Hepatic Sarcoidosis with an Increased Serum Level of Immunoglobulin G4

Masanori Inoue; Tetsuhiro Chiba; Yoh Zen; Hajime Yokota; Tatsuo Kanda; Sadahisa Ogasawara; Harutoshi Sugiyama; Makoto Arai; Fumihiko Kanai; Makoto Ogawa; Fumio Imazeki; Osamu Yokosuka

doi:10.2169/internalmedicine.51.8224

CASE REPORTS

Hepatic Sarcoidosis with an Increased Serum Level of Immunoglobulin G4

Masanori Inoue, Tetsuhiro Chiba, Yoh Zen, Hajime Yokota, Tatsuo Kanda, Sadahisa Ogasawara, Harutoshi Sugiyama, Makoto Arai, Fumihiko Kanai, Makoto Ogawa, Fumio Imazeki, Osamu Yokosuka

Author information

Masanori Inoue
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Tetsuhiro Chiba
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Yoh Zen
Institute of Liver Studies, King's College Hospital, UK
Hajime Yokota
Department of Radiology, Graduate School of Medicine, Chiba University, Japan
Tatsuo Kanda
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Sadahisa Ogasawara
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Harutoshi Sugiyama
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Makoto Arai
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Fumihiko Kanai
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Makoto Ogawa
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Fumio Imazeki
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan
Osamu Yokosuka
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan

Keywords: hepatic sarcoidosis, immunoglobulin G4, liver biopsy, granuloma

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 21 Pages 3095-3098

DOI https://doi.org/10.2169/internalmedicine.51.8224

Details

Abstract

A 70-year-old woman with an increased uptake of 18-Fluorodeoxyglucose (FDG) in whole liver on positron emission tomography (PET) was referred to our hospital. Laboratory examinations showed increased serum levels of total immunoglobulin G (IgG) and IgG4. Gallium scintigraphy showed a remarkable uptake in the liver but not in any other organs. On computed tomography (CT) and magnetic resonance imaging (MRI), multiple foci of abnormal density were observed in the liver, but the pancreas and bile duct lacked any indications of IgG4-related sclerosing disease. A liver biopsy specimen revealed multiple non-necrotizing granulomas. This is the first report of hepatic sarocidosis in a patient with an elevated serum level of IgG4.

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