Refractory gastric ulcer with abundant IgG4-positive plasma cell infiltration: A case report

Figure 1 Endoscopic findings show chronic persistent inflammation of the stomach. A: Multiple active ulcers and edematous mucosa in June 2004; B: Multiple scarring ulcers and erythematous mucosa in August 2006; C: Multiple healing and scarring ulcers in July 2007; D: Multiple active ulcers and edematous mucosa with luminal stenosis in July 2008.

Figure 2 Endoscopic view after indigo carmine dye spray showed luminal deformity and active ulcers in February 2009. A: Multiple scarring ulcers appearing like pseudo-diverticulum in the upper body of the stomach and stenosis of the upper body due to annular scarring ulcers; B: Linear ulcers on the lesser curve of the middle body of the stomach.

Figure 3 Histopathological findings of biopsy specimens of the stomach. A: Mild infiltration of IgG4-positive plasma cells at the scarring ulcer (15/high power field); B: Severe infiltration of IgG4-positive plasma cells at the active ulcer (50/high power field).