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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2016
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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. |
format | Online Article Text |
id | pubmed-4970241 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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