The Teaching Point

Isolated gastric IgG4-related disease can masquerade as an infiltrative gastric malignancy, showing both diffuse gastric mural thickening and an ulcer on CT, with associated lymphadenopathy. Serum IgG4 levels remain important for evaluation and longitudinal assessment, but elevated serum levels are neither necessary nor sufficient for IgG4-diagnosis.






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From the manuscript

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

Free full text article: Isolated IgG4-related gastric disease presenting as diffuse gastric wall thickening with ulcer

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.






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