Matsumoto Kotaro, Kikuchi Kentaro, Kuniyoshi Noriyuki, Tsunashima Hiromichi, Sekine Katsunori, Mabuchi Masatoshi, Doi Shinpei, Zen Yoh, Miyakawa Hiroshi
Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan.
Fourth Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Japan.
Intern Med. 2019 Dec 15;58(24):3537-3543. doi: 10.2169/internalmedicine.3204-19. Epub 2019 Jul 31.
A 70-year-old woman was referred to our hospital due to symptoms of dry eyes, dry mouth, and epigastric pain. Computed tomography showed distal pancreatic swelling, liver edge dullness and surface irregularities. Serum anti-nuclear antibody titers, immunoglobulin G and IgG4 levels were elevated. Autoimmune pancreatitis (AIP) was diagnosed based on endoscopic findings and a histopathological examination. Her AIP improved after starting prednisolone treatment. A liver biopsy revealed interface hepatitis with lymphoplasmacyte and IgG4-positive plasma cell infiltration. In addition, non-alcoholic steatohepatitis (NASH) was diagnosed based on the presence of parenchymal steatosis, ballooning hepatocytes, and pericellular fibrosis. We experienced a unique liver disease case showing IgG4-related liver disease overlapping with NASH.
一名70岁女性因干眼症、口干和上腹部疼痛症状转诊至我院。计算机断层扫描显示胰腺远端肿胀、肝缘钝圆及表面不规则。血清抗核抗体滴度、免疫球蛋白G及IgG4水平升高。根据内镜检查结果和组织病理学检查诊断为自身免疫性胰腺炎（AIP）。开始泼尼松龙治疗后，她的AIP病情有所改善。肝脏活检显示界面性肝炎伴淋巴细胞和浆细胞以及IgG4阳性浆细胞浸润。此外，根据实质脂肪变性、气球样变肝细胞和细胞周围纤维化的存在诊断为非酒精性脂肪性肝炎（NASH）。我们遇到了一例独特的肝脏疾病病例，显示IgG4相关肝病与NASH重叠。
