IGG4 Related Inflammatory Pseudotumor of the Liver: Particularities of a Rare Diagnosis
DOI:
https://doi.org/10.24950/rspmi/CC/205/1/2018Keywords:
Immunoglobulin G, Liver NeoplasmsAbstract
Liver´s inflammatory pseudotumor (LIP) is a rare, benign,
nonneoplastic mass, that constitutes an exaggerated inflammatory response to an aggression – infection/trauma/autoimmune disease. Recently, an IgG4-related LIP has been
recognized. We present a 57-year-old male with prostatic adenocarcinoma and chronic alcoholism with fever and abdominal pain. Laboratory tests showed leucocytosis (16100/uL),
elevated C-reactive protein (52.7 mg/dL), high sedimentation
rate (130 mm/h) and hepatic cytolysis. Hepatic nodules, suspicious of secondary/primary lesions were observed by computerized tomography. Alpha-fetoprotein and serotypes for
hepatotropic viruses were negative. Streptococcus viridans
was isolated in the blood cultures and targeted antibiotic
therapy was started. Fever disappeared but hepatic lesions
remained. Increased level of serum IgG4 (188 mg/dL) was
observed. The liver biopsy showed myofibroblast proliferation with storiform pattern, suggesting LIP, and IgG4+ plasmocytes. Steroid therapy was initiated successfully. The diagnosis of IgG4 related LIP is rare, however, the prognosis is
usually good after a course of steroid therapy
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