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Duodenal papillitis is a gastrointestinal lesion commonly complicating IgG4-related diseases. Lesions of the esophagus, stomach, and colon with IgG4-positive plasma cell infiltration also complicate IgG4-related diseases. However, few reports have been published on complicating duodenal bulbitis. We encountered a patient with an IgG4-related disease complicated by duodenal bulbitis. A 72-year-old man attended our hospital with a chief complaint of urine discoloration. A blood test showed increased hepatobiliary enzymes (aspartate aminotransferase 401U/L, alanine aminotransferase 1148U/L, total bilirubin 1.4mg/dL, direct bilirubin 0.8mg/dL, alkaline phosphatase 2527U/L, γ-glutyl transpeptidase 1792U/L). All tumormarkerswere slightly raised. Contrast computed tomography showed a tumor with lower contrast enhancement in the pancreatic head (●" Fig.1b). Bile duct stenosis was also noted in the pancreatic head. Biliary duct dilatation was noted on the hepatic side. No pancreatic duct dilatation was observed. Diffuse pancreatic enlargement and a peripancreatic capsule were identified (●" Fig.1a).Magnetic resonance imaging showed diffuse pancreatic ductal stenosis (●" Fig.2). An additional blood test showed a high IgG4 level (608mg/dL) and the presence of antinuclear antibodies (1 : 40, homogeneous). Cytological and histological biopsies taken from the common bile duct during endoscopic retrograde cholangiopancreatography showed neither malignancy nor pathological findings Fig.1 Computed tomographic findings in the pancreas: a diffuse pancreatic enlargement and a peripancreatic capsule, b tumor with lower contrast enhancement in the pancreatic head.

A case of IgG4-related disease complicated by duodenal bulbitis with IgG4-positive plasma cell infiltration