IgG4-related autoimmune pancreatitis complicated by splenic artery pseudoaneurysm

Description

A 65-year-old man presented with a 1-year history of swelling of the submandibular salivary glands bilaterally. Blood tests revealed C-reactive protein (CRP) level of 0.28 mg/L, leucocyte count of 5.22x10⁹/L (neutrophil count 3.07x10⁹/L), haemoglobin level of 13.1 g/dL and platelet count of 234x10⁹/L. Serum IgG and IgG4 levels were 2054 mg/dL (normal 861–1747) and 540 mg/dL (4.8–105), respectively. Biopsy of the right submandibular gland revealed a dense lymphoplasmacytic infiltrate and storiform fibrosis with increased IgG4-positive plasma cells (IgG4:IgG ratio 67%). Contrast-enhanced CT (CE-CT), which was performed to evaluate other sites of involvement, showed diffuse enlargement of the pancreas with a capsule-like rim (figure 1A). A diagnosis of IgG4-related sialadenitis and autoimmune pancreatitis was made. The patient had no abdominal complaints or jaundice, and he was followed up with careful observation.

Figure 1

Contrast-enhanced CT on presentation (A) and after 1 year of observation (B) showing diffuse enlargement of...

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