case_images: PMC11307484_01
case_images: Histopathological findings in the submandibular gland. (A) Hematoxylin-eosin staining and (B) IgG4 immunohistochemistry. Magnification: 200x. Scale bars are shown in the figure.
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case_images: We performed a biopsy of the submandibular lesion, which was consistent with the pathological features of comprehensive diagnostic criteria (dense lymphocyte and plasma cell infiltration with fibrosis, ratio of IgG4-positive plasma cells /IgG-positive cells greater than 40%, and the number of IgG4-positive plasma cells greater than 10 per high-powered field), and diagnosed the patient with IgG4-RD (Figure 1).
case_images: Representative endoscopic findings of the gastrointestinal tract before the treatment of IgG4-RD. (A) Esophagogastroduodenoscopic findings in the duodenum. (B) Capsule endoscopic findings in the ileum. (C) Colonoscopic findings in the terminal ileum. These examinations did not reveal any morphological changes such as ulcers, strictures, or submucosal tumors, which are frequently reported in IgG4-related gastrointestinal diseases.
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case_images: We performed esophagogastroduodenoscopy, capsule endoscopy, and colonoscopy, which did not reveal any organic lesions that could have caused her abdominal symptoms (Figure 2).
case_images: Histopathological findings in the duodenum and terminal ileum. The upper row shows the hematoxylin-eosin staining of the duodenum (A) and terminal ileum (B). The middle row shows IgG4 immunohistochemistry (IHC) of the duodenum (C) and terminal ileum (D) before treatment. The lower row shows the IgG4 IHC of the duodenum (E) and terminal ileum (F) after PSL treatment. Magnification: 200x. Scale bars are shown in the figure.
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case_images: B) and IgG4-positive cell infiltration deep into the lamina propria (Figure 3C and D). Based on these pathological findings (ratio of IgG4-positive plasma cells /IgG-positive cells greater than 40%, the number of IgG4-positive plasma cells greater than 10 per high-powered field, and bottom-heavy plasmacytosis), we diagnosed the patient with IgG4-GID. We did not detect lymphocyte or IgG4-positive plasma cell infiltration in endoscopic biopsy specimens of the duodenum and terminal ileum after six months of treatment (Figure 3E and F).
case_images: The clinical course of this case (stool frequency, serum IgG4 levels, and abdominal pain).
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case_images: Her abdominal pain and diarrhea improved immediately after the initiation of PSL (Figure 4).