Korean J Med.  2019 Jun;94(3):287-293. 10.3904/kjm.2019.94.3.287.

Immunoglobulin G4-Related Gastric Ulcer Mimicking Advanced Stomach Cancer in a Patient with Type I Autoimmune Pancreatitis

• Park JH
• Noh JH
• Lee JH
• Lee G
• Hong SM
• Cho KB
• Kim MH

• KMID: 2449427
• DOI: http://doi.org/10.3904/kjm.2019.94.3.287

Abstract

Type I autoimmune pancreatitis (AIP), a form of chronic pancreatitis, is included within the spectrum of immunoglobulin G4-related diseases (IgG4-RD). IgG4-RD can involve the salivary glands, bile ducts, kidneys and retroperitoneum, and the pancreas, and responds well to corticosteroid treatment. However, gastric involvement in IgG4-RD has been rarely reported. Here we report the case of a 56-year-old man with type I autoimmune pancreatitis who presented with a giant gastric ulcer mimicking advanced gastric cancer, which was subsequently determined to be IgG4-RD. Both the patient' symptoms and his ulcerative lesions in the stomach responded to steroid treatment, which obviated the need for major surgery such as gastrectomy. Our case demonstrates the importance of recognizing potential gastric involvement in IgG4-RD, especially in a patient with concurrent AIP/IgG4-RD or a history of the disease, who is evaluated for an intractable and/or atypical gastric ulcer. A prompt diagnosis and proper management will avoid unnecessary surgery.

Keyword

Gastric ulcer; Pancreatitis; IgG4-related disease

MeSH Terms

Bile Ducts
Diagnosis
Gastrectomy
Humans
Immunoglobulins*
Kidney
Middle Aged
Pancreas
Pancreatitis*
Pancreatitis, Chronic
Salivary Glands
Stomach Neoplasms*
Stomach Ulcer*
Stomach*
Ulcer
Unnecessary Procedures
Immunoglobulins