85-year-old man with altered mental status
History and images
Our appreciation is extended to Dr. Abdul Abid, University of Texas Medical Branch, for contributing this case.
History: An 85-year-old man with a previous history of percutaneous cholecystostomy tube placement following an episode of gangrenous cholecystitis presented with a fever and altered mental status. An abdominal computed tomography (CT) scan with contrast showed multiple hypoattenuating lesions within the liver, raising concern for malignancy. A liver biopsy was obtained. Photomicrographs are shown.
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Immunoglobulin G4 (IgG4) disease
IgG4 positive, anaplastic lymphoma kinase (ALK)‐1 negative, cluster of differentiation 1a (CD1a) negative
IgG4 negative, ALK-1 negative, CD1a negative
IgG4 negative, ALK-1 positive, CD1a negative
IgG4 negative, ALK-1 negative, CD1a positive