Isolated IgG4-related gastric disease presenting as diffuse gastric wall thickening with ulcer

Authors

  • David Yurui Lim
  • Lionel Tim-Ee Cheng
  • Damien Meng Yew Tan
  • Issam Al Jajeh

DOI:

https://doi.org/10.3941/jrcr.v12i9.3493

Keywords:

Immunoglobulin G, radiology, endoscopy, stomach, IgG4, IgG2, IgG4-RD

Abstract

An 81-year-old male presented with loss of appetite, early satiety and iron deficiency anaemia. A computed tomography (CT) scan of the abdomen and pelvis during initial work-up revealed diffuse gastric mural thickening associated with a large ulcer and adjacent gastro-hepatic lymphadenopathy. The CT appearances, together with the clinical features, were highly suspicious for an infiltrative type of gastric malignancy. Endoscopic biopsy however showed erosive inflammation, IgG4 plasmacytosis and fibrosis, raising the possibility of IgG4-related disease. A serologic assay for IgG showed normal IgG4 and elevated IgG2 serum levels. After appropriate steroid treatment, endoscopy and CT scan showed resolution of the ulcer and gastric wall thickening. This case shows yet another possible appearance of gastric involvement in IgG4-related disease on the current evolving spectrum of this disease presentation. Greater awareness and education of this disease would help in patient care, ensuring earlier diagnosis, prevention of severe organ damage and morbidity, as well as unnecessary surgery.

Author Biographies

David Yurui Lim

Department of Diagnostic Radiology

Singapore General Hospital

Senior Resident

Lionel Tim-Ee Cheng

Department of Diagnostic Radiology

Singapore General Hospital

Consultant

Damien Meng Yew Tan

Department of Gastroenterology and Hepatology

Singapore General Hospital

Senior Consultant

Issam Al Jajeh

Department of Anatomical Pathology

Singapore General Hospital

Senior Consultant

Published

2018-09-25

Issue

Section

Gastrointestinal Radiology