Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2015; 3(12): 1000-1004
Published online Dec 16, 2015. doi: 10.12998/wjcc.v3.i12.1000
Colovesical fistula caused by glucocorticoid therapy for IgG4-related intrapelvic mass
Yohei Yabuuchi, Hiroyuki Matsubayashi, Masato Matsuzaki, Akio Shiomi, Michihisa Moriguchi, Ichiro Kawamura, Ichiro Ito, Hiroyuki Ono
Yohei Yabuuchi, Hiroyuki Matsubayashi, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Masato Matsuzaki, Division of Urology, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Akio Shiomi, Division of Colon Surgery, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Michihisa Moriguchi, Division of Intervention Radiology, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Ichiro Kawamura, Division of Infectious Diseases, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Ichiro Ito, Division of Pathology, Shizuoka Cancer Center, Suntogun, Shizuoka 411-8777, Japan
Author contributions: Yabuuchi Y and Matsubayashi H participated in writing the case report and revising the draft; Matsubayashi H, Matsuzaki M, Shiomi A, Moriguchi M and Kawamura I were engaged in his treatment; Ito I helped in the pathological diagnosis; Ono H helped to supervise and approve the final manuscript.
Institutional review board statement: Institutional Review Board of Shizuoka Cancer Center ethically approved current case report (Institutional code number: 25-J123-25-1-3).
Informed consent statement: The patient provided informed written consent prior to this study.
Conflict-of-interest statement: All authors disclose no conflict.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroyuki Matsubayashi, MD, PhD, Chief, Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntogun, Shizuoka 411-8777, Japan. h.matsubayashi@scchr.jp
Telephone: +81-55-9895222 Fax: +81-55-9895783
Received: July 6, 2015
Peer-review started: July 7, 2015
First decision: July 29, 2015
Revised: August 19, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 16, 2015
Processing time: 154 Days and 9.7 Hours
Abstract

IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder that can occur in almost all systemic organs and generally responds to corticosteroid treatment. We report a rare case of an IgG4-related intrapelvic mass lesion that responded to steroid therapy but caused a fistula between the sigmoid colon and bladder. A 71-year-old man was followed after treatment for hepatocellular carcinoma. Follow-up computed tomography (CT) incidentally depicted left hydronephrosis with an ill-demarcated intrapelvic mass lesion. This lesion was histologically diagnosed as IgG4-RD by open biopsy, and peroral steroid therapy was initiated. One month after starting steroids, a colovesical fistula was detected by follow-up CT. A colostomy and urethral catheterization were emergently performed. The patient recovered and the mass lesion was drastically minimized by the initiation of glucocorticoids; however, he still needs urethral catheterization. IgG4-RD develops in various systemic organs and generally responds well to steroids. Clinicians must be watchful for the complications of responses to corticosteroids, such as fistulization, when the mass lesion of IgG4-RD is adjacent to multiple luminal organs.

Keywords: IgG4-related disease; Intrapelvic mass; Steroid therapy; Colovesical fistula; Colostomy; Urethral catheterization

Core tip: IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that is effectively treated with glucocorticoids. Progression of this disease may cause serious complications or several symptoms; hence, glucocorticoid therapy is often inevitable. To date, critical adverse events caused by steroid treatment for IgG4-RD have seldom been reported. The current case report describes a rare, but severe, adverse event of colovesical fistula following a good response to glucocorticoids.