controlling stomach innervation, as well as the differentiation of gastric epithelial cell lineages and their respective hormones/factors that influence acid production. The programmed development of each of these elements is exquisitely regulated and allows human neonates to produce gastric acid; it also helps us define expectations of acid production in preterm infants at all gestational ages.

A 7-y-old girl with genital herpes following sexual abuse presented with dysuria, fever and meningeal signs. Acyclovir (15 mg/kg/d for 10 d) was administered for severe genitourinary symptoms. The CSF culture was positive for HSV type 2. Complete resolution of all symptoms demonstrates that, as in adults, HSV-2 meningitis does not require high-dose or prolonged acyclovir therapy.