IgG4-Related Hepatic Inflammatory Pseudotumor Complicated by Actinomycosis during Steroid Therapy
정재원, 배윤성, 임진홍, 이동기, 유정식,
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정재원 ( Chung Jae-Won )
Yonsei University College of Medicine Gangnam Severance Hospital Department of Radiology
배윤성 ( Bae Yoon-Sung )
Yonsei University College of Medicine Gangnam Severance Hospital Department of Pathology
임진홍 ( Lim Jin-Hong )
Yonsei University College of Medicine Gangnam Severance Hospital Department of Surgery
이동기 ( Lee Dong-Ki )
Yonsei University College of Medicine Gangnam Severance Hospital Department of Internal Medicine
유정식 ( Yu Jeong-Sik )
Yonsei University College of Medicine Gangnam Severance Hospital Department of Radiology
Abstract
For a 67-year-old man with diabetes mellitus, a 9-cm liver mass was found on CT during the diagnostic work-up for weight loss and fever. Dynamic CT and MRI showed a layered pattern of contrast enhancement suggesting the imaging features of the solid inflammatory mass. After tissue diagnosis of immunoglobulin G4 (IgG4)-related disease by gun needle biopsy, steroid therapy induced partial shrinkage of the mass on the follow-up CT at 4 weeks. On the 5-month follow-up CT with the maintenance of low-dose oral steroid medication, disease progression with invasion to diaphragm brought surgical intervention of right hemihepatectomy considering the possibility of combined malignancy. In the area of diaphragmatic destruction, focal actinomycosis was complicated in the main mass of IgG4-related disease. We are the first to describe a rare case of IgG4-related inflammatory pseudotumor, complicated by actinomycosis, showing an invasive nature that mimicked malignancy during steroid therapy in a diabetic patient.
키워드
Liver; Inflammatory Pseudotumor; IgG4-Related Disease; Actinomycosis; Prednisolone
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