Journey to diagnosis:An unfinished exploration of IgG4-related sclerosing cholangitis

IgG4-related sclerosing cholangitis(IgG4-SC)is an inflammatory disease that leads to bile duct stricture,characterized by the infiltration of IgG4-positive plasma cells into the bile duct wall,thickening of the bile duct wall,and narrowing of the lumen.The differential diagnosis of IgG4-SC mainly includes primary sclerosing cholangitis,cholangiocarcinoma,and pancreatic cancer.IgG4-SC is often associated with autoimmune pancreatitis and can be accurately diagnosed based on clinical diagnostic criteria.However,isolated IgG4-SC is difficult to distinguish from biliary tumors.Given the significant differences in biological behavior,treatment,and prognosis between these diseases,accurately identifying isolated IgG4-SC has very important clinical significance.

Primary hypertension in a postoperative paraganglioma patient:A case report

BACKGROUND Primary hypertension is a common clinical disease.Pheochromocytoma and paraganglioma is a rare cause of secondary hypertension.The diagnosis of the latter is still difficult,and the relationship between the two is not clear.The successful diagnosis of this case confirmed that standardized etiological investigation of secondary hypertension is necessary,contributes to the accurate diagnosis of rare diseases,and is conducive to the formulation or optimization of treatment plans.It shows an example of the coexistence of primary hypertension and secondary hypertension.CASE SUMMARY The patient was a 54-year-old male and was hospitalized with high blood pressure for 4 years.The patient’s blood pressure was measured at 150/100 mmHg during physical examination 4 years ago and had no paroxysmal or persistent elevated blood pressure,no typical triad of headache,palpitation,and sweating,without postural hypotension.After taking nifedipine sustained release tablets intermittently,the blood pressure did not meet the standard.Physical examination revealed blood pressure of 180/120 mmHg.There was no abnormality in cardiopulmonary and abdominal examination.The results of blood and/or urinary catecholamines/metanephrine and normetanephrine before and after operation were normal.Fundus examination revealed retinal arteriosclerosis in both eyes.There was a history of paraganglioma diagnosed by pathology after retroperitoneal tumor resection,a family history of hypertension,and a history of passive smoking.The clinical diagnosis was subclinical paraganglioma,primary hypertension,and hypertensive fundus lesions.The patient’s blood pressure was regulated,blood lipid was reduced,and anti-inflammatory,and symptomatic support were given.After treatment,the blood pressure was stable and up to standard without discomfort symptoms.CONCLUSION Subclinical paraganglioma and primary hypertension can coexist.The holistic thinking in clinical practice is helpful to the early diagnosis of rare diseases.