Yuan-Rung Li1, Chan-Feng Pan2, Hoi-Hung Chan1, Kowk-Hung Lai1, Ping-I Hsu1
1Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
2Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Tóm tắt
SummaryA 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.
