2008 Volume 50 Issue 12 Pages 3054-3061
A 73-old-man was admitted to our hospital with weight loss and jaundice. Abdominal computed tomography showed dilatation of intrahepatic bile ducts, but did not show pancreatic swelling. ERCP showed multiple strictures in intrahepatic bile ducts and mild stricture of the main pancreatic duct. From the findings of this cholangiogram, differential diagnosis between IgG4-related autoimmune sclerosing cholangitis and primary sclerosing cholangitis was difficult. Serum IgG and IgG4 level were high, and biopsy of intrahepatic bile duct revealed infiltration of IgG4-bearing plasma cells. Therefore, we diagnosed IgG4-related autoimmune sclerosing cholangitis without pancreatic swelling, and oral steroid therapy was commenced. In this case, the diagnosis was possible based on serological and histological examination.
