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A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment

BACKGROUND: Hepatic inflammatory pseudotumor (IPT) is a rare disease which often mimics a malignant tumor and is therefore often misdiagnosed and surgically resected. Recently, a concept of IgG4-related diseases (IgG4-RD) has been proposed that is becoming widely recognized and includes IgG4-related...

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Autores principales: Shibata, Masayuki, Matsubayashi, Hiroyuki, Aramaki, Tsuyoshi, Uesaka, Katsuhiko, Tsutsumi, Naoyuki, Sasaki, Keiko, Ono, Hiroyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970241/
https://www.ncbi.nlm.nih.gov/pubmed/27484098
http://dx.doi.org/10.1186/s12876-016-0504-6
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author Shibata, Masayuki
Matsubayashi, Hiroyuki
Aramaki, Tsuyoshi
Uesaka, Katsuhiko
Tsutsumi, Naoyuki
Sasaki, Keiko
Ono, Hiroyuki
author_facet Shibata, Masayuki
Matsubayashi, Hiroyuki
Aramaki, Tsuyoshi
Uesaka, Katsuhiko
Tsutsumi, Naoyuki
Sasaki, Keiko
Ono, Hiroyuki
author_sort Shibata, Masayuki
collection PubMed
description BACKGROUND: Hepatic inflammatory pseudotumor (IPT) is a rare disease which often mimics a malignant tumor and is therefore often misdiagnosed and surgically resected. Recently, a concept of IgG4-related diseases (IgG4-RD) has been proposed that is becoming widely recognized and includes IgG4-related hepatic IPT. Corticosteroids are widely accepted as the standard treatment. CASE PRESENTATION: A 72-year-old Japanese man, who had been followed for ten years after surgery and chemotherapy for treatment of hilar and lower bile duct cancers, developed intermittent fever and abdominal pain and visited this hospital. Blood examinations revealed an inflammatory reaction, worsened glucose intolerance, and an increased level of serum IgG4 (137 mg/dL). Computed tomography (CT) revealed a 5 cm-sized mass in hepatic segment 7. Because of his cancer history, not only was a benign mass suspected, but there was also the possibility of a recurrent biliary malignancy. Liver biopsy was performed and the histology met the criteria for IgG4-related IPT. Corticosteroid therapy was initiated and his symptoms quickly resolved. However, two months later, a repeat CT demonstrated that the hepatic mass had been replaced by an abscess. The abscess was initially refractory, despite tapering corticosteroid treatment, controlling diabetes by intensive insulin therapy, administration of antibiotics, and percutaneous abscess drainage. Finally, after six months, the condition resolved. CONCLUSION: The diagnosis of hepatic IPT is sometimes difficult. To differentiate it from a malignant tumor, histological examination is necessary. Although corticosteroids are recognized as the standard therapy, unexpected and critical complications can develop in cases of IgG4-related hepatic IPT.
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spelling pubmed-49702412016-08-03 A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment Shibata, Masayuki Matsubayashi, Hiroyuki Aramaki, Tsuyoshi Uesaka, Katsuhiko Tsutsumi, Naoyuki Sasaki, Keiko Ono, Hiroyuki BMC Gastroenterol Case Report BACKGROUND: Hepatic inflammatory pseudotumor (IPT) is a rare disease which often mimics a malignant tumor and is therefore often misdiagnosed and surgically resected. Recently, a concept of IgG4-related diseases (IgG4-RD) has been proposed that is becoming widely recognized and includes IgG4-related hepatic IPT. Corticosteroids are widely accepted as the standard treatment. CASE PRESENTATION: A 72-year-old Japanese man, who had been followed for ten years after surgery and chemotherapy for treatment of hilar and lower bile duct cancers, developed intermittent fever and abdominal pain and visited this hospital. Blood examinations revealed an inflammatory reaction, worsened glucose intolerance, and an increased level of serum IgG4 (137 mg/dL). Computed tomography (CT) revealed a 5 cm-sized mass in hepatic segment 7. Because of his cancer history, not only was a benign mass suspected, but there was also the possibility of a recurrent biliary malignancy. Liver biopsy was performed and the histology met the criteria for IgG4-related IPT. Corticosteroid therapy was initiated and his symptoms quickly resolved. However, two months later, a repeat CT demonstrated that the hepatic mass had been replaced by an abscess. The abscess was initially refractory, despite tapering corticosteroid treatment, controlling diabetes by intensive insulin therapy, administration of antibiotics, and percutaneous abscess drainage. Finally, after six months, the condition resolved. CONCLUSION: The diagnosis of hepatic IPT is sometimes difficult. To differentiate it from a malignant tumor, histological examination is necessary. Although corticosteroids are recognized as the standard therapy, unexpected and critical complications can develop in cases of IgG4-related hepatic IPT. BioMed Central 2016-08-02 /pmc/articles/PMC4970241/ /pubmed/27484098 http://dx.doi.org/10.1186/s12876-016-0504-6 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Shibata, Masayuki
Matsubayashi, Hiroyuki
Aramaki, Tsuyoshi
Uesaka, Katsuhiko
Tsutsumi, Naoyuki
Sasaki, Keiko
Ono, Hiroyuki
A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment
title A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment
title_full A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment
title_fullStr A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment
title_full_unstemmed A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment
title_short A case of IgG4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment
title_sort case of igg4-related hepatic inflammatory pseudotumor replaced by an abscess after steroid treatment
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970241/
https://www.ncbi.nlm.nih.gov/pubmed/27484098
http://dx.doi.org/10.1186/s12876-016-0504-6
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