Gastric Ulcer with IgG4-related Disease, Report of a Case Yoichiro Nuki 1 , Mami Kitazaki 1 , Atsushi Hirano 1 , Junji Umeno 1 , Takehiro Torisu 1 , Shinichiro Kawatoko 2 , Yoshifumi Hori 2 , Minako Fujiwara 3 , Takayuki Matsumoto 4 , Motohiro Esaki 5 1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 2Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan 4Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan 5Department of Endoscopic Diagnostic and Therapeutics, Saga University Hospital, Saga, Japan Keyword: IgG4関連疾患 , 胃潰瘍 , 消化管病変 , 内視鏡 , ステロイド pp.1739-1745
Published Date 2019/12/25
DOI https://doi.org/10.11477/mf.1403201907
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 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.

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