Clinical Snapshot IgG4-Associated Inflammatory Pseudotumor with Bilobar Hepatic Foci
A previously healthy 58-year-old man had elevated hepatic enzyme concentrations in a routine test; computed tomography revealed multiple, bilobar abnormal foci in the liver, and, after an extensive work-up to rule out other possible causes, he was referred to us with the suspected diagnosis of Hodgkin’s lymphoma. A bone marrow biopsy of the iliac crest, however, yielded no evidence of lymphomatous infiltration. The hepatic foci that were thought to be a manifestation of lymphoma (Figure) were found, on biopsy and histological examination, to have the typical appearance of IgG4-associated cholangiitis, with up to 200 IgG4-positive plasma cells per high-power field. Serologic testing revealed a markedly elevated IgG4 concentration (2528.5 mg/dL). Short-term high-dose steroid treatment was given, followed by immune suppression with azathioprine. The liver values returned to normal, the serum IgG4 level fell to 678.4 mg/dL, and the hepatic nodules were no longer visible on a follow-up magnetic resonance scan 5 months later. As this case illustrates, IgG4-associated disease can mimic Hodgkin’s lymphoma both histologically and in imaging studies.
Dr. med. Matthias Büchter, Prof. Dr. med. Guido Gerken, PD Dr. med. Alisan Kahraman, Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen,
Conflict of interest statement: The authors state that they have no conflict of interest.
Cite this as: Büchter M, Gerken G, Kahraman A: IgG4-associated inflammatory pseudotumor with bilobar hepatic foci.
Dtsch Arztebl Int 2018; 115: 181. DOI: 10.3238/arztebl.2018.0181
Translated from the original German by Ethan Taub, M.D.