51
|
Kotsis GP, Peteinaki AP, Sakellaridis AC, Andriotis EE, Koufopoulos N. Immunoglobulin G4-related Disease: Presentation of the First Case with Isolated Pterygopalatine Fossa Involvement. Cureus 2019; 11:e4719. [PMID: 31355079 PMCID: PMC6650185 DOI: 10.7759/cureus.4719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Immunoglobulin G4-related disease is an immune-mediated fibroinflammatory disease with single or multiple organ involvement. Clinically it mimics several benign and malignant tumors, as well as infectious, and inflammatory disorders. It typically presents as multiple tumor-forming lesions. Histological and immunohistochemical findings are characteristic. Serum immunoglobulin G4 levels are usually increased. Systemic corticosteroid administration is the treatment of choice with good response, especially in early disease stages. We present the first case of immunoglobulin G4-related disease presenting as an isolated tumor forming lesion of the left pterygopalatine fossa. Imaging studies indicated a benign process. Histological findings were consistent with IgG4-related disease. The patient showed a good response to systemic corticosteroid treatment and remains free of symptoms 18 months following diagnosis.
Collapse
Affiliation(s)
- Georgios P Kotsis
- Otorhinolaryngology / Head & Neck Surgery, "Saint Savvas" General Anti-Cancer and Oncological Hospital of Athens, Athens, GRC
| | | | - Athanasios C Sakellaridis
- Otorhinolaryngology / Head & Neck Surgery, "Saint Savvas" General Anti-Cancer and Oncological Hospital of Athens, Athens, GRC
| | - Efthymios E Andriotis
- Interventional Radiology, "Saint Savvas" General Anti-Cancer and Oncological Hospital of Athens, Athens, GRC
| | | |
Collapse
|
52
|
Lee CM, Alalwani M, Prayson RA, Gota CE. Retrospective single-centre analysis of IgG4-related disease patient population and treatment outcomes between 2007 and 2017. Rheumatol Adv Pract 2019; 3:rkz014. [PMID: 31432002 PMCID: PMC6649925 DOI: 10.1093/rap/rkz014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/18/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The aim was to gain a better understanding of the prevalence, organ involvement, clinical characteristics and long-term outcomes of medical and surgical treatments of IgG4-related disease (IgG4-RD). Methods Query of the Cleveland Clinic pathology database for IgG4 plasma cell staining between 2007 and 2017 yielded 1481 results, of which 57 cases were identified as highly likely (n = 28; 49%) or probable (n = 29; 51%) IgG4-RD by histopathological criteria and IgG4 serum concentrations. Patient demographics, type of treatment and outcomes were retrieved from medical records. Patients were designated as being in remission if indicated in the chart and/or symptom- and objective finding-free for >6 months, relapsed if symptoms/findings recurred after remission, active if no remission was achieved during follow-up, and as unable to determine if the duration of follow-up was <60 days or they were lost to follow-up. Results Of all patients who met the IgG4 staining criteria (n = 119), half (n = 57) satisfied the IgG4-RD histopathological criteria; 63% were males, age 57.9 ± 14.8 years. The average follow-up was 2.7 ± 2.2 years. The pancreas was the most affected organ in our cohort (26.4%). Almost half of the patients (45.6%; n = 26) were managed surgically, 21.1% (n = 12) medically, and 24.6% (n = 14) received both types of treatment. Medical treatment included prednisone (45.6%), MTX (5.3%), AZA (7%) and rituximab (8.8%). Remission was achieved by 77% of patients receiving surgical, 67% receiving medical and 72% receiving both treatments. Conclusion A histological diagnosis of IgG4-RD could be made in half of the patients who had IgG4+ plasma cells ≥10/high-power field or IgG4+/IgG+ ratio >40%. In our cohort, surgical treatment compared with medical treatment had a higher proportion of remission according to our outcome classification.
Collapse
Affiliation(s)
- Chan Mi Lee
- The Education Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Mohamed Alalwani
- Department of Rheumatologic and Immunologic Disease, Orthopaedic and Rheumatologic Institute, Cleveland Clinic
| | - Richard A Prayson
- The Education Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Carmen E Gota
- The Education Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,Department of Rheumatologic and Immunologic Disease, Orthopaedic and Rheumatologic Institute, Cleveland Clinic
| |
Collapse
|
53
|
Albitar HAH, Carmona EM. 48-Year-Old Man With Bilateral Mediastinal Lymphadenopathy, Orbital Pseudotumors, Kidney Masses, and Acute Pancreatitis. Mayo Clin Proc 2019; 94:531-535. [PMID: 30713047 DOI: 10.1016/j.mayocp.2018.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/26/2018] [Accepted: 05/14/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Hasan Ahmad Hasan Albitar
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Eva M Carmona
- Advisor to resident and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
54
|
Head and neck immunoglobulin G4 related disease: systematic review. The Journal of Laryngology & Otology 2018; 132:1046-1050. [PMID: 30558692 DOI: 10.1017/s0022215118002153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immunoglobulin G4 related disease is a recently described systemic syndrome. The head and neck region is the second most common site for presentation after the pancreas. METHODS PubMed and the Cochrane Library were searched from 1995 to July 2017 for all the studies on immunoglobulin G4 related disease diagnosed in the head and neck compartment. Patient-specific data were extracted and basic statistical analysis was performed. RESULTS Ninety-one patients were identified. Treatment was specified in 76 patients. Twenty patients received surgical treatment, eight of them in association with medical therapy. Fifty-six patients received medical treatment. The disease recurred in 25 per cent of patients treated with surgical treatment alone, in 3.6 per cent of patients treated with medical treatment alone and in 12.5 per cent of patients treated with both. All medical treatment protocols contained high-dose corticosteroids. CONCLUSION Early and correct diagnosis can avoid unnecessary surgical treatment, and glucocorticoid therapy can improve the long-term prognosis.
Collapse
|
55
|
Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
Collapse
Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| |
Collapse
|
56
|
Sulieman I, Mahfouz A, AlKuwari E, Szabados L, Elmoghazy W, Elaffandi A, Khalaf H. IgG4-related disease mimicking pancreatic cancer: Case report and review of the literature. Int J Surg Case Rep 2018; 50:100-105. [PMID: 30096533 PMCID: PMC6082998 DOI: 10.1016/j.ijscr.2018.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022] Open
Abstract
Pancreatic masses pose a diagnostic challenge, and cancer has to be always considered. IgG4-related disease is a rare cause of pancreatic masses. Biopsy from the pancreas is not always required if histopathology from a more accessible peripheral site lesion confirms the diagnosis. Multiorgan involvement and aortitis should raise suspicion of IgG4-related disease.
Introduction Most patients with pancreatic masses pose a diagnostic challenge when a benign lesion is suspected, and often, resection is needed before a benign diagnosis is confirmed. Presentation of case A 57 years old male patient presented with a pancreatic head mass, obstructive jaundice and submandibular lymph node enlargement. He also had a history of recurrent eye pain and redness, skin lesions, and benign prostatic hypertrophy. MRI showed a pancreatic head mass with double duct sign, aortic thickening, bilateral renal lesions, diffuse lymph node enlargement, and prostatic enlargement. FDG-PET/CT demonstrated abnormal uptake corresponding to the MRI lesions, and there were elevated IgG4 levels on blood investigations. Biopsy of an inguinal lymph node revealed infiltrates with IgG4 plasma cells, consistent with the diagnosis of IgG4 disease. The patient was treated with IV steroids and showed significant improvement. Discussion IgG4 related disease is a rare entity that is characterized by lesions that show heavy infiltration with IgG4 positive plasma cells, storiform fibrosis, and obliterative phlebitis. The pancreas is the most commonly involved organ, but several other organ systems are involved, and this helps in clinical suspicion of the diagnosis. A biopsy from any easily accessible site that shows the characteristic histological features is sufficient for diagnosis. Patients respond quickly to steroids, but recurrence is frequent. Conclusion IgG4 related disease is a rare cause of pancreatic tumorous lesions that need a high index of suspicion for diagnosis and should be differentiated from pancreatic neoplastic lesions.
Collapse
Affiliation(s)
- Ibnouf Sulieman
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, PO Box 3050, Qatar.
| | - Ahmed Mahfouz
- Department of Radiology, Hamad General Hospital, Doha, PO Box 3050, Qatar.
| | - Einas AlKuwari
- Department of Pathology, Hamad General Hospital, Doha, PO Box 3050, Qatar.
| | - Lajos Szabados
- Department of Nuclear Medicine, Hamad General Hospital, Doha, PO Box 3050, Qatar.
| | - Walid Elmoghazy
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, PO Box 3050, Qatar.
| | - Ahmed Elaffandi
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, PO Box 3050, Qatar.
| | - Hatem Khalaf
- Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, PO Box 3050, Qatar.
| |
Collapse
|
57
|
Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M. Primary sclerosing cholangitis. Lancet 2018; 391:2547-2559. [PMID: 29452711 DOI: 10.1016/s0140-6736(18)30300-3] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/24/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
Primary sclerosing cholangitis is a rare, chronic cholestatic liver disease characterised by intrahepatic or extrahepatic stricturing, or both, with bile duct fibrosis. Inflammation and fibrosis of bile ducts and the liver are followed by impaired bile formation or flow and progressive liver dysfunction. Patients might be asymptomatic at presentation or might have pruritus, fatigue, right upper quadrant pain, recurrent cholangitis, or sequelae of portal hypertension. The key diagnostic elements are cholestatic liver biochemistry and bile duct stricturing on cholangiography. Genetic and environmental factors are important in the cause of the disease, with the intestinal microbiome increasingly thought to play a pathogenetic role. Approximately 70% of patients have concurrent inflammatory bowel disease and patients require colonoscopic screening and surveillance. Primary sclerosing cholangitis is associated with increased malignancy risk and surveillance strategies for early cholangiocarcinoma detection are limited. No single drug has been proven to improve transplant-free survival. Liver transplantation is effective for advanced disease but at least 25% of patients develop recurrent disease in the graft.
Collapse
Affiliation(s)
- Jessica K Dyson
- Department of Hepatology, Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - David E J Jones
- Department of Hepatology, Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Ansgar W Lohse
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark Hudson
- Department of Hepatology, Newcastle upon Tyne Hospitals NHS Foundation Trust and Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| |
Collapse
|
58
|
Llamas-Velasco M, Stengel B, Pérez-González YC, Mentzel T. Late-Stage Erythema Elevatum Diutinum Mimicking a Fibroblastic Tumor: A Potential Pitfall. Am J Dermatopathol 2018; 40:442-444. [PMID: 29293121 DOI: 10.1097/dad.0000000000001088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Erythema elevatum diutinum (EED) is a rare dermatosis with evolving histopathological features that vary according to the age of the lesions, with a variable fibrosis and a fascicled proliferation of spindle cells in late phases. The authors present an otherwise healthy 57-year-old woman with multiple indurated nodules on the inner aspect of both feet. Skin biopsy showed storiform interlacing bundles of spindled cells with plump nuclei and some areas with neutrophils and leukocytoclasia. CD34 and S100 were negative. This case is noteworthy clinically due to its location and its histopathological presentation that comprises a wide differential diagnosis, including inflammatory pseudotumor, dermatofibrosarcoma protuberans, superficial nodular fasciitis, hyalinized leiomyoma, sclerosing spindle cell perineuroma, and sclerotic fibroma. The authors have reviewed the main histopathological and immunohistochemical features that help in the differential diagnosis of this rare variant of EED. A careful search for leukocytoclasia and neutrophilic vasculitis is mandatory to establish the right diagnosis of nodular or late-stage EED and avoid the pitfall of considering this a neoplastic process.
Collapse
Affiliation(s)
- Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Berhard Stengel
- Pathology Department, Institute of Pathology, Güstrow, Germany
| | | | - Thomas Mentzel
- Dermatopathology Department, Friedrichshafen Dermatopathologie, Friedrichshafen, Germany
| |
Collapse
|
59
|
Brour J, Sassi H, Koubaa Mahjoub W, Ouederni M, Hassairi A, Chedly Debbiche A, Chéour M. Exophtalmie bilatérale pseudo-tumorale révélant un syndrome hyper-IgG4 orbitaire. J Fr Ophtalmol 2018; 41:521-525. [DOI: 10.1016/j.jfo.2017.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/24/2017] [Accepted: 10/02/2017] [Indexed: 10/14/2022]
|
60
|
Zhao PX, Adzavon YM, Ma JM, Shang L, Chen DY, Xie F, Liu MY, Zhang X, Lyu BB, Zhang MZ, Yang LQ, Ma XM. IgG4 and IgE co-positive group found in idiopathic orbital inflammatory disease. Int J Ophthalmol 2018; 11:36-42. [PMID: 29375988 DOI: 10.18240/ijo.2018.01.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/28/2017] [Indexed: 12/22/2022] Open
Abstract
AIM To reveal the cytokines involved in idiopathic orbital inflammatory disease (IOID) and the relationship between Th17 cells, IgE and IOID pathogenesis. METHODS Whole blood samples were processed immediately after collection and serological IgG4, IgG, and IgE antibodies were tested using ELISA. IOID and orbital cavernous hemangioma (CH) tissue samples underwent Bio-Plex multiplex cytokine detection. Hematoxylin-Eosin (HE) staining of all paraffin samples suggested the histological features of IOIDs, and expressions of IgG4 and IL-17A in affected tissues were detected by immunohistochemistry. RESULTS Among 40 IOID plasma samples, 52.5% (21/40) were positive for IgG4 and 25% (10/40) were positive for IgE. Overlapped IgG4 or IgE positive samples accounted for 22.5% (9/40). Therefore, IOID samples were separated into three groups. The IgE+/IgG4+ group had a relevantly lower level of pro-inflammatory cytokine expression. IL-4 (Th2 cell related), IL-10 and TGF-β1 (Treg cell immunity related) were elevated in all three groups. Some of the Th17 cell related cytokines (i.e. IL-17A/F, IL-25, IL-23, and IL-33) displayed higher expression levels in the IgE-/IgG4- group compared to the other two groups. CONCLUSION We discovered an IgG4-IgE co-positive group as well as Th17 cell immune involvement in IgG4-IgE co-negative subgtroup in IOID for the first time. The pathogenesis of IOID could differ from different subgroups according to the IgG4 and IgE detection. Therefore, we recommend that, Treatment stratagy should be made according to the clinical assessment of IgG4-IgE and Th17 profile detection.
Collapse
Affiliation(s)
- Peng-Xiang Zhao
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Yao Mawulikplimi Adzavon
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Jian-Min Ma
- Beijing Ophthalmology & Vision Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Lei Shang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Dan-Ying Chen
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Fei Xie
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Meng-Yu Liu
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Xin Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Bao-Bei Lyu
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Ming-Zi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Lin-Qi Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| | - Xue-Mei Ma
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China
| |
Collapse
|
61
|
Sakai Y, Imamura Y. Case report: IgG4-related mass-forming thyroiditis accompanied by regional lymphadenopathy. Diagn Pathol 2018; 13:3. [PMID: 29378608 PMCID: PMC6389070 DOI: 10.1186/s13000-017-0681-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/22/2017] [Indexed: 12/24/2022] Open
Abstract
Background It has been recently accepted that IgG4-related thyroiditis is comparable to the Hashimoto and Riedel thyroiditis and Graves disease which are rich in IgG4-secreting plasma cells. Many physicians believe that in IgG4-related thyroiditis, the thyroid is entirely enlarged and diffusely affected, which is similar to conventional thyroiditis, but rarely ever accompanied by pseudoneoplastic mass formation as in IgG4-related disease in the other organs. This report introduces another pattern of IgG4-related thyroiditis as mass-forming thyroiditis and presents the occurrence of IgG4-related regional lymphadenopathy as an unusual accompanying symptom. Case presentation A 66-year-old woman presented with an approximately 2.5-cm mass in the right thyroidal lobe and regional lymph node swelling, which were preoperatively misinterpreted as thyroidal carcinoma. After lobectomy, histological examination was performed, revealing that the mass showed dense stromal fibrosis, lymphoplasmacytic infiltration, and effacement of thyroid follicles, while the background thyroidal tissue seemed to mimic lymphocytic thyroiditis without fibrosis. Immunohistochemistry revealed predominance of IgG4-secreting plasma cells among infiltrating lymphocytes independent of mass lesion or background tissue. In addition, the regional Delphian and paratracheal lymph nodes were swollen, histologically showing numerous IgG4-secreting plasma cell infiltrations in the interfollicular zone. Conclusions IgG4-related mass-forming thyroiditis, which may be an extremely rare but recognizable pattern of IgG4-related thyroiditis, may be distinguishable from Hashimoto and Riedel thyroiditis, Graves disease, and thyroidal carcinoma. In addition, the regional IgG4-related lymphadenopathy, also possibly misdiagnosed as metastatic thyroidal carcinoma, may be a newly recognized manifestation of IgG4-related thyroiditis.
Collapse
Affiliation(s)
- Yasuhiro Sakai
- Department of Tumor Pathology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan. .,Division of Diagnostic Pathology/Surgical Pathology, University of Fukui Hospital, Eiheiji, Japan.
| | - Yoshiaki Imamura
- Division of Diagnostic Pathology/Surgical Pathology, University of Fukui Hospital, Eiheiji, Japan
| |
Collapse
|
62
|
Mattoo H, Stone JH, Pillai S. Clonally expanded cytotoxic CD4 + T cells and the pathogenesis of IgG4-related disease. Autoimmunity 2017; 50:19-24. [PMID: 28166682 DOI: 10.1080/08916934.2017.1280029] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
IgG4-related disease (IgG4-RD) is a systemic condition of unknown cause characterized by highly fibrotic lesions, with dense lymphoplasmacytic infiltrates containing a preponderance of IgG4-expressing plasma cells. CD4+ T cells and B cells constitute the major inflammatory cell populations in IgG4-RD lesions. IgG4-RD patients with active, untreated disease show a marked expansion of plasmablasts in the circulation. Although the therapeutic depletion of B cells suggests a role for these cells in the disease, a direct role for B cells or IgG4 in the pathogenesis of IgG4-RD is yet to be demonstrated. Among the CD4+ T-cell subsets, Th2 cells were initially thought to contribute to IgG4-RD pathogenesis, but many previous studies were confounded by the concomitant history of allergic diseases in the patients studied and the failure to use multi-color staining to definitively identify T-cell subsets in tissue samples. More recently, using an unbiased approach to characterize CD4+ T-cell subsets in patients with IgG4-RD - based on their clonal expansion and ability to infiltrate affected tissue sites - CD4+ CTLs have been identified as the major CD4+ T-cell subset in disease lesions as well as in the circulation. CD4+ CTLs in affected tissues secrete pro-fibrotic cytokines including IL-1β, TGF-β1, and IFN-γ as well as cytolytic molecules such as perforin and granzymes A and B. In this review, we examine possible mechanisms by which activated B cells and plasmablasts may collaborate with the expanded CD4+ CTLs in driving the fibrotic pathology of the disease and describe the lacunae in the field and in our understanding of IgG4-RD pathogenesis.
Collapse
Affiliation(s)
- Hamid Mattoo
- a Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - John H Stone
- a Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Shiv Pillai
- a Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| |
Collapse
|
63
|
An 84-Year-Old Man With Progressive Dyspnea and an Abnormal Chest CT Scan. Chest 2017; 152:e45-e49. [PMID: 28797400 DOI: 10.1016/j.chest.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/16/2017] [Accepted: 03/06/2017] [Indexed: 11/21/2022] Open
Abstract
CASE PRESENTATION An 84-year-old man without a history of smoking presented with progressive dyspnea of 6 months' duration accompanied by fatigue and unintentional weight loss. He denied fever, chills, chest pain, hemoptysis, rash, joint pains, or muscle aches. He had multiple hospitalizations for similar presentations that were diagnosed as pneumonia. History was significant for diastolic heart failure, hypertension, and type 2 diabetes mellitus.
Collapse
|
64
|
Wang L, Chu X, Ma Y, Zhang M, Wang X, Jin L, Tan Z, Li X, Li X. A Comparative Analysis of Serum IgG4 Levels in Patients With IgG4-Related Disease and Other Disorders. Am J Med Sci 2017; 354:252-256. [DOI: 10.1016/j.amjms.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 02/06/2023]
|
65
|
Jadhav KK, Kumar V, Punatar CB, Joshi VS, Sagade SN. Retroperitoneal fibrosis-clinical presentation and outcome analysis from urological perspective. Investig Clin Urol 2017; 58:371-377. [PMID: 28868510 PMCID: PMC5577335 DOI: 10.4111/icu.2017.58.5.371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose To study clinical presentation, laboratory results, imaging findings and treatment options and outcomes of retroperitoneal fibrosis (RPF). To determine whether it follows the same natural course and response to treatment in the Asian population as in the Western world. Materials and Methods Medical records of patients diagnosed with RPF on imaging and histopathology between February 2010 and April 2016 were reviewed. Results Of the 21 patients analyzed, mean age at presentation was 50.81 years. The male to female ratio was 0.9:1. Pain was most common presenting complaint (95.23% cases), almost 85% cases were idiopathic and rests were postradiation induced. The median creatinine level was 1.8 mg/dL. The mean erythrocyte sedimentation rate (ESR) was 53.2 mm/h. Hydronephrosis was present in all patients and 47.6% had atrophic kidneys. Diffuse retroperitoneal mass was present in 61.1%. Ureterolysis with lateralization, omental wrapping or gonadal pedicle wrap was done in 17 cases. Two patients underwent uretero-ureterostomy. One patient underwent ileal replacement of ureter, and one ileal conduit. Eighteen patients received concurrent medical treatment, 11 were given tamoxifen, 2 steroids (Prednisolone), and five were given both. Of the 20 patients with follow-up, 70% had complete symptomatic relief; ESR improvement was seen in 77.8%. Follow-up ultrasound showed resolved and decreased hydronephrosis in 20% and 55% respectively. One patient had treatment failure and 17.65% had disease recurrence. Conclusions RPF is a rare disease with varied presentation and outcomes. The male to female ratio may be equal in Asians and smoking could be lesser contributing factor. More Asian cohort studies are required to support same.
Collapse
Affiliation(s)
- Kunal Kishor Jadhav
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Vikash Kumar
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Chirag B Punatar
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Vinod S Joshi
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| | - Sharad N Sagade
- Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Maharashtra, India
| |
Collapse
|
66
|
Chen YC, Chan HH, Lai KH, Tsai TJ, Hsu PI. Type 1 (IgG4-related) autoimmune pancreatitis: Experiences in a medical center in southern Taiwan within the past 10 years. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yen-Chun Chen
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Division of Gastroenterology; Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; Chiayi Taiwan
| | - Hoi-Hung Chan
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Department of Biological Sciences; National Sun Yat-sen University; Kaohsiung Taiwan
- College of Pharmacy and Health Care; Tajen University; Pingtung Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Business Management; National Sun Yat-sen University; Kaohsiung Taiwan
| | - Kwok-Hung Lai
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Tzung-Jiun Tsai
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Ping-I Hsu
- Division of Gastroenterology & Hepatology; Department of Internal Medicine, Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| |
Collapse
|
67
|
Terzic B, Spasic M, Djuric P, Vasiljevic V, Radjen S, Mijuskovic M. Retroperitoneal fibrosis and constrictive pericarditis-IgG4 related diseases: A case report. Exp Ther Med 2017; 13:3603-3606. [PMID: 28588687 DOI: 10.3892/etm.2017.4425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/20/2017] [Indexed: 12/24/2022] Open
Abstract
Retroperitoneal fibrosis (RPF) is a rare disease characterized by infiltration of inflammatory cells and deposition of thickened fibrous tissues. The present study presents the case of a 53-year-old patient treated for generalized weakness and fatigue for 1 year prior to hospitalization. A cardiac ultrasound revealed pericardial effusion that required pericardiocentesis, during which 1,400 ml serous fluid with the characteristics of an exudate was aspirated. A pericardiectomy was performed due to persistent effusion and histological examination indicated pericardial fibrosis. A thoracic-abdominal computed tomography scan revealed the presence of retroperitoneal fibrosis. The patient was treated with corticosteroids and azathioprine. Follow-up examinations showed a significant reduction in the amount of abdominal fibrous tissue and no increase in pericardial effusion 1 year following the end of treatment. The patient continues to have regular follow-up control examinations with a cardiologist and nephrologist.
Collapse
Affiliation(s)
- Brankica Terzic
- Nephrology Clinic, Military Medical Academy, 11000 Belgrade, Serbia
| | - Marijan Spasic
- Cardiology Clinic, Military Medical Academy, 11000 Belgrade, Serbia
| | - Predrag Djuric
- Cardiology Clinic, Military Medical Academy, 11000 Belgrade, Serbia
| | | | - Slavica Radjen
- Institute of Hygiene, Military Medical Academy, 11000 Belgrade, Serbia
| | | |
Collapse
|
68
|
Morris S, Byun Robinson A, Redline R, Brooks EB, Cunningham RJ, Ross J, Zeft RG. A Curious Case of Ureteral Obstruction in a 15-Year-Old Female. Clin Pediatr (Phila) 2017; 56:500-503. [PMID: 27449991 DOI: 10.1177/0009922816660544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simrat Morris
- 1 UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | | | - Raymond Redline
- 1 UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | | | | | - Jonathan Ross
- 1 UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Reut G Zeft
- 1 UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| |
Collapse
|
69
|
Baptista B, Casian A, Gunawardena H, D'Cruz D, Rice CM. Neurological Manifestations of IgG4-Related Disease. Curr Treat Options Neurol 2017; 19:14. [PMID: 28374231 PMCID: PMC5378735 DOI: 10.1007/s11940-017-0450-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT IgG4-related disease (IgG4-RD) is a multisystem inflammatory disorder. Early recognition of IgG4-RD is important to avoid permanent organ dysfunction and disability. Neurological involvement by IgG4-RD is relatively uncommon, but well recognised-hypertrophic pachymeningitis and hypophysitis are the most frequent manifestations. Although the nervous system may be involved in isolation, this more frequently occurs in conjunction with involvement of other systems. Elevated circulating levels of IgG4 are suggestive of the condition, but these are not pathognomonic and exclusion of other inflammatory disorders including vasculitis is required. Wherever possible, a tissue diagnosis should be established. The characteristic histopathological changes include a lymphoplasmacytoid infiltrate, storiform fibrosis and obliterative phlebitis. IgG4-RD typically responds well to treatment with glucocorticoids, although relapse is relatively common and treatment with a steroid-sparing agent or rituximab may be required. Improved understanding of the pathogenesis of IgG4-RD is likely to lead to the development of more specific disease treatments in the future.
Collapse
Affiliation(s)
| | - Alina Casian
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Harsha Gunawardena
- Department of Rheumatology, Brunel Building, Southmead Hospital, Bristol, UK
- Musculoskeletal Research Unit, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - David D'Cruz
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
- Division of Immunology, Infection and Inflammatory Diseases, King's College London, New Hunt's House, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
| | - Claire M Rice
- School of Clinical Sciences, Level 1, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
- Department of Neurology, Brunel Building, Southmead Hospital, Bristol, UK.
| |
Collapse
|
70
|
Liu W, Chen W, He X, Qu Q, Hong T, Li B. Poor response of initial steroid therapy for IgG4-related sclerosing cholangitis with multiple organs affected. Medicine (Baltimore) 2017; 96:e6400. [PMID: 28328835 PMCID: PMC5371472 DOI: 10.1097/md.0000000000006400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IgG4-related sclerosing cholangitis (IgG4-SC) is a rare biliary manifestation in which many other organs might be affected. The purpose of our study was to investigate the different clinical characteristics and initial steroid response between IgG4-SC patients with and without other organs affected.A series of patients with IgG4-SC in the period from January 2006 to December 2015 at our hospital were included. The pancreas and major salivary glands were screened, and the initial corticosteroid therapy was given. Clinical information was collected and analyzed including demographics, clinical presentation, IgG4 serology, imaging features, and treatment outcomes.The study identified 72 IgG4-SC patients, including 60 males and 12 females. The mean age was 59.8 years old. Among these IgG4-SC patients, 10 patients had only bile duct involved, 42 patients had 2 organs involved and 20 patients had multiple organs involved. In patients with multiple organs involved, more complaints were given (mean 2.9 kinds), higher serum IgG4 levels were found (23458 ± 19402.7 mg/L), and more stricture lesions of biliary tract were shown. All 72 patients exhibited a disease response within 4 to 6 weeks of starting steroids. The remission rate in the multiple lesions group was lower (60%), and the recurrence rate is higher (83.3%). The relapse-free survival was 20.0 months in the single lesion group, which is longer than that in the multiple lesions group (3.1 months, P < 0.05).The IgG4-SC patients with multiple organs affected had more complaints, higher serum IgG4 levels, and poor response to initial steroids.
Collapse
|
71
|
18F-FDG PET/CT Features of Chronic Sclerosing Sialadenitis Presenting as Localized IgG4-Related Disease. Clin Nucl Med 2017; 42:131-132. [DOI: 10.1097/rlu.0000000000001482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
72
|
|
73
|
Li X, Duan W, Zhu X, Xu J. Immunoglobulin G4-related acquired hemophilia: A case report. Exp Ther Med 2016; 12:3988-3992. [PMID: 28105131 PMCID: PMC5228537 DOI: 10.3892/etm.2016.3898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/22/2016] [Indexed: 12/24/2022] Open
Abstract
Acquired hemophilia A (AHA) is a relatively rare and life-threatening bleeding disorder whose pathogenesis is not completely understood. The present study reports a rare case of immunogubulin (IgG)4-related AHA with multisystemic involvement. A 55-year old male patient presented with symptoms of bronchial asthma and multiple subdermal hematomas. Chest computed tomography showed multiple diffuse nodular lesions with thickening of bronchovascular bundles, and scattered high-density spots in both lung lobes. Laboratory investigations showed increased activated partial prothrombin time (120.0 sec), a markedly decreased factor VIII (FVIII) activity (0.5%), a high-titer of FVIII inhibitor (27.2 Bethesda units/ml) and a marked increase in serum IgG4 (>4.03 g/l) level. Left inguinal lymph node biopsy revealed capsular thickening with marked lymphoplasmacytic infiltration, occlusive phlebitis and irregular fibrosis. Immunostaining revealed numerous IgG4-positive plasma cells (>100 cells/human plasma fibronectin) in the nodular lesions, with an IgG4/IgG ratio of >40%. The symptoms were markedly alleviated following corticosteroid therapy. The current study presents the first reported case of a rare IgG4-related AHA that presented with unusual clinical features and multisystemic involvement. The patient responded well to corticosteroid therapy. Documentation of such rare cases will help in characterizing the pathogenesis, and prompt recognition and timely treatment of this rare disorder.
Collapse
Affiliation(s)
- Xiaoyan Li
- Department of Respiratory Medicine, Shanxi DAYI Hospital of Shanxi Medical University, Taiyuan, Shanxi 030032, P.R. China
| | - Wei Duan
- Department of Respiratory Medicine, Shanxi DAYI Hospital of Shanxi Medical University, Taiyuan, Shanxi 030032, P.R. China
| | - Xiang Zhu
- Department of Pathology, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Jianying Xu
- Department of Respiratory Medicine, Shanxi DAYI Hospital of Shanxi Medical University, Taiyuan, Shanxi 030032, P.R. China
- Correspondence to: Dr Jianying Xu, Department of Respiratory Medicine, Shanxi DAYI Hospital of Shanxi Medical University, 99 Longcheng Avenue, Taiyuan, Shanxi 030032, P.R. China, E-mail:
| |
Collapse
|
74
|
Stamatopoulos A, Patrini D, Koletsis E, Borg E, Khiroya R, Hayward M, Lawrence D, Panagiotopoulos N. IgG4 related lung disease extending to the thoracic vertebrae. Respir Med Case Rep 2016; 19:162-165. [PMID: 27766198 PMCID: PMC5066297 DOI: 10.1016/j.rmcr.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 09/25/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is a fibroinflammatory condition that can affect practically every organ. Although it was first identified in pancreas and salivary glands, major organs like liver, biliary tree, kidney, thyroid glands and lungs are commonly involved, sometimes resulting in organ failure. We describe a case of an 41-year-old man presented with back pain after a rotator cuff injury. A Computed Tomography (CT) revealed incidentally a right lower lobe paravertebral lesion extending across the T5 and T6 vertebral levels and invading into the adjacent pleural surface. The laboratory findings and the CT guided biopsy were inconclusive. Morphological and immunohistochemical findings after a lung biopsy by video-assisted thoracic surgery (VATS) were suggestive to IgG4-related lung disease (IgG4-RLD), which was confirmed with high serum levels of IgG4. This represents the first case of a IgG4-RLD lesion located in the mediastinum and extending to the adjacent pleural surface and vertebrae and should be included in the differential diagnosis of posterior mediastinal masses.
Collapse
Affiliation(s)
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | - Efstratios Koletsis
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | - Elaine Borg
- Department of Pathology, University College London Hospitals (UCLH), London, UK
| | - Reena Khiroya
- Department of Pathology, University College London Hospitals (UCLH), London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | |
Collapse
|
75
|
Della-Torre E, Stone JH. “How I manage” IgG4-Related Disease. J Clin Immunol 2016; 36:754-763. [DOI: 10.1007/s10875-016-0331-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/29/2016] [Indexed: 12/18/2022]
|
76
|
|
77
|
Sekiguchi H, Horie R, Kanai M, Suzuki R, Yi ES, Ryu JH. IgG4-Related Disease: Retrospective Analysis of One Hundred Sixty-Six Patients. Arthritis Rheumatol 2016; 68:2290-9. [DOI: 10.1002/art.39686] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/15/2016] [Indexed: 12/19/2022]
|
78
|
Egner W, Swallow K, Lock RJ, Patel D. Falsely low immunoglobulin (Ig)G4 in routine analysis: how not to miss IgG4 disease. Clin Exp Immunol 2016; 186:57-63. [PMID: 27125474 DOI: 10.1111/cei.12805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 12/16/2022] Open
Abstract
Immunoglobulin (Ig)G4 disease can have apparently 'normal' levels of IgG4 due to antigen excess conditions. IgG4 measurement therefore appears falsely low. UK National External Quality Assurance Scheme (UK NEQAS) data and other reports have suggested that this problem occurred despite pre-existing antigen excess detection steps. To determine the clinical relevance of the problem, we examined the prevalence and characteristics of prozoning in our laboratory and patient cohorts. We establish that the prevalence of raised IgG4 in routine IgG4 analysis is low (< 1%) using one of the two routine methods in use in the United Kingdom. We show that subsequent assay modification appears to have reduced the likelihood of misleading readings. However, the original version of the assay prozoned to low levels (below 0·64 g/l) in 41% of high IgG4 samples in our patients. This may explain the previous reports of low sensitivity of raised IgG4 for IgG4RD, and predictive values should be re-evaluated in this disease using modified prozone-resistant protocols. All laboratories providing IgG4 measurements should verify that their assays are fit for the clinical quality requirement of detection raised IgG4 levels and must verify the upper limit of their reference ranges and freedom from prozoning.
Collapse
Affiliation(s)
- W Egner
- Department of Immunology and Protein Reference Unit, Sheffield.,Immunochemistry and Allergy (IIA), Sheffield Teaching Hospitals NHS Trust, UK NEQAS Immunology, Sheffield
| | - K Swallow
- Department of Immunology and Protein Reference Unit, Sheffield
| | - R J Lock
- Immunology and Immunogenetics, North Bristol NHS Trust, Bristol
| | - D Patel
- Immunochemistry and Allergy (IIA), Sheffield Teaching Hospitals NHS Trust, UK NEQAS Immunology, Sheffield
| |
Collapse
|
79
|
Abstract
BACKGROUND AND AIM Immunoglobulin G4-associated cholangitis (IAC) shares many similar symptoms with cholangiocarcinoma (CCA). However, the treatment and the prognosis are substantially different. This study aimed to identify the important markers for the differential diagnosis of these 2 diseases. METHODS Thirty IAC patients and 275 CCA patients were reviewed retrospectively for their clinical symptoms, serological tests, and imaging characteristics. Posttreatment responses were also studied. RESULTS IgG4 had 100% specificity for IAC at a cutoff of 6 times the upper normal limit. IAC patients had a significantly higher incidence of weight loss (P=0.025) and a higher level of weight loss (P=0.008) than CCA patients. The positive rates of biological markers CA199, CA242, and CEA in CCA and IAC were 81.5% versus 42.9%, 45.5% versus 4.5%, and 29.2% versus 7.1%, respectively. Levels of these tumor markers in CCA were significantly higher than in IAC (P<0.05). The thickened wall [17/18 (94.4%) vs. 3/10 (30%), P=0.001] and the occupying lesion on the bile duct [1/18 (5.6%) vs. 8/10 (80%), P<0.001] were found to be significantly different in IAC and CCA, respectively, by endoscopic ultrasonography. Autoimmune pancreatitis was the most frequently observed comorbidity of IAC (25/30). All IAC patients respond positively to steroid treatment. CONCLUSIONS Increased tumor markers, 6-fold higher levels of serum IgG4, and other organs' involvement could be the reference factors for a differential diagnosis of IAC and CCA. Endoscopic ultrasonography might be an effective imaging tool for diagnosis, although clinical signs and symptoms of IAC and CCA are similar. Experimental steroid treatment can be useful in the diagnosis for certain difficult cases.
Collapse
|
80
|
Önder Ö, Bilgin RR, Köşkderelioğlu A, Gedizlioğlu M. Orbital Myositis: Evaluating Five New Cases Regarding Clinical and Radiological Features. Noro Psikiyatr Ars 2016; 53:173-177. [PMID: 28360792 DOI: 10.5152/npa.2015.10214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/27/2015] [Indexed: 01/06/2023] Open
Abstract
Orbital myositis (OM) is an inflammatory disorder of the extraocular muscles. The signs and symptoms of OM are periorbital pain, eyelid swelling and redness, restricted ocular motility, and strabismus. There are at least two major forms, described by Benedikt GH Schoser, a limited oligosymptomatic ocular myositis (LOOM), which is associated with conjunctival injection only, and severe exophthalmic ocular myositis (SEOM), which presents with additional ptosis, chemosis, and proptosis. We report the clinical and radiological features of five patients with OM who were recently followed in our clinic. Three patients, one man and two women, were placed in the LOOM group, and the other two patients, both women, were in the SEOM group. In both groups, the initial complaints were pain worsening with eye movements and double vision, with only one patient in the SEOM group having pain worsening secondary to Crohn's disease. The most affected muscles were the medial and lateral recti. All the patients were treated with corticosteroids, resulting in rapid improvement. Only one patient in the SEOM group experienced a relapse. Orbital magnetic resonance imaging of all the patients revealed enlargement and contrast enhancement of the involved muscles. Although clinical and radiological features are quite consistent, delayed diagnosis in some patients demonstrates the importance of the awareness of OM.
Collapse
Affiliation(s)
- Özlem Önder
- Clinic of Neurology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Rıfat Reha Bilgin
- Clinic of Neurology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Aslı Köşkderelioğlu
- Clinic of Neurology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Muhteşem Gedizlioğlu
- Clinic of Neurology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
81
|
Woo YJ, Kim JW, Yoon JS. Clinical implications of serum IgG 4 levels in patients with IgG 4-related ophthalmic disease. Br J Ophthalmol 2016; 101:256-260. [PMID: 27215743 DOI: 10.1136/bjophthalmol-2016-308592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 05/01/2016] [Indexed: 12/24/2022]
Abstract
AIMS The present study aimed to investigate the clinical implications of serum IgG4 levels in patients with IgG4-related ophthalmic disease (ROD). METHODS The medical records of 31 patients who met the diagnostic criteria for IgG4-ROD were retrospectively reviewed. Twenty-five patients whose serum IgG4 levels could be identified were included. Clinical manifestations and serum IgG4 levels before and after corticosteroid treatment were obtained. Factors associated with relapse were evaluated by comparing the features of patients with disease relapse with those of patients without relapse. RESULTS Twenty-four patients were 'definite' and one was 'probable' for IgG4-ROD according to the diagnostic criteria. Serum IgG4 levels were higher in patients with systemic involvement (p=0.046). All patients improved clinically after corticosteroid treatment. Serum IgG4 levels decreased after steroid treatment (p=0.005) and normalised in nine patients. In cases of relapse, serum IgG4 levels increased along with the aggravation of symptoms (p=0.047). Serum IgG4 levels that were still elevated (≥135 mg/dL) after steroid treatment (p=0.034) and cessation of steroid treatment during disease remission (p=0.043) were predictive factors for IgG4-ROD relapse. CONCLUSIONS Serum IgG4 level can be considered an adjunctive marker for treatment response in IgG4-ROD. Patients with serum IgG4 levels that remain elevated after steroid treatment should be carefully observed for relapse. A continuing maintenance dose of oral steroid is recommended to prevent relapse, even when clinical remission is achieved.
Collapse
Affiliation(s)
- Young Jun Woo
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Won Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
82
|
Utility of FDG PET/CT for Differential Diagnosis of Patients Clinically Suspected of IgG4-Related Disease. Clin Nucl Med 2016; 41:e237-43. [DOI: 10.1097/rlu.0000000000001153] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
83
|
Abstract
IgG4 related disease is a poorly understood immune mediated condition. Lung involvement is rare and difficult to diagnose and can mimic primary lung malignancy on imaging. A patient who was found to have an incidental lung lesion with risk factors for primary pulmonary malignancy is reported.
Collapse
|
84
|
Kavand S, Lehman JS, Gibson LE. Granuloma Faciale and Erythema Elevatum Diutinum in Relation to Immunoglobulin G4-Related Disease: An Appraisal of 32 Cases. Am J Clin Pathol 2016; 145:401-6. [PMID: 27124923 DOI: 10.1093/ajcp/aqw004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To elucidate whether granuloma faciale (GF) and erythema elevatum diutinum (EED), two inflammatory skin dermatoses, meet the consensus histopathologic diagnostic criteria for immunoglobulin G4-related disease (IgG4-RD). METHODS With institutional review board approval, we assessed the clinical, microscopic, and immunophenotypic features of skin specimens of patients with GF and EED. We compared these findings with previously published consensus diagnostic criteria for IgG4-RD. RESULTS Thirty-two patients (GF, n = 25; EED, n = 7) met study inclusion criteria. Histopathologic findings of small-vessel vasculitis, dermal fibrosis, and plasma cell infiltrates were uniformly present, and eosinophilic inflammation was frequent. No specimen met diagnostic criteria for IgG4-RD. CONCLUSIONS Our results indicate that despite some histopathologic similarities between GF/EED and IgG4-RD, the cases did not meet the consensus immunohistochemical diagnostic criteria for IgG4-RD.
Collapse
Affiliation(s)
- Sima Kavand
- From the Department of Medicine, Presence Saint Francis Hospital, University of Illinois, Evanston
| | - Julia S Lehman
- Departments of Dermatology, Pathology and Laboratory Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Lawrence E Gibson
- Departments of Dermatology, Pathology and Laboratory Medicine, Mayo Clinic College of Medicine, Rochester, MN.
| |
Collapse
|
85
|
Moghaddam PA, Virk R, Sakhdari A, Prasad ML, Cosar EF, Khan A. Five Top Stories in Thyroid Pathology. Arch Pathol Lab Med 2016; 140:158-70. [PMID: 26910221 DOI: 10.5858/arpa.2014-0468-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Thyroid carcinoma is the most common malignant tumor of endocrine organs, yet it only accounts for approximately 1% of all cancers in the United States with more than 35,000 new cases diagnosed each year and more than 450,000 people living with this disease. While most tumors can be diagnosed without much difficulty, a few tumor types, especially tumors with follicular pattern, sometimes pose a diagnostic challenge. OBJECTIVE To discuss morphologic, immunohistochemical, and molecular features of thyroid tumors. We also explore the clinicopathologic features of papillary microcarcinoma and medullary microcarcinoma and how the latter is related and differentiated from C-cell hyperplasia. Finally with the ever-growing list of organ systems involved in immunoglobulin (Ig) G4-related diseases, we discuss the still not completely explored IgG-4-related thyroid disease. DATA SOURCES Data were obtained from review of the pertinent peer-reviewed literature and institutional experience. CONCLUSIONS Histomorphologic evaluation still remains the gold standard for diagnosis in most cases of thyroid diseases. The application of ancillary studies such as immunohistochemistry and molecular diagnosis, including next-generation sequencing, is becoming more common.
Collapse
Affiliation(s)
- Parnian Ahmadi Moghaddam
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
| | - Renu Virk
- and the Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Drs Virk and Prasad)
| | - Ali Sakhdari
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
| | - Manju L Prasad
- and the Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Drs Virk and Prasad)
| | - Ediz F Cosar
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
| | - Ashraf Khan
- From the Department of Pathology, University of Massachusetts Memorial Medical Center, Worcester (Drs Moghaddam, Sakhdari, Cosar, and Khan)
| |
Collapse
|
86
|
Mozzo E, Donà D, Zannin ME, Giaquinto C, Rampon O. Ocular involvement in an HIV-infected patient: not always an infectious disease. An interesting case without apparent cause. Int J STD AIDS 2016; 27:1130-1133. [PMID: 26823370 DOI: 10.1177/0956462416629263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
Abstract
We describe the case of a young girl with vertically-transmitted HIV infection who presented with chronic ocular inflammation characterized by several relapses and remissions. Good viral and immunological status made infective or neoplastic causes unlikely; the diagnosis was challenging and finally spontaneous remission was observed after several months. Clinical and histopathological findings made idiopathic orbital inflammatory syndrome the most probable diagnosis for our patient.
Collapse
Affiliation(s)
- Elena Mozzo
- Department of Child's and Woman's Health, University of Padova, Italy
| | - Daniele Donà
- Department of Child's and Woman's Health, University of Padova, Italy
| | | | - Carlo Giaquinto
- Department of Child's and Woman's Health, University of Padova, Italy
| | - Osvalda Rampon
- Department of Child's and Woman's Health, University of Padova, Italy
| |
Collapse
|
87
|
Kotetsu Y, Ikegame S, Takebe-Akazawa K, Koga T, Okabayashi K, Takata S. A case of IgG4-related lung disease complicated by asymptomatic chronic Epstein-Barr virus infection. CLINICAL RESPIRATORY JOURNAL 2016; 11:1012-1017. [PMID: 26808729 DOI: 10.1111/crj.12458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/07/2015] [Accepted: 01/09/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION IgG4-related disease is characterized by IgG4-positive plasmacyte infiltration into various organs, but its etiology is not unknown. OBJECTIVES To elucidate the etiology of IgG4-related disease. METHODS We experienced an interesting case of IgG4-related lung disease complicated by chronic EB virus infection. RESULTS A 70-year-old male visited our hospital due to failure of pneumonia treatment. Chest computed tomography (CT) showed consolidation in the right middle field and slight mediastinal lymphadenopathy in the subcarinal region. Lung consolidation improved with antibiotics; subcarinal lymphadenopathy progressed after 4 months. Malignant lymphoma was suspected given elevated sIL2-R levels (1862 U/mL). Patchy ground glass opacities appeared in the bilateral lung field just before surgical biopsy. He was diagnosed with IgG4-related lung disease after inspection of a pathological specimen obtained from the right upper lung and right hilar lymph node. EB virus-infected cells were also detected in the lymph node. Blood examination revealed EB virus viremia, but the patient did not present with symptoms or organ involvement. This led to a diagnosis of asymptomatic chronic EB virus infection. CONCLUSION Recent studies have suggested an association between EB virus infection and IgG4-related diseases in the pathological exploration of surgically resected lymph nodes. Our case is the first case of IgG4-related lung disease in which EB virus infection was both pathologically and clinically proved. The present case is of particular interest in view of this newly reported association, and may serve as a fundamental report for future studies connecting EB virus infection with IgG4-related diseases.
Collapse
Affiliation(s)
- Yasuaki Kotetsu
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan
| | - Satoshi Ikegame
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan
| | - Keiko Takebe-Akazawa
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan
| | - Takaomi Koga
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan
| | - Kan Okabayashi
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan
| | - Shohei Takata
- Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan
| |
Collapse
|
88
|
IgG4-related disease: what urologists should know. Int Urol Nephrol 2016; 48:301-12. [DOI: 10.1007/s11255-015-1189-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/13/2015] [Indexed: 12/24/2022]
|
89
|
Okada F, Sadanaga A, Nishizaka H, Mashiba K, Tamiya S, Fukagawa S, Yamaguchi T. A suspected case of IgG4-related bilateral arthritis of the knee. J Orthop Sci 2016; 21:100-4. [PMID: 26740419 DOI: 10.1016/j.jos.2015.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 02/09/2023]
Affiliation(s)
- Fumi Okada
- Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-0077, Japan.
| | - Atsushi Sadanaga
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-0077, Japan
| | - Hiroaki Nishizaka
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-0077, Japan
| | - Kouichi Mashiba
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-0077, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-0077, Japan
| | - Shingo Fukagawa
- Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-0077, Japan
| | - Tsukasa Yamaguchi
- Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-0077, Japan
| |
Collapse
|
90
|
|
91
|
Oles K, Sładzień J, Bartuś K, Leszczyńska J, Bojanowska E, Krakowczyk Ł, Mika J. Characteristics, diagnosis and therapeutic strategies for IgG4-related orbital disease. Pharmacol Rep 2015; 68:507-13. [PMID: 27116895 DOI: 10.1016/j.pharep.2015.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/24/2022]
Abstract
Thanks to detailed studies conducted in recent years, a new disease syndrome was identified in 2001. It is known as a IgG4-related disease and its differentiation is based on the analysis of IgG4 levels in the affected tissues. The IgG4-related disease is considered to be a generalized pathological process involving a wide spectrum of various disorders that may affect distant organs. Orbital IgG4-related disease is a recently reported issue that may prove important for the elucidation of the etiology of idiopathic, lymphoplasmacytic or fibrotic disorders of various organs, including the orbits. In this article, we are describing epidemiology and differential diagnostics of IgG4-related orbital disease with particular focus on pseudotumors, MALT lymphomas and lymphocyte/plasma cell infiltrations of the orbit. We are also discussing therapeutic possibilities currently available in the management of the disease.
Collapse
Affiliation(s)
- Krzysztof Oles
- Department of Oncological and Reconstructive Surgery, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland.
| | - Jacek Sładzień
- Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Kraków, Poland.
| | - Krzysztof Bartuś
- Department of Cardiac and Vascular Surgery and Transplantology, The Institute of Cardiology, Medical College Jagiellonian University, John Paul II Hospital, Kraków, Poland.
| | - Joanna Leszczyńska
- Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Kraków, Poland.
| | - Emila Bojanowska
- Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Kraków, Poland.
| | - Łukasz Krakowczyk
- Department of Oncological and Reconstructive Surgery, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland.
| | - Joanna Mika
- Department of Pain Pharmacology, Institute of Pharmacology, Kraków, Poland.
| |
Collapse
|
92
|
Singh RK, Isaac TJB, Thangakunam B, Mathews N, Korula A. Isolated pulmonary manifestation of IgG4 disease with response to steroids and relapse: A rare case report. Lung India 2015; 32:659-61. [PMID: 26664186 PMCID: PMC4663883 DOI: 10.4103/0970-2113.168110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ranjit Kumar Singh
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India. E-mail:
| | | | | | - Nittin Mathews
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anila Korula
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
93
|
Liu TT, Weng SW, Wang MC, Huang WT. Nontuberculous mycobacterial infection with concurrent IgG4-related lymphadenopathy. APMIS 2015; 124:216-20. [DOI: 10.1111/apm.12492] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/03/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Ting-Ting Liu
- Department of Pathology; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Shao-Wen Weng
- Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Ming-Chung Wang
- Department of Hematology and Oncology; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Wan-Ting Huang
- Department of Pathology; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| |
Collapse
|
94
|
Sarkar A, Pitchumoni CS. The protean manifestations of IgG4-RD in gastrointestinal disorders. Dis Mon 2015; 61:493-515. [DOI: 10.1016/j.disamonth.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
95
|
Tran MN, Langguth D, Hart G, Heiner M, Rafter A, Fleming SJ, Scalia GM. IgG4-related systemic disease with coronary arteritis and aortitis, causing recurring critical coronary ischemia. Int J Cardiol 2015; 201:33-4. [DOI: 10.1016/j.ijcard.2015.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/01/2015] [Indexed: 01/13/2023]
|
96
|
Adachi H, Okuyama H, Yamaya H, Kurose N, Kojima K, Toga H, Yokoyama H. A case of IgG4-related kidney disease complicated by eosinophilic lung disease. CEN Case Rep 2015; 4:162-168. [PMID: 28509093 PMCID: PMC5413763 DOI: 10.1007/s13730-014-0160-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 11/12/2014] [Indexed: 12/24/2022] Open
Abstract
IgG4-related disease is a systemic chronic inflammatory disorder characterized by a high blood level of IgG4 and the organ injuries by marked infiltration of IgG4-positive plasma cells and fibrosis. A 71-year-old male was hospitalized for a cough, malaise and anorexia. IgG4-related disease was suspected due to marked elevation of the serum IgG4 level. However, on lung biopsy, only eosinophil infiltration was demonstrated with no plasma cell infiltration. Otherwise abdominal contrast-enhanced CT showed mild enlargement of the bilateral kidneys and many differed contrasted areas and FDG PET-CT. Moreover, renal biopsy specimens showed typical tubulointerstitial nephritis with a large number of IgG4-positive plasma cells infiltration (the IgG4/IgG-positive cell rate, 89 %) and fibrosis. We diagnosed this patient as typical IgG4-related kidney disease. He was treated by the moderate dose of prednisolone (0.8 mg/kg/day) alone, and showed prompt response in the clinical condition, and both the lung and kidney lesions. In this case, it was useful for diagnosis of IgG4-related diseases to evaluate an image such as abdominal contrast-enhanced CT and FDG PET-CT. Our case might be one of the possible patterns of IgG4-related lung diseases. In addition, we thought that there might be an association between hypereosinophilia and IgG4-related kidney disease.
Collapse
Affiliation(s)
- Hiroki Adachi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Hiroshi Okuyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hideki Yamaya
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University School of Medicine, Uchinada, Ishikawa, Japan
| | - Koji Kojima
- Department of Respiratory Medicine, Kanazawa Medical University School of Medicine, Uchinada, Ishikawa, Japan
| | - Hirohisa Toga
- Department of Respiratory Medicine, Kanazawa Medical University School of Medicine, Uchinada, Ishikawa, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| |
Collapse
|
97
|
[Multifocal tumors in a 56-year-old male patient]. Radiologe 2015; 55:1009-13. [PMID: 26515284 DOI: 10.1007/s00117-015-0037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
98
|
A Case Report of an Atypical Presentation of IgG4-Related Disease and Idiopathic CD4 Lymphocytopenia. Case Rep Med 2015; 2015:512370. [PMID: 26491451 PMCID: PMC4600861 DOI: 10.1155/2015/512370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/05/2015] [Accepted: 09/13/2015] [Indexed: 12/24/2022] Open
Abstract
The IgG4-related disease is a fibroinflammatory disease characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum levels of IgG4. Idiopathic CD4 lymphocytopenia is a heterogenic and rare syndrome characterized by the detection of a persistent absolute CD4 T cells count <300 cells/mm3 (or <20% of total T cells) in more than one occasion and no evidence of HIV infection in absence of immunodeficiency or therapy associated with depressed levels of CD4 T cells. We report the case of a 50-year-old man with a multiorgan IgG4-related disease presenting in a temporal association with a profound and symptomatic idiopathic CD4 lymphocytopenia. Both clinical pictures improved after steroid treatment. Idiopathic CD4 lymphocytopenia has been associated with a number of autoimmune conditions but, to the best of our knowledge, this is the first case in which an association with the IgG4-related disease is reported.
Collapse
|
99
|
Wu A, Andrew NH, McNab AA, Selva D. IgG4-Related Ophthalmic Disease: Pooling of Published Cases and Literature Review. Curr Allergy Asthma Rep 2015; 15:27. [PMID: 26141575 DOI: 10.1007/s11882-015-0530-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In recent years, IgG4-related ophthalmic disease (IgG4-ROD) has emerged as a common cause of orbital inflammation, accounting for a substantial proportion of idiopathic orbital inflammation and lymphoid hyperplasia. The last pooled analysis of published cases was conducted in 2012, but a large number of new cases have been added to the literature since then. In this review, we present the demographic, clinical, histological, and treatment data for 172 published cases of biopsy-confirmed IgG4-ROD. Results are accompanied by a review of the relevant literature.
Collapse
Affiliation(s)
- Albert Wu
- South Australian Institute of Ophthalmology, University of Adelaide, Level 8, East Wing, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia,
| | | | | | | |
Collapse
|
100
|
IgG4-related kidney disease – A review. Pathol Res Pract 2015; 211:707-11. [DOI: 10.1016/j.prp.2015.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/05/2015] [Accepted: 03/25/2015] [Indexed: 12/18/2022]
|