Elevated serum IgG4 and eosinophilia in a persistent indeterminate biliary stricture with high-risk features: a case report - Report - MDSpire

Elevated serum IgG4 and eosinophilia in a persistent indeterminate biliary stricture with high-risk features: a case report

  • By

  • Ruohan Yu

  • Jing Zhang

  • Sheng-Guang Li

  • Tong Zhang

  • Lina Zhang

  • Yadan Zou

  • Ting Long

  • Yanfeng Zhang

  • Ji Li

  • July 6, 2026

  • 0 min

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Increased Serum IgG4 Levels and Eosinophilia Observed in a Case Study

Overview

This case study presents a 68-year-old man with a persistent indeterminate biliary stricture characterized by elevated serum IgG4 and eosinophilia. Corticosteroid treatment led to laboratory improvements, but the anatomical stenosis persisted.

Background

Indeterminate biliary strictures pose a significant diagnostic challenge as they can arise from various conditions, including inflammatory diseases and malignancies. The overlapping clinical and serologic features complicate the differentiation between benign and malignant etiologies.

Data Highlights

No numerical data or trial data available in the article.

Key Findings

  • A 68-year-old man presented with progressive jaundice and cholestatic liver injury.
  • Laboratory tests revealed marked eosinophilia and elevated serum IgG4 levels.
  • Imaging showed an indeterminate common bile duct stricture with upstream biliary dilatation.
  • Pathology indicated chronic inflammation with eosinophils but negative IgG4 staining.
  • Despite corticosteroid treatment, anatomical stenosis persisted, prompting further malignancy assessment.

Clinical Implications

The persistence of anatomical stenosis despite laboratory improvements indicates the need for careful evaluation in patients with indeterminate biliary strictures.

Conclusion

This case highlights the complexity of diagnosing indeterminate biliary strictures.

Related Resources & Content

  1. Journal of Gastroenterology, 2025 -- An Investigation into the Clinicopathological Features of Autoimmune Hepatitis Associated with IgG4 and IgG4 Hepatopathy
  2. European Radiology, 2023 -- Evaluation of Functional Strictures in Primary Sclerosing Cholangitis Patients Through Hepatobiliary Contrast-Enhanced MRI: A Proof-of-Concept Investigation
  3. Journal of Gastroenterology, 2026 -- IgG4-related disease in gastroenterology: from pathogenesis to clinical management and long-term outcomes
  4. Open Forum Infectious Diseases — Urogenital Schistosomiasis Presenting as IgG4-Related Disease in an HIV-Positive Patient
  5. Endoscopic and novel approaches for evaluation of indeterminate biliary strictures
  6. Management of IgG4-related cholangitis: diagnosis, therapy, and long-term surveillance
  7. Eosinophilic cholangitis as an indeterminate biliary mimic: A systematic review of outcomes

Original Source(s)

Elevated serum IgG4 and eosinophilia in a persistent indeterminate biliary stricture with high-risk features: a case report

  • by Ruohan Yu, Jing Zhang, Sheng-Guang Li, Tong Zhang, Lina Zhang, Yadan Zou, Ting Long, Yanfeng Zhang, Ji Li

  • July 6, 2026

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