IgG4-associated ampullitis and cholangiopathy in Crohn's disease

Udayakumar Navaneethan, Xiuli Liu, Ana E. Bennett, R. Matthew Walsh, Preethi G.K. Venkatesh, Bo Shen

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Inflammatory bowel disease (IBD) is reported to be associated with autoimmune pancreatitis and IgG4-related sclerosing disease. We report a case of a 28. year old African American male with a long history of upper gastrointestinal tract Crohn's disease (CD) with multiple surgeries who developed medically refractory disease with small bowel obstruction. He had abnormal liver function tests with imaging evidence of chronic pancreatitis and ampullary inflammatory process. He underwent Whipple's procedure. Histopathological evaluation of surgical specimens of the ampulla and distal common bile duct showed accumulation of IgG4-positive plasma cells in the lamina propria. Preoperative endoscopic biopsies also showed chronic active enteritis involving the duodenum and jejunum with increased IgG4-expressing plasma cell infiltration. His serum IgG4 was 164. mg/dL. The association of IgG4-expressing plasma cell accumulation in the gastrointestinal tract with IBD in patients with hepatobiliary manifestation may have pathogenetic, diagnostic and therapeutic implications.

Original languageEnglish
Pages (from-to)451-456
Number of pages6
JournalJournal of Crohn's and Colitis
Volume5
Issue number5
DOIs
StatePublished - Oct 2011

Keywords

  • Ampullitis
  • Autoimmune
  • Cholangitis
  • IgG4
  • Primary sclerosing cholangitis

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