[Immunoglobulin G4-related sclerosing cholangitis diagnosed by liver biopsy: a case report]

Nihon Shokakibyo Gakkai Zasshi. 2017;114(3):464-472. doi: 10.11405/nisshoshi.114.464.
[Article in Japanese]

Abstract

Patients with immunoglobulin (Ig) G4-related sclerosing cholangitis typically have a high serum IgG4 level. However, here we describe our experience of a patient with a normal serum IgG4 level for whom the cholangitis was diagnosed by liver biopsy. A 61-year-old male presented with elevated liver enzymes and a normal serum IgG4 level. The hilar, intrahepatic, and upper extrahepatic bile ducts were stenotic, with no evidence of a pancreatic lesion. We therefore performed a liver biopsy to differentiate between cholangiocarcinoma and primary sclerosing cholangitis. Pathological examination revealed lymphoplasmacytic infiltrates around the bile ducts with a storiform fibrosis. IgG4-positive plasma cells were also observed. These results fulfilled the Japanese diagnostic criteria for IgG4-related sclerosing cholangitis. When this condition is suspected, liver biopsy should be performed even when serum IgG4 levels are normal.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Biopsy
  • Cholangiopancreatography, Magnetic Resonance
  • Cholangitis, Sclerosing / complications
  • Cholangitis, Sclerosing / diagnostic imaging
  • Cholangitis, Sclerosing / pathology*
  • Cholestasis, Intrahepatic / diagnostic imaging
  • Cholestasis, Intrahepatic / etiology
  • Humans
  • Immunoglobulin G / blood
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed

Substances

  • Immunoglobulin G