IgG4関連疾患に伴った胃潰瘍の1例

Gastric Ulcer with IgG4-related Disease, Report of a Case

要旨●患者は50歳代，女性．心窩部痛を主訴に前医を受診し，上部消化管内視鏡検査で前庭部小彎前壁に潰瘍性病変を指摘された．生検病理組織学的検査で腫瘍性病変が疑われたため，当院に紹介され入院となった．当院での生検はすべてGroup 1であったが，腹部CTおよびPET検査で腎臓，気管支，涙腺，顎下腺にIgG4関連疾患を疑う所見を認めた．血清学検査ではIgG4の著明な上昇を認めたため，初回内視鏡時の生検を遡及的に検討したところ，免疫組織化学染色で，粘膜固有層にIgG4陽性の形質細胞が増加しており，IgG陽性細胞との比率は55.5%と上昇していた．H. pylori除菌療法を施行し，ステロイドの投与を行うことで潰瘍は瘢痕化し，血清IgG4値も減少した．以上より，IgG4関連疾患に伴った胃潰瘍と考えられた．

　A 50-year-old female patient was admitted to a referring hospital because of fasting epigastric pain. Esophagogastroduodenoscopy revealed an ulcerating lesion in the gastric antrum. Consequently, the patient was referred to our hospital for further examination because bioptic examination indicated this lesion to be a neoplasm. Although bioptic re-examination failed to confirm any neoplastic changes, thoracoabdominal CT（computed tomography）showed peribronchial thickening and multiple masses in both the kidneys. Furthermore, positron emission tomography-CT showed an abnormal uptake of 18F-fluorodeoxyglucose in the kidneys and bronchi as well as in the lacrimal and submaxillary glands. These findings were consistent with IgG4-related disease ; additional immunology revealed elevated serum IgG4 levels. In addition, histological re-examination of the gastric bioptic specimens revealed increased numbers of IgG4-positive plasma cells in the gastric mucosa and an IgG4/IgG ratio of 55.5%. Therefore, the initial diagnosis of gastric ulcer with IgG4-related disease was eventually confirmed.