Open AccessImmunoglobulin G4‐related disease presenting with obstructive jaundice
Author(s) -
Li YuanRung,
Pan ChanFeng,
Chan HoiHung,
Lai KowkHung,
Hsu PingI
Publication year - 2014
Publication title -
advances in digestive medicine
Language(s) - English
Resource type - Journals
ISSN - 2351-9800
DOI - 10.1016/j.aidm.2013.06.002
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , magnetic resonance cholangiopancreatography , lumen (anatomy) , pathology , autoimmune pancreatitis , pancreas , common bile duct , igg4 related disease , biopsy , radiology , pancreatitis , gastroenterology , disease
Summary A 48‐year‐old male presented with diffuse abdominal fullness for 1 month and tea‐colored urine for 10 days. Abdominal computed tomography/magnetic resonance cholangiopancreatography revealed diffuse enlargement of the pancreas and unusual soft tissue density around the left ureter. Endoscopic retrograde cholangiopancreatography demonstrated lumen narrowing of the distal common bile duct and irregularity of the pancreatic duct. Markedly elevated serum immunoglobulin G4 (IgG4) was also noted. Biopsy of soft tissue from the area surrounding the left ureter identified lymphoplasmacytic infiltration with high concentrations of IgG4‐positive plasma cells accompanied by obliterative phlebitis, compatible with IgG4‐related disease. The patient was administered steroid therapy and his symptoms improved. Clinicians should be aware of possible IgG4‐related disease in a patient presenting with obstructive jaundice and diffuse pancreatic enlargement because glucocorticoid administration can achieve good response.