Biliary Obstruction Due to IgG4-Related Disease

Abstract

A man in his sixth decade of life with a history of myasthenia gravis and antiphospholipid syndrome complicated by embolic strokes presented for evaluation of progressive jaundice and pruritus. Laboratory evaluation revealed marked hyperbilirubinemia and elevated lipase. Computed tomography imaging revealed a pancreatic head masslike lesion with a peripancreatic low-attenuation rim and dilation of the pancreatic and biliary ducts (Figure 1) as well as multifocal hypoenhancing lesions in the bilateral kidneys (Figure 2).