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Singh K, Bennett O, Wegner EA, Marsden A, Grewal DS. 18 F-FDG PET/CT in Pediatric Immunoglobulin G4-Related Disease. Clin Nucl Med 2024; 49:e364-e366. [PMID: 38451857 DOI: 10.1097/rlu.0000000000005151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
ABSTRACT A 14-year-old boy presented with severe, nonintentional weight loss, fatigue, and cough. Investigations were notable for raised inflammatory markers and significantly elevated serum immunoglobulin G4 (IgG4). 18 F-FDG PET/CT was obtained for assessment of disease involvement and extent, to exclude differential diagnoses and to guide biopsy. The study demonstrated extensive FDG-avid nodal disease and multisystem organ involvement. Excisional biopsy of a right inguinal lymph node demonstrated reactive changes with numerous IgG4-positive plasma cells consistent with IgG4-related disease. He was commenced on immunosuppressive therapy with consequent weight restoration and symptom resolution.
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Affiliation(s)
| | | | | | - Amanda Marsden
- Department of Rheumatology, Sydney Children's Hospital Network
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Towheed ST, Zanjir W, Ren KYM, Garland J, Clements-Baker M. Renal Manifestations of IgG4-Related Disease: A Concise Review. Int J Nephrol 2024; 2024:4421589. [PMID: 38957780 PMCID: PMC11217581 DOI: 10.1155/2024/4421589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/28/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024] Open
Abstract
IgG4-related disease (IgG4-RD) is an immune-mediated disorder marked by fibro-inflammatory masses that can infiltrate multiple organ systems. Due to its relatively recent discovery and limited understanding of its pathophysiology, IgG4-related disease may be difficult to recognize and is consequently potentially underdiagnosed. Renal involvement is becoming regarded as one of the key features of this disease. To date, the most well-recognized renal complication of IgG4-related disease is tubulointerstitial nephritis, but membranous glomerulonephritis, renal masses, and retroperitoneal fibrosis have also been reported. This concise review has two objectives. First, it will briefly encapsulate the history, epidemiology, and presentation of IgG4-related disease. Second, it will examine the reported renal manifestations of IgG4-related disease, exploring the relevant histology, imaging, clinical features, and treatment considerations. This synthesis will be highly relevant for nephrologists, rheumatologists, general internists, and renal pathologists to raise awareness and help improve early recognition of IgG4-related kidney disease (IgG4-RKD).
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Czarnywojtek A, Agaimy A, Pietrończyk K, Nixon IJ, Vander Poorten V, Mäkitie AA, Zafereo M, Florek E, Sawicka-Gutaj N, Ruchała M, Ferlito A. IgG4-related disease: an update on pathology and diagnostic criteria with a focus on salivary gland manifestations. Virchows Arch 2024; 484:381-399. [PMID: 38316669 DOI: 10.1007/s00428-024-03757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a multi-organ disorder characterized by a highly variable clinical presentation depending on the affected organ/s, extent of tumefactive fibroinflammatory lesions, and associated functional impairment. The disease pursues a chronic, relapsing, often asymptomatic course and hence may pose a significant diagnostic challenge. Diagnostic delay can lead to progressive fibrosis and irreversible organ damage resulting into significant morbidity and even mortality. Given its broad clinical spectrum, physicians of all specialties may be the first clinicians facing this diagnostic challenge. Outside the pancreatobiliary system, the head and neck represents the major site of IgG4-RD with variable organ-specific diffuse or mass-forming lesions. In up to 75% of cases, elevated serum IgG4 levels are observed, but this figure possibly underestimates the fraction of seronegative cases, as the disease manifestations may present metachronously with significant intervals. Together with negative serology, this can lead to misdiagnosis of seronegative cases. A standardized nomenclature and diagnostic criteria for IgG4-RD were established in 2012 and revised in 2020 facilitating scientific research and expanding the range of diseases associated with IgG4 abnormalities. In addition to orbital pseudotumor, dacryoadenitis, Riedel thyroiditis, sinonasal manifestations, and rare miscellaneous conditions, IgG4-related sialadenitis is one of the most frequent presentations in the head and neck region. However, controversy still exists regarding the relationship between sialadenitis and IgG4-RD. This review focuses on the clinicopathological features of IgG4-related sialadenitis and its contemporary diagnostic criteria.
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Affiliation(s)
- Agata Czarnywojtek
- Department of Pharmacology, Poznan University of Medical Sciences, 60-806, Poznan, Poland
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355, Poznan, Poland
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | | | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, EH8 9YL, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, KU Leuven University Hospitals, 3000, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, 3000, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, and the Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014, Helsinki, Finland
| | - Mark Zafereo
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX, 77005, USA
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, 60-806, Poznan, Poland.
| | - Nadia Sawicka-Gutaj
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355, Poznan, Poland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, 35100, Padua, Italy
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Joseph J, Prabhu V, Thomas M, Karuppusami R, Kodiatte TA, Michael R, Rymbai ML, Mathew J. Myofibroblast and pro-fibrotic cytokines in fibrosis of IgG4-related disease (IgG4-RD) patients from South Asia: preliminary data. Clin Rheumatol 2024; 43:1103-1110. [PMID: 38308685 DOI: 10.1007/s10067-023-06861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Fibrosis is a typical pathological characteristic in IgG4-RD patients and often irreversible. There exists a lack of suitable markers for detection of earlier onset of fibrosis in various organs in IgG4-RD patients. Hence, this study aims at analysing ambispectively the myofibroblasts and the pro-fibrotic cytokines, IFN gamma and IL-33 involved in IgG4-RD associated fibrosis in South Asian patients. METHOD Archived biopsy samples of definite/probable/possible cases of IgG4-RD, classified according to diagnostic criteria, taken from patients who attended the OPD and IPD of our tertiary care centre during January 2015-January 2020 were chosen for this study. The paraffin sections were examined qualitatively for fibrosis and the excessive collagen deposition by Hematoxylin & Eosin and Masson's Trichrome staining. Also, the presence of alpha-Smooth muscle actin (α-SMA) expressing myofibroblasts and the involvement of pro-fibrotic cytokines (IFN-gamma, IL-33) were assessed by Immunohistochemistry and scored semi-quantitatively (+mild, ++moderate, +++ severe). Serum IL-33 levels were analysed by indirect Elisa (R & D Systems). RESULTS Myofibroblasts were present in 10/12 biopsy samples, in moderate levels in 4 (33%) and very high levels (+++) in 3 (25%) of the patients. IFN-gamma was expressed at low levels in 6 (50%) and absent in 6 (50%). All patients showed IL-33 expression with very high levels in tissue (6, 50%), as well as in serum samples. CONCLUSION The findings of this study reinforce the role of myofibroblasts and profibrotic cytokines like IL-33 in fibrosis of Ig4-RD patients, pointing to their potential as earlier predictive markers of onset and extent of fibrosis.
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Affiliation(s)
- Josna Joseph
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - V Prabhu
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, India
| | | | - Rajiv Michael
- Head and Neck Surgery Unit I, Christian Medical College, Vellore, India
| | - Manbha L Rymbai
- Department of Hepatopancreaticobiliary (HPB) Surgery, Christian Medical College, Vellore, India
| | - John Mathew
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
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Su HZ, Hong LC, Huang M, Zhang F, Wu YH, Zhang ZB, Zhang XD. A nomogram based on ultrasound scoring system for differentiating between immunoglobulin G4-related sialadenitis and primary Sjögren syndrome. Dentomaxillofac Radiol 2024; 53:43-51. [PMID: 38214944 PMCID: PMC11003662 DOI: 10.1093/dmfr/twad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/21/2023] [Accepted: 11/11/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES Accurate distinguishing between immunoglobulin G4-related sialadenitis (IgG4-RS) and primary Sjögren syndrome (pSS) is crucial due to their different treatment approaches. This study aimed to construct and validate a nomogram based on the ultrasound (US) scoring system for the differentiation of IgG4-RS and pSS. METHODS A total of 193 patients with a clinical diagnosis of IgG4-RS or pSS treated at our institution were enrolled in the training cohort (n = 135; IgG4-RS = 28, pSS = 107) and the validation cohort (n = 58; IgG4-RS = 15, pSS = 43). The least absolute shrinkage and selection operator regression algorithm was utilized to screen the most optimal clinical features and US scoring parameters. A model for the differential diagnosis of IgG4-RS or pSS was built using logistic regression and visualized as a nomogram. The performance levels of the nomogram model were evaluated and validated in both the training and validation cohorts. RESULTS The nomogram incorporating clinical features and US scoring parameters showed better predictive value in differentiating IgG4-RS from pSS, with the area under the curves of 0.947 and 0.958 for the training cohort and the validation cohort, respectively. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSIONS A nomogram based on the US scoring system showed favourable predictive efficacy in differentiating IgG4-RS from pSS. It has the potential to aid in clinical decision-making.
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Affiliation(s)
- Huan-Zhong Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Long-Cheng Hong
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Mei Huang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Feng Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Yu-Hui Wu
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Zuo-Bing Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
| | - Xiao-Dong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, China
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Cong X, Mao XD, Wu LL, Yu GY. The role and mechanism of tight junctions in the regulation of salivary gland secretion. Oral Dis 2024; 30:3-22. [PMID: 36825434 DOI: 10.1111/odi.14549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Abstract
Tight junctions (TJs) are cell-cell interactions that localize at the most apical portion of epithelial/endothelial cells. One of the predominant functions of TJs is to regulate material transport through paracellular pathway, which serves as a selective barrier. In recent years, the expression and function of TJs in salivary glands has attracted great interest. The characteristics of multiple salivary gland TJ proteins have been identified. During salivation, the activation of muscarinic acetylcholine receptor and transient receptor potential vanilloid subtype 1, as well as other stimuli, promote the opening of acinar TJs by inducing internalization of TJs, thereby contributing to increased paracellular permeability. Besides, endothelial TJs are also redistributed with leakage of blood vessels in cholinergic-stimulated submandibular glands. Furthermore, under pathological conditions, such as Sjögren's syndrome, diabetes mellitus, immunoglobulin G4-related sialadenitis, and autotransplantation, the integrity and barrier function of TJ complex are impaired and may contribute to hyposalivation. Moreover, in submandibular glands of Sjögren's syndrome mouse model and patients, the endothelial barrier is disrupted and involved in hyposecretion and lymphocytic infiltration. These findings enrich our understanding of the secretory mechanisms that link the importance of epithelial and endothelial TJ functions to salivation under both physiological and pathophysiological conditions.
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Affiliation(s)
- Xin Cong
- Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Department of Physiology and Pathophysiology, Peking University School of Basic Sciences, Beijing, China
| | - Xiang-Di Mao
- Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Department of Physiology and Pathophysiology, Peking University School of Basic Sciences, Beijing, China
| | - Li-Ling Wu
- Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Department of Physiology and Pathophysiology, Peking University School of Basic Sciences, Beijing, China
| | - Guang-Yan Yu
- Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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7
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Lai KKH, Aljufairi FMAA, Sebastian JU, Yip CCY, Wei Y, Jia R, Cheuk W, Cheng ACO, Chin JKY, Chu CY, Kwong CH, Yip NKF, Li KKW, Chan WH, Yip WWK, Young AL, Chan E, Ko CKL, Chan CKM, Yuen HKL, Chen LJ, Tham CCY, Pang CP, Chong KKL. Systemic Involvement in Immunoglobulin G4-Related Ophthalmic Disease. Ocul Immunol Inflamm 2023:1-7. [PMID: 38055933 DOI: 10.1080/09273948.2023.2280709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) poses clinical challenges due to its heterogeneous ocular and systemic manifestations. We aim to report the systemic involvement and the clinical, serological and radiological associations of a cohort of Chinese patients. METHODS A territory-wide, biopsy-proven, Chinese cohort. A retrospective, masked chart review of medical records, orbital images, and histopathology reports. RESULTS A total of 122 (65 male) patients with a follow-up of 81 ± 49 (24 to 84) months were reviewed. Ninety (74%) patients presented bilaterally. Subacute upper eyelid swelling was the commonest presentation (82/122, 67%). During follow-up, 91/122 patients (75%) underwent extra-orbital imaging including computer tomography (692 films), ultrasonography (182 films), magnetic resonance imaging (76 films) and whole body FDG-PET scan (33 films). Eighty-six (95%) of these 91 patients had extra-orbital involvement radiologically (2.7 ± 1.6 regions, range: 0 to 9). Lymph node was the most prevalent (N = 60,66%), followed by salivary gland (N = 51,56%), lung (N = 49,54%), kidney (N = 22, 24%), hepatobiliary tree (N = 18, 20%) and pancreas (N = 17, 19%). Other organs include thyroid, aorta, meninges/brain and skin. Twenty-eight (23%) patients had allergic diseases (19 asthma, 16 allergic rhinitis, and 6 eczemas). Fifty-seven (48%) patients had paranasal sinusitis. Serum eosinophilia was associated with a higher number (3.24 versus 2.52, P = 0.0304) of organ involvement. Patients with deep organ involvement was associated with a higher age of IgG4-ROD onset (70 ± 12 versus 56 ± 13, P < 0.0001). CONCLUSIONS 95% of the patients who underwent systemic imaging in our cohort had systemic organ involvement. An early physicians' assessment and radiological imaging are recommended after the diagnosis of IgG4-ROD.
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Affiliation(s)
- Kenneth K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fatema Mohamed Ali Abdulla Aljufairi
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Manama, Bahrain
| | - Jake Uy Sebastian
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - Carson C Y Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yingying Wei
- Department of Statistics, The Chinese University of Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Ruofan Jia
- Department of Statistics, The Chinese University of Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Andy C O Cheng
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region, China
| | - Joyce K Y Chin
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Chung Yin Chu
- Department of Ophthalmology, Grantham Hospital, Hong Kong Special Administrative Region, China
| | - Chi Ho Kwong
- Department of Ophthalmology, Caritas Medical Center, Hong Kong Special Administrative Region, China
| | - Nelson K F Yip
- Department of Ophthalmology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - W H Chan
- Department of Ophthalmology, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
| | - Wilson W K Yip
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Edwin Chan
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Callie K L Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Hunter K L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Clement C Y Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
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Whitehair RM, Aguilera NS, Pramoonjago P, Craig JW. Increased IgG4+ plasma cells are common in excised lymph nodes from children and adolescents without IgG4-related disease. J Hematop 2023; 16:209-216. [PMID: 38175435 DOI: 10.1007/s12308-023-00565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024] Open
Abstract
Lymphadenopathy is a common finding in patients with IgG4-related disease (IgG4-RD) and often associated with increased IgG4+ plasma cells in this setting. The histologic features of so-called IgG4-related lymphadenopathy (IgG4-LAD) have seldom been investigated in children and adolescents, and step-wise progression to extranodal IgG4-RD has not been described. This study was performed to further evaluate the frequency, pathologic features, and clinical significance of IgG4-LAD-like histologic changes in the pediatric setting. We analyzed 37 benign lymph nodes collected semi-consecutively from children aged 0-18 years at our institution for both absolute and relative IgG4+ plasma cell abundance and recurrent histomorphologic patterns associated with IgG4-LAD. The combination of IgG4+/IgG+ plasma cell ratio >40% and IgG4+ plasma cell count ≥50 were considered as IgG4-LAD-like per expert consensus guidelines. Seven cases (19%) met both diagnostic criteria. The dominant histomorphologic patterns were follicular hyperplasia (n = 6), interfollicular expansion (n = 3), and progressive transformation of germinal centers (n = 3). Extranodal manifestations of IgG4-RD were not identified in this cohort (38 months average follow-up). Instead, clinical and laboratory findings indicated that lymph node enlargement in most patients could likely be attributed to alternative processes including antecedent dentistry, concurrent infection, and incipient Crohn's disease. Our findings suggest that the histologic features of IgG4-LAD are likely much more common in children and adolescents than previously recognized, often existing in complex with common reactive lymphadenopathies. The diagnostic value of routine immunohistochemical assessment for IgG4+ plasma cells in benign lymph nodes from pediatric patients without established extranodal IgG4-RD and/or other supportive clinical and laboratory data is therefore uncertain.
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Affiliation(s)
- Rachel M Whitehair
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, 22908-0904, USA
| | - Nadine S Aguilera
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, 22908-0904, USA
| | - Patcharin Pramoonjago
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, 22908-0904, USA
| | - Jeffrey W Craig
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, 22908-0904, USA.
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Sasaki D, Kashiwagura H, Teruuchi Y. Development of an LC-MS/MS method for absolute quantification of IgG4 by evaluating dependence on the digestion efficiency using a non-cleavable/dually-cleavable internal calibrator set. Biochem Biophys Res Commun 2023; 682:381-385. [PMID: 37844447 DOI: 10.1016/j.bbrc.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
The measurement of serum IgG4 levels is mandatory for the diagnosis of IgG4-related disease, but no widely accepted reference material exists due to a lack of consensus on the standard assay. Therefore, we developed here an LC-MS/MS method for absolute quantification of IgG4 in a purified IgG sample, addressing a concern over the reliability depending on the proteolytic digestion efficiency. Our method uses internal calibrator sets containing unique amino acid sequences within IgG4, each of which comprises non-cleavable and dually-cleavable peptides labeled with different numbers of isotopes for mass separation, to determine digestion efficiency. Surrogate peptides generated by trypsin or lysyl endopeptidase digestion were selected based on selectivity, stability, and identifiability. IgG4 quantification using synthetic calibrator peptides showed high precision across the two conditions with different peptidases (relative differences ≤6.1%), even with low digestion efficiencies (<20%), which was within the interday precision under an established condition (% coefficient of variation ≤6.9%, digestion efficiencies >90%, n = 5). These results indicate that the LC-MS/MS method for quantifying IgG4 is robust against digestion efficiency variations and is applicable to validating an IgG4 reference material.
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Affiliation(s)
- Daisuke Sasaki
- Medical R&D Center, Nitto Boseki Co., Ltd., Koriyama, Japan
| | | | - Yuya Teruuchi
- Medical R&D Center, Nitto Boseki Co., Ltd., Koriyama, Japan.
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10
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Matias TB, Cordeiro RA, Duarte JA, de Jarry VM, Appenzeller S, Villarinho L, Reis F. Immune-Mediated Hypertrophic Pachymeningitis and its Mimickers: Magnetic Resonance Imaging Findings. Acad Radiol 2023; 30:2696-2706. [PMID: 36882352 DOI: 10.1016/j.acra.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 03/08/2023]
Abstract
Hypertrophic pachymeningitis (HP) is a rare and chronic inflammatory disorder presenting as localized or diffuse thickening of the dura mater. It can be idiopathic or an unusual manifestation of immune-mediated, infectious, and neoplastic conditions. Although some cases may remain asymptomatic, HP can lead to progressive headaches, cranial nerve palsies, hydrocephalus, and other neurological complications, which makes its recognition a fundamental step for prompt treatment. Regarding the diagnosis workup, enhanced MRI is the most useful imaging method to evaluate dural thickening. This article addresses the MR imaging patterns of immune-mediated HP, including immunoglobulin G4-related disease, neurosarcoidosis, granulomatosis with polyangiitis, rheumatoid pachymeningitis, and idiopathic HP. The main infectious and neoplastic mimicking entities are also discussed with reference to conventional and advanced MR sequences.
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Affiliation(s)
- Thiago Bezerra Matias
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rafael Alves Cordeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juliana Avila Duarte
- Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Vinicius Menezes de Jarry
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luciano Villarinho
- Department of Radiology, Rhode Island Medical Imaging, Brown University, USA
| | - Fabiano Reis
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Vujasinovic M, Nikolic S, Gordon Achour A, Löhr JM. Autoimmune pancreatitis and micronutrients. Dig Liver Dis 2023; 55:1375-1381. [PMID: 37121818 DOI: 10.1016/j.dld.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Nutritional deficiencies, including fat-soluble vitamins and minerals have been detected in many autoimmune diseases, including those involving the digestive system, but have yet to be assessed in autoimmune pancreatitis (AIP). The aim of the present study was to determine the prevalence of micronutrient deficiencies in patients with AIP as well as to investigate their relationship with relapse. PATIENTS AND METHODS We retrospectively analysed medical records of patients treated for AIP. Demographic and clinical data were collected. RESULTS One hundred patients were included in the final analysis. The male-to-female ratio was 2.5:1; median age at diagnosis was 57 years (range 19-85). Median follow-up was 53 months, and during this time, 38% of patients suffered from at least one micronutrient deficiency. The most prevalent micronutrient deficiencies were vitamin D (16.1%) and zinc (25.5%). Relapse was observed in 37% of the AIP patients. Initial analysis showed that AIP relapse was associated with any micronutrient deficiency as well as zinc and vitamin D deficiency, but after stratifying for AIP type 1 and adjusting for PEI and elevated IgG4 levels, the association ceased to be statistically significant. CONCLUSION Zinc and vitamin D deficiencies may be common in patients with AIP, indicating that these micronutrients might play a role in the natural course of AIP. Importantly, any micronutrient deficiency may be prevalent even in the light of treated PEI, which emphasizes the potential of micronutrients as an additional tool in the workup and follow-up of AIP patients.
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Affiliation(s)
- Miroslav Vujasinovic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm 141 86, Sweden; Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.
| | - Sara Nikolic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm 141 86, Sweden; Department of Gastroenterology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Alina Gordon Achour
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm 141 86, Sweden
| | - J Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm 141 86, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
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12
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Alsalamah NI, Alhrabi B, Alhumaily N, AlHadidi R, Basubrain LS, Al Asmari Z. Efficacy and Safety of Glucocorticoid Monotherapy Versus the Combination of Glucocorticoid and Immunosuppressive Agents for Immunoglobulin G4-Related Disease: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47099. [PMID: 38022154 PMCID: PMC10646549 DOI: 10.7759/cureus.47099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
We conducted the current systematic review and meta-analysis to evaluate the efficacy and safety of the combination of glucocorticoid and immunosuppressive agents (IM) compared to glucocorticoid (GC) monotherapy for the treatment of immunoglobulin G4-related disease (IgG4-RD). PubMed, Web of Science, Scopus, OVID, and the Cochrane Library were searched for related articles. Meta-analysis was conducted with outcomes including relapse rate, remission, and adverse events. We calculated the odds ratio (ORs) and 95% confidence interval (CI) with the meta-analysis model. Ten studies involving 906 patients were included in the systematic review; of them, seven studies were included in the meta-analysis. The effect size showed that the GC group was associated with a higher relapse rate (OR = 2.97, 95% CI [1.91, 4.62], p < 0.0001) and a less complete remission rate (OR = 0.27, 95% CI [0.16, 0.47], p < 0.0001) than the combination of GC and IM group. While there was no significant difference between the two compared groups in terms of adverse events (OR = 0.73, 95% CI [0.44, 1.21], p = 0.22). No significant heterogeneity was detected regarding all outcomes (p > 0.1, I2 < 50%). Treatment of IgG4-RD patients with a combination of GC and IM was associated with higher remission rates, lower relapse rates, and comparable safety profiles. Larger RCTs should be conducted and focused on exploring the genetic and geographic differences between different cohorts.
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Affiliation(s)
| | | | | | - Rawad AlHadidi
- Pharmaceutical Care Department, Ministry of National Guard - Health Affairs, Jeddah, SAU
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13
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Yasuda MA, Sandelski M, Borrowdale R. IgG4-RD in a Unilateral Parotid Mass: A Rare Manifestation and Review of the Literature. Cureus 2023; 15:e35689. [PMID: 37012957 PMCID: PMC10066708 DOI: 10.7759/cureus.35689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
IgG4 related disease (IgG4-RD) is a rare, immune-mediated inflammatory disease that varies widely in its presentation because it can affect nearly any organ. We present a case of a 73-year-old male who presented with an ill-defined mass of the parotid gland, found to be IgG4-RD, after several months of work up and tissue sampling. Most cases of salivary gland involvement in IgG4-RD present as bilateral swelling of the submandibular glands. We present this case as a unique manifestation of salivary gland disease in IgG4-RD as a persistent, non-discrete unilateral mass in the parotid gland. It is critical that clinicians who regularly treat salivary gland pathologies are familiar with this rare disease and its potential manifestations in the oral cavity.
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14
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Diz-Lopes M, Nogueira F, da Cunha Marques JA, Pedrosa S, Marques-Gomes C, Martins-Rocha T, Von-Hafe P, Souto-Moura C. Lung and Pleural Immunoglobulin G4-Related Disease: Two Contrasting Case Reports. Cureus 2023; 15:e35439. [PMID: 36994276 PMCID: PMC10041472 DOI: 10.7759/cureus.35439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/26/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an immunomediated disease that can virtually affect any organ. Despite the pancreas being known as the most frequently involved organ, pulmonary and pleural IgG4-RD is being increasingly reported. The authors present two cases of IgG4-RD diagnosed in the same year, with different presentations and outcomes, in which the lung and pleural involvement were essential for the diagnosis. Recognizing IgG4-RD as a possible cause of chronic pleural effusion and/or thickening and lung abnormalities is important for an early diagnosis and prognosis improvement.
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15
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Jayachamarajapura Onkaramurthy N, Suresh SC, Theetha Kariyanna P, Jayarangaiah A, Prakash G, Raju B. IgG4 related disease and aortitis: an up-to-date review. Scand J Rheumatol 2023; 52:306-316. [PMID: 36763458 DOI: 10.1080/03009742.2022.2145744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Aortic involvement in immunoglobulin G4-related disease (IgG4-RD) is extremely rare and is often overlooked during the aortitis work-up. IgG4-related aortitis differs from non-IgG4-related aortitis in its histopathological features, site of involvement, laboratory markers, and treatment options. The histopathological examination of the vessel walls characteristically reveals adventitial thickening with intimal sparing, typically affecting the infrarenal abdominal aorta. In addition, inadequate knowledge about the disease often leads to delayed or missed diagnosis and undermanagement of a potentially treatable condition. Hence, in this paper, we review the unique clinical manifestations, laboratory markers, diagnostic features, current treatment strategies, and novel experimental therapeutic options in the management of IgG4-related aortitis.
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Affiliation(s)
| | - S C Suresh
- Department of Internal Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - P Theetha Kariyanna
- Division of Interventional Cardiology, Marshfield Clinic Health System, Marshfield, WI, USA
| | - A Jayarangaiah
- Department of Hematology and Oncology, Prevea Cancer Center at HSHS Sacred Heart Hospital, Eau Claire, WI, USA
| | - G Prakash
- Department of Hepatobiliary Surgery, New Jersey Medical College, Newark, NJ, USA
| | - B Raju
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
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16
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Muller R, Ebbo M, Habert P, Daniel L, Briantais A, Chanez P, Gaubert JY, Schleinitz N. Thoracic manifestations of IgG4-related disease. Respirology 2023; 28:120-131. [PMID: 36437514 PMCID: PMC10100266 DOI: 10.1111/resp.14422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a recently described rare systemic fibroinflammatory disease with an estimated incidence of less than 1 in 100,000 persons per year. The disease can affect virtually any organ and is characterized by unifying histopathological findings. Recently, four subgroups of patients have been characterized: hepatobiliary, head and neck, Mikulicz syndrome and retroperitoneal fibrosis, who illustrate the mainly abdominal and ENT tropism of the disease. Yet, thoracic involvement is not uncommon. It can be detected in up to 30% of patients with systemic IgG4-RD and is the exclusive manifestation of the disease in about 10% of cases. Clinical symptoms are nonspecific and may include dyspnoea, cough or chest pain. Chest CT findings are heterogeneous and primarily include peribronchovascular thickening, nodules, ground-glass opacities and lymphadenopathy. There is no specific diagnostic test for IgG4-RD thoracic involvement, which may mimic malignancy or vasculitis. Therefore, a cautious approach is needed to make an accurate diagnosis: a search for extra-thoracic manifestations, elevated serum IgG4 levels, circulating levels of plasmablasts and pathologic evidence of disease is warranted. Although very suggestive, neither the presence of a polyclonal IgG4 lymphoplasmacytic infiltrate, storiform fibrosis or obliterative phlebitis are sufficient to confirm the histological diagnosis. Steroids are recommended as first-line therapy. Rituximab or disease-modifying antirheumatic drugs may be used in relapsed or rare cases of steroid-refractory disease. In this review, we summarize current knowledge regarding the pathophysiology, epidemiology, diagnostic modalities (clinical-biological-imaging-histopathology) and treatment of IgG4-RD thoracic involvement.
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Affiliation(s)
- Romain Muller
- Internal Medicine Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | - Mikael Ebbo
- Internal Medicine Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | - Paul Habert
- Imaging Department, Hopital Nord, APHM, Aix Marseille University, Marseille, France.,LIIE (Experimental Interventional Imaging Laboratory), Aix Marseille University, Marseille, France
| | - Laurent Daniel
- Anatomopathology Department, APHM, Aix Marseille University, Marseille, France
| | - Antoine Briantais
- Internal Medicine Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | - Pascal Chanez
- Pneumology Department, Hopital Nord, APHM, Aix Marseille University, Marseille, France
| | - Jean Yves Gaubert
- Imaging Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
| | - Nicolas Schleinitz
- Internal Medicine Department, Hopital La Timone, APHM, Aix Marseille University, Marseille, France
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17
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Lian M, Wang Q, Chen S, Yang Y, Hong G. The association of serum immunoglobulin and complement levels and liver fibrosis and inflammation stage in patients with chronic hepatitis B. J Viral Hepat 2023; 30:437-447. [PMID: 36695325 DOI: 10.1111/jvh.13810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/14/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
The utility of measurement of serum immunoglobulin and complement in chronic hepatitis B (CHB) patients remains controversial. This study aimed to investigate the association of serum immunoglobulin and complement levels and liver fibrosis and inflammation stage in CHB patients. A total of 687 patients with CHB who underwent liver biopsy were enrolled. Serum immunoglobulin and complement were measured before liver biopsy, and liver pathological results were recorded. Associations of serum immunoglobulin and complement levels and liver fibrosis and inflammation stage were analysed. C3, C4, IgG and IgG1 had statistically significant differences among different fibrosis and different inflammation groups. Both C3 and C4 negatively correlated with fibrosis and inflammation stage, but IgG and IgG1 showed opposite results. C3, C4, IgG and IgG1 had statistical significance to predict ≥S2, ≥S3 and S4, and also had statistical significance to predict ≥G2, ≥G3 and G4. The area under curve (AUC) of the combination of C3, C4 and IgG (C3 + C4 + IgG) for predicting ≥S2, ≥S3 and S4 was 0.640 (95% CI: 0.603, 0.676), 0.674 (95% CI: 0.638, 0.709) and 0.744 (95% CI: 0.710, 0.776), respectively. The AUC of C3 + C4 + IgG for predicting ≥G2, ≥G3 and G4 was 0.723 (95% CI: 0.688, 0.756), 0.674 (95% CI: 0.638, 0.709) and 0.771 (95% CI: 0.738, 0.802), respectively. C3, C4, IgG and IgG1 are correlated with liver fibrosis and inflammation stage in CHB patients. C3, C4, IgG and IgG1 have diagnostic value for liver fibrosis and inflammation. C3 + C4 + IgG may improve diagnostic accuracy.
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Affiliation(s)
- Mingjian Lian
- Department of clinical laboratory, Xiamen Key Laboratory of Genetic Testing, the first affiliated hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qianming Wang
- Department of clinical laboratory, Xiamen Key Laboratory of Genetic Testing, the first affiliated hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Shidong Chen
- Department of clinical laboratory, Xiamen Key Laboratory of Genetic Testing, the first affiliated hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yuanyuan Yang
- Department of clinical laboratory, Xiamen Key Laboratory of Genetic Testing, the first affiliated hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Guolin Hong
- Department of clinical laboratory, Xiamen Key Laboratory of Genetic Testing, the first affiliated hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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18
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Chakraborty AM, Sahoo SK, Chatterjee D, Dutta P, Kumar R, Bhadada SK. IgG4-related hypophysitis: A monocentric experience from North India. Surg Neurol Int 2022; 13:578. [PMID: 36600729 PMCID: PMC9805655 DOI: 10.25259/sni_1013_2022] [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] [Received: 11/04/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Immunoglobulin (Ig)G4-related disease is a systemic fibroinflammatory disease characterized by dense infiltration of IgG4-positive plasma cells in the affected tissue(s) with or without elevated plasma levels of IgG4. Hypophysitis itself is a very rare disease with reported prevalence in the operative specimens are around 0.2-0.88%. IgG4-related hypophysitis (IgG4-RH) may account for a substantial percentage of cases previously regarded as idiopathic hypophysitis. Methods This study is a registry-based, retrospective, and cohort study from a tertiary care hospital in North India. The medical records and clinical data of biopsy-proven and suspected IgG4-RH patients registered were retrospectively analyzed. Treatment outcome of cases was also explored during this analysis. Results Two thousand and six sellar area space-occupying lesions have been operated-on since 2006, among them only four patients had IgG4-RH on histopathological specimen. One case was diagnosed on clinical suspicion. Mean age of the patients was 31.8 ± 6.32 years. Most frequent presenting complaint was headaches. Extracranial manifestations were present in four patients. The most common pituitary dysfunction was cortisol deficiency. 18 F-fluorodeoxyglucose positron emission tomography (18F FDG PET) was helpful in three cases for diagnosis of hypophysitis and other organ involvement. Classical histological findings with storiform fibrosis, obliterative phlebitis seen in two cases, and IgG4-positive plasma cell infiltration were positive in four cases. Surgery was the primary modality of treatment in all four cases. Only one patient received steroids as a primary therapeutic modality. Conclusion IgG4-RH is rare. High index of suspicion is required to diagnosis the case precisely. FDG PET is helpful in diagnosing hypophysitis and extrapituitary lesions.
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Affiliation(s)
- Ananda Mohan Chakraborty
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushant Kumar Sahoo
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Corresponding author: Pinaki Dutta, Professor, Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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19
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McCombe PA, Hardy TA, Nona RJ, Greer JM. Sex differences in Guillain Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy and experimental autoimmune neuritis. Front Immunol 2022; 13:1038411. [PMID: 36569912 PMCID: PMC9780466 DOI: 10.3389/fimmu.2022.1038411] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Guillain Barré syndrome (GBS) and its variants, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP and its variants, are regarded as immune mediated neuropathies. Unlike in many autoimmune disorders, GBS and CIDP are more common in males than females. Sex is not a clear predictor of outcome. Experimental autoimmune neuritis (EAN) is an animal model of these diseases, but there are no studies of the effects of sex in EAN. The pathogenesis of GBS and CIDP involves immune response to non-protein antigens, antigen presentation through non-conventional T cells and, in CIDP with nodopathy, IgG4 antibody responses to antigens. There are some reported sex differences in some of these elements of the immune system and we speculate that these sex differences could contribute to the male predominance of these diseases, and suggest that sex differences in peripheral nerves is a topic worthy of further study.
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Affiliation(s)
- Pamela A. McCombe
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia,*Correspondence: Pamela A. McCombe,
| | - Todd A. Hardy
- Department of Neurology, Concord Hospital, University of Sydney, Sydney, NSW, Australia,Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Robert J. Nona
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Judith M. Greer
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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20
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Meli M, Arrabito M, Salvatorelli L, Soma R, Presti S, Licciardello M, Miraglia V, Scuderi MG, Belfiore G, Magro G, Russo G, Di Cataldo A. Report of Two Cases of Pediatric IgG4-Related Lymphadenopathy (IgG4-LAD): IgG4-Related Disease (IgG4-RD) or a Distinct Clinical Pathological Entity? CHILDREN (BASEL, SWITZERLAND) 2022; 9:1472. [PMID: 36291407 PMCID: PMC9600987 DOI: 10.3390/children9101472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
IgG4-related disease (IgG4-RD) is a recently discovered immune-mediated fibroinflammatory condition, uncommon in the pediatric population, that could involve multiple organs and induce cancer-like lesions and organ damage. Its main features are multiple injuries in different sites, a dense lymphoplasmacytic infiltrate rich in IgG4 plasma cells, storiform fibrosis, and often high serological concentrations of IgG4. Autoimmune pancreatitis is the most common manifestation, mainly in adults. Two cases of IgG4-RD in children with lymph node localization of disease are reported. Localized or systemic lymph node involvement is common, but lymph node enlargement as the first and only manifestation of IgG4-RD is unusual, and therefore, hard to differentiate from other diseases. IgG4-related lymphadenopathy (IgG4-LAD) is most likely a distinct disease, described as isolated lymphadenopathy, related to the presence of elevated numbers of IgG4-positive plasma cells. Both disorders are likely to be misdiagnosed in children because they are characterized by rare and polymorphic features. IgG4-RD and IgG4-LAD should be considered in the differential diagnosis of disorders characterized by lymphadenopathy of uncertain etiology.
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Affiliation(s)
- Mariaclaudia Meli
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Marta Arrabito
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Lucia Salvatorelli
- Anatomic Pathology Unit, University Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Rachele Soma
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Santiago Presti
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Maria Licciardello
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Vito Miraglia
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Maria Grazia Scuderi
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia, University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Giuseppe Belfiore
- Unit of Paediatric Radiology, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Gaetano Magro
- Anatomic Pathology Unit, University Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Giovanna Russo
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Andrea Di Cataldo
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
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21
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Nadi A, Benhayoun Y, Cherkaoui R, Delsa H, Rouibaa F. Case Series of Autoimmune Pancreatitis and IgG4-Related Sclerosing Cholangitis. Cureus 2022; 14:e26657. [PMID: 35949783 PMCID: PMC9357350 DOI: 10.7759/cureus.26657] [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] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is an emerging immune-mediated disease that can involve any organ. The involvement of the pancreas and biliary tract is the most common and well-studied in the literature. It is characterized by a non-specific presentation, mimicking a malignant process. The goal was to look at the different clinical and paraclinical aspects of this disease, as well as the challenges that come from its management. It was made up of three observations of patients with IgG4-RD involving the biliary tract and pancreas. The first observation concerned intrahepatic biliary cholangitis that was accompanied by porto-mesenteric thrombosis, which was discovered by cholestatic jaundice on the 15th day after an appendectomy, and the patient improved under corticosteroids and anticoagulants. The second observation concerned an acute revelation of the disease. It was an acute attack of chronic pancreatitis of IgG4-RD. The main symptoms were pancreatic pain and exocrine pancreatic insufficiency, and corticosteroid therapy allowed remission. The third observation was related to autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis, revealed by jaundice with cholestasis. The patient acquired corticosteroid resistance and an adverse progression to decompensated cirrhosis, and liver transplantation was indicated. The clinical presentation of IgG4-RD is heterogeneous, as evidenced by our three clinical observations. There are still significant gaps in our understanding, particularly in terms of pathogenesis and factors that influence therapy response. Further observational and interventional research is needed to better manage this disease.
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Affiliation(s)
- Anass Nadi
- Gastroenterology and Hepatology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Yassamin Benhayoun
- Gastroenterology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Reda Cherkaoui
- Radiology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Hanane Delsa
- Gastroenterology and Hepatology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Fedoua Rouibaa
- Gastroenterology and Hepatology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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22
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Qi Z, Liu J, Li G, Zhang Y. Immunoglobulin G4-Related Spinal Intramedullary Inflammatory Pseudotumor: A Case Report and Literature Review. Front Neurol 2022; 13:878414. [PMID: 35837229 PMCID: PMC9275449 DOI: 10.3389/fneur.2022.878414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disease that affects several organs. An inflammatory pseudotumor is a histologically proven benign tumor-like lesion that most commonly involves the lung and orbit. It is rare in the central nervous system, but rarest in the spinal canal. In this report, we present a case of IgG4-related intramedullary spinal inflammatory pseudotumor, along with a literature review. A 29-year-old male was transferred to the Department of Neurosurgery of Lanzhou University Second Hospital with progressive quadriparesis after numbness and weakness in both lower limbs for 50 days. Enhanced magnetic resonance imaging (MRI) of the spine revealed an isointense signal on T1-weighted images and a hyperintense signal on T2-weighted images from an enhanced mass located at the thoracic vertebrae region, for which a schwannoma was highly suspected. Then, a posterior median approach was adopted. The lesion was resected. The patient received further glucocorticoid after the diagnosis of an IgG4-related inflammatory pseudotumor was established, and the patient's symptoms improved, such as quadriparesis and lower limb weakness. This case highlights the importance of considering IgG4-related inflammatory pseudotumor as a differential diagnosis in patients with lesions involving the spinal intramedullary compartment and lower limb weakness when other more threatening causes have been excluded. IgG4-related inflammatory pseudotumor is etiologically unclear and prognostically unpredictable, and imaging may not help establish the diagnosis of IgG4-related inflammatory pseudotumor due to its resemblance to malignant tumors, and total resection might not be warranted. Glucocorticoid and surgery are usually the first-line treatments used.
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Affiliation(s)
- Zhou Qi
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianli Liu
- Department of Medical Imaging, Lanzhou University Second Hospital, Lanzhou, China
| | - Guoqiang Li
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Yinian Zhang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
- Neurosurgery Center of Zhujiang Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Yinian Zhang
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Ahmad M, Spandorfer R, Al Naqeeb J, Khosroshahi A. Mimickers of Immunoglobulin G4-Related Disease. J Clin Rheumatol 2022; 28:e647-e650. [PMID: 34670992 DOI: 10.1097/rhu.0000000000001796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Madiha Ahmad
- From the Department of Rheumatology, Emory University, Atlanta, GA
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IgG4-related pseudotumours: a series of 12 cases and a review of the literature. Pathology 2022; 54:563-572. [DOI: 10.1016/j.pathol.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 11/22/2022]
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Kamisawa T. Immunoglobulin G4-related Disease: A New Systemic Disease Emerging in Japan. JMA J 2022; 5:23-35. [PMID: 35224257 PMCID: PMC8826784 DOI: 10.31662/jmaj.2021-0113] [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] [Received: 06/17/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory disease characterized by organ enlargement and elevated serum IgG4 levels. In 2003, IgG4-RD was proposed as a distinct form of IgG4-related systemic disease based on a histopathological study involving patients with autoimmune pancreatitis. IgG4-RD occurs mainly in older men and can affect almost any organ simultaneously or metachronously. Pathophysiologically, IgG4-RD occurs when an autoantigen triggers an immune response characterized by Th2 predominance with increased production of cytokines, such as interleukin 4 (IL-4), IL-5, IL-10, IL-13, and tumor growth factor-β (TGF-β), in the affected organ. IL-10 and TGF-β produced by the increased number of regulatory T cells induce a switch from B cells to IgG4-producing plasma cells and fibrosis, respectively. The characteristic histological features consist of dense infiltration of lymphocytes and IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. IgG4-RD is diagnosed based on a combination of clinical, serological, radiological, and histopathological findings. Differentiating IgG4-RD from malignant tumors or similar inflammatory diseases in the affected organs is important. The 2019 America College of Rheumatology/European League against Rheumatism classification criteria for IgG4-RD have high diagnostic sensitivity and specificity. IgG4-RD generally responds well to treatment with steroids, and a swift response is reassuring and provides further diagnostic confirmation. However, relapses are common during tapering or after cessation of steroids. In Japan, low-dose steroid maintenance therapy is usually given to prevent a relapse. B-cell depletion with rituximab is effective in patients resistant to or dependent on steroids. Most patients with IgG4-RD who receive steroid therapy show good short-term clinical, morphological, and functional outcomes. However, long-term outcomes, such as relapse, fibrosis development, and associated malignancies, have not been clearly defined. Therefore, novel treatment strategies, including rituximab, need to be tested in international randomized controlled clinical trials.
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Affiliation(s)
- Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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26
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Update on classification, diagnosis, and management of immunoglobulin G4-related disease. Chin Med J (Engl) 2022; 135:381-392. [PMID: 34985023 PMCID: PMC8869566 DOI: 10.1097/cm9.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized chronic fibro-inflammatory autoimmune disease, and its recognition has been constantly increasing worldwide over the last few years. A correct and timely recognition, as well as appropriate intervention, is crucial for the treatment of IgG4-RD. For certain subtypes of IgG4-RD, organ-specific criteria are formulated to make the diagnosis more accurate. New biomarkers have emerged in the recent years to aid the disease diagnosis, its prognosis prediction, as well as therapy response monitoring. Although recurrence is very common in IgG4-RD, glucocorticoid is still the first-line treatment for the majority of patients. The factors that affect the likelihood of disease relapse are multifaceted. The selection strategy of various steroid-sparing agents is still being explored. Besides, when patients have special sites involvement leading to severe clinical conditions, surgical operation or interventional therapy should also be considered. An update on classification, diagnosis, and management of IgG4-RD is provided in the current study to fully elucidate the recommended clinical practice of this mysterious disease.
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Min SN, Zhu MQ, Mao XD, Li W, Wei T, Mei M, Zhang Y, Wu LL, Yu GY, Cong X. The Contribution of the Interleukin-4-Induced Epithelial Cell Senescence to Glandular Fibrosis in IgG4-Related Sialadenitis. Arthritis Rheumatol 2021; 74:1070-1082. [PMID: 34927394 DOI: 10.1002/art.42052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/17/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Immunoglobulin G4-related sialadenitis (IgG4-RS) is a chronic fibro-inflammatory disease characterized by glandular fibrosis and hyposalivation. Here we aimed to explore the role of cellular senescence in the pathogenesis of IgG4-RS-related fibrosis. METHODS The expression of senescence markers and proinflammatory cytokines in the submandibular glands (SMGs) of IgG4-RS patients (n = 18) and controls (n = 14) was determined by proteomics, real-time polymerase chain reaction (PCR), western blot, and immunohistochemistry. After interleukin-4 (IL-4) treatment, high-throughput RNA-sequencing was performed to identify the differentially expressed genes in SMG-C6 cells. A glandular fibrosis model was established by the intraglandular injection of IL-4 into mouse SMGs (n = 8 per group). RESULTS Salivary acinar and ductal epithelial cells underwent senescence in IgG4-RS patients, as indicated by the elevated activity of senescence-associated β-galactosidase, lipofuscin accumulation, enhanced expression of senescence markers (p53 and p16INK4A ), and upregulation of senescence-associated secretory phenotype factors. Moreover, there was a significant increase in IL-4 levels in SMGs of IgG4-RS patients, which positively correlated with p16INK4A expression and the fibrosis score. Incubation with IL-4 exacerbated salivary epithelial cell senescence by increasing the expression of p16INK4A through ROS-p38 mitogen-activated protein kinase (MAPK) pathway. The supernatant collected from IL-4-induced senescent SMG-C6 cells enhanced fibroblast activation and matrix protein production. Furthermore, injecting IL-4 promoted fibrosis and senescence phenotypes in the SMGs in vivo. CONCLUSION The cellular senescence induced by IL-4 through the ROS-p38 MAPK-p16INK4A pathway promoted fibrogenesis during IgG4-RS. Our data suggest that cellular senescence could serve as a novel therapeutic target for treating IgG4-RS.
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Affiliation(s)
- Sai-Nan Min
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Meng-Qi Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Xiang-Di Mao
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, P. R. China
| | - Wei Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Tai Wei
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Mei Mei
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Yan Zhang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, P. R. China
| | - Li-Ling Wu
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, P. R. China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Xin Cong
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, P. R. China
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28
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Li Y, Luo B, Zhang J, Zhou X, Shao S, Xu W, Yang Y, Yuan G. Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves' ophthalmopathy. Clin Endocrinol (Oxf) 2021; 95:657-667. [PMID: 33938028 DOI: 10.1111/cen.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Previous study suggested IgG4 levels were associated with the development of Graves' ophthalmopathy (GO). The aims of the present study were to investigate the role of IgG4 levels in glucocorticoid (GC) treatment in GO patients. DESIGN 69 GO patients were enrolled. Serum thyroid hormones, thyroid antibodies, IgG, IgG4, ophthalmological examinations and orbital MRI were performed. Furthermore, the clinical outcomes (a composite response endpoint including the clinical activity score (CAS), proptosis, vision, intraocular pressure, diplopia and lid width) after high-dose intravenous GC treatment in 32 active moderate-to-severe GO patients were compared. PATIENTS 69 consecutive patients with GO were asked to participate in the study. 32 of 69 GO patients were treated with high-dose intravenous GCs. MEASUREMENTS Measurement of serum IgG and IgG4, serum thyroid hormones and thyroid autoantibodies. An overall ophthalmic assessment was performed pretherapy (week 0) and post-therapy (week 12). RESULTS 33.3% of GO patients (23/69) had elevated IgG4 levels. IgG4 levels were positively correlated with the severity and activity of GO. After GC therapy, IgG4, IgG4/IgG, vision and CAS were significantly improved in GO patients. Patients with high IgG4 levels had a significantly reduced extraocular muscle area (EOMs) and better clinical outcomes than patients with normal IgG4 levels. CONCLUSIONS Our results suggest a possible subgroup of elevated IgG4 GO patients, with more severe ophthalmopathy and better response to GCs treatment compare with normal IgG4 GO patients.
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Affiliation(s)
- Yaling Li
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Unit, Wuhan Hospital of Traditional Chinese and Western Medical, Wuhan, China
| | - Ban Luo
- Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhang
- Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xinrong Zhou
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shiying Shao
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Weijie Xu
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Pyae PK, Cama R, Nicholson AG, Vancheeswaran R. Curious case of the unexplained exudative pleural effusion. BMJ Case Rep 2021; 14:e245796. [PMID: 34544724 PMCID: PMC8454451 DOI: 10.1136/bcr-2021-245796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 74-year-old male patient who was referred to the respiratory clinic with an incidental finding of a left sided pleural effusion. He was initially being treated by the general practitioner for chest infection with productive cough that had limited resolution after course of oral antibiotics. At the pleural clinic, 1.5 L of serosanguineous fluid was drained and sent for diagnostics. However, the diagnosis only reached as far as idiopathic exudative effusion with lymphocytes and plasma cells. He was then referred for video-assisted thoracoscopic surgery pleural biopsy and pleurodesis. It revealed black pleura with abundant IgG4 positive cells. He is followed up in respiratory clinic where further discussion and treatment has commenced.
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Affiliation(s)
- Phyoe Kyaw Pyae
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rigers Cama
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Rama Vancheeswaran
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
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30
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Bu F, Koo SC. Clinicopathologic Characterization of IgG4-Rich Pediatric Head and Neck Lesions. Arch Pathol Lab Med 2021; 146:611-618. [PMID: 34473213 DOI: 10.5858/arpa.2021-0041-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Immunoglobulin G4 (IgG4)-related disease is rare but well characterized in adults; however, the clinical and histologic manifestations in children may differ. OBJECTIVE.— To review the clinical and histologic features of IgG4-rich head and neck lesions in a pediatric population. DESIGN.— Retrospective search for cases with IgG4 immunohistochemical staining performed at our institution from 2011 to 2019. Review of clinical courses, serology profiles, histologic patterns, and immunohistochemical staining patterns. RESULTS.— Four pediatric IgG4-rich lesions were identified and showed distinct histologic patterns from adult IgG4-related disease, including absence of pathognomonic findings associated with the latter. One case showed intralesional immunoglobulin light-chain restriction. Clinical review showed serum IgG4 elevation in 2 of 4 cases, presence of additional autoantibody positivity, and a generally benign/treatment-responsive clinical course. CONCLUSIONS.— Pediatric IgG4-related disease shows distinct clinical, serologic, and histologic features from its adult counterpart. Pediatric IgG4-related disease involving the orbit has unique clinical characteristics, including frequently normal serum IgG4 levels and female predominance. Awareness and evaluation for these features may improve diagnosis and treatment.
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Affiliation(s)
- Fang Bu
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Bu, Koo).,the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio (Bu, Koo).,Bu is currently at the Department of Pathology and Laboratory Medicine, Children's Minnesota, Minneapolis
| | - Selene C Koo
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Bu, Koo).,the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio (Bu, Koo).,Koo is currently at the Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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31
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Amirbaigloo A, Esfahanian F, Mouodi M, Rakhshani N, Zeinalizadeh M. IgG4-related hypophysitis. Endocrine 2021; 73:270-291. [PMID: 33837927 DOI: 10.1007/s12020-021-02714-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
Hypophysitis is a rare pituitary inflammatory disorder classified in different ways. Immunoglobulin G4-related disease (IgG4-RD), also a rare disease is a systemic fibro-inflammatory condition characterized by infiltration of tissue with IgG4-positive plasma cells; however prevalence of both of them probably is underestimated. In this paper, we present an Iranian patient with biopsy-proven IgG4-related hypophysitis and then review the clinical characteristics, laboratory, imaging, pathologic findings and therapeutic management as well as prognosis of 115 published cases of hypophysitis secondary to IgG4-related disease.
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Affiliation(s)
| | - Fatemeh Esfahanian
- Department of Endocrinology and Metabolism, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Marjan Mouodi
- Department of Endocrinology and Metabolism, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasser Rakhshani
- Department of Pathology, Firoozgar Hospital, Iran University of medical sciences, Tehran, Iran
| | - Mehdi Zeinalizadeh
- Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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32
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Liu Y, Wang Z, Ren L, Zeng Q, Wang Z, Bian W, Zhang Y, Fu J, Chen D, Yu G, Zhang S, Li Z. Sonographic findings of immunoglobulin G 4-related sialadenitis and differences from Sjögren's syndrome. Scand J Rheumatol 2021; 51:128-134. [PMID: 34283677 DOI: 10.1080/03009742.2021.1917144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate ultrasonic features of the major salivary glands in patients with immunoglobulin G4-related sialadenitis (IgG4-RS) and to explore the differences between IgG4-RS and Sjögren's syndrome (SS). METHOD We conducted the study in 150 patients with IgG4-RS and 100 patients with SS. Ultrasonographic variables of the static images of major salivary glands were analysed. An experienced radiologist scored the confidence rating regarding the presence of the characteristic imaging findings using a five-grade rating system. Ultrasonography scores between IgG4-RS and SS were compared. RESULTS The major salivary glands were significantly larger in patients with IgG4-RS than in the SS group. The main features of ultrasonography of the salivary glands in IgG4-RS were various hypoechoic lesions and increased colour Doppler signalling. In contrast, the major salivary glands in SS exhibited hyperechoic lines and/or spots and obscuration of the gland configuration. The scores of the summarized sonographic characteristics also showed statistically significant differences between the IgG4-RS and SS groups. CONCLUSION This study revealed different ultrasonic features of the major salivary glands in patients with IgG4-RS and SS. The scored sonographic features were helpful in differentiating IgG4-RS from SS. Consequently, we suggest that ultrasonography of major salivary glands could be a useful imaging procedure in the evaluation of patients suspected of having IgG4-RS.
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Affiliation(s)
- Y Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Z Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - L Ren
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Q Zeng
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Z Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - W Bian
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Y Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - J Fu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - D Chen
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - G Yu
- Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing, China
| | - S Zhang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Z Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
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Qureshi A, Ghobrial Y, De Castro J, Siami-Namini K, Newman KA. Autoimmune pancreatitis - What we know and what do we have to know? Autoimmun Rev 2021; 20:102912. [PMID: 34280553 DOI: 10.1016/j.autrev.2021.102912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ammar Qureshi
- Eisenhower Health, Internal Medicine Residency Program, 39000 Bob Hope Dr, Rancho Mirage, CA 92270, United States of America.
| | - Youssef Ghobrial
- Eisenhower Health, Internal Medicine Residency Program, 39000 Bob Hope Dr, Rancho Mirage, CA 92270, United States of America
| | - Joline De Castro
- Eisenhower Health, Internal Medicine Residency Program, 39000 Bob Hope Dr, Rancho Mirage, CA 92270, United States of America
| | - Koushan Siami-Namini
- Eisenhower Health, Department of Pathology, 39000 Bob Hope Dr, Rancho Mirage, CA 92270, United States of America.
| | - Kam A Newman
- University of California, Riverside (UCR), School of Medicine, Eisenhower Health, Internal Medicine Residency Program, Division of Rheumatology, 39000 Bob Hope Dr, Rancho Mirage, CA 92270, United States of America.
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IgG4 as a Biomarker in Graves' Orbitopathy. Mediators Inflamm 2021; 2021:5590471. [PMID: 34220335 PMCID: PMC8213474 DOI: 10.1155/2021/5590471] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/29/2021] [Indexed: 12/26/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory disorder associated with fibrosis and abundant tissue lymphoplasmacytic infiltrations. It typically affects the pancreas, the salivary glands, and the retroperitoneal space. However, it might also involve multiple other organs, including the orbit and the thyroid. Recent studies have suggested that IgG4 plays a role in the pathophysiology of autoimmune thyroid diseases. This ultimately led to the establishment of new clinical entities called IgG4-related thyroid disease and thyroid disease with an elevation of IgG4. The aim of this paper is to describe the pathophysiological, histopathological, and clinical features of Graves' Disease (GD) and Graves' Orbitopathy (GO) with elevated IgG4 levels. Multiple studies have demonstrated higher IgG4 serum concentrations in GD patients than in healthy euthyroid controls. Depending on the studied population, elevated serum IgG4 levels occur in 6.4-23% (average: 10.3%) of all patients with GD, 8.3-37.5% (average: 17.6%) of patients with GO, and 0-9.8% (average: 5.4%) of patients with GD without GO, while GO patients comprise 37.5-100% (average: 65.8%) of all GD patients with elevated IgG4 levels. Characteristic features of GD with elevated IgG4 levels include lower echogenicity of the thyroid gland on ultrasound examination, peripheral blood eosinophilia, higher prevalence of orbitopathy, and better response to antithyroid drugs with a tendency to develop hypothyroidism when compared to patients with GD and normal levels of IgG4. Typical signs of GO accompanied by increased concentration of IgG4 include younger age at diagnosis, and more severe course of the disease with a higher Clinical Activity Score (CAS).. We strongly recommend considering the diagnosis of GO with elevated IgG4 in patients with an established diagnosis of GD, elevated serum IgG4 levels, and clinical features of ophthalmic disease overlapping with those of IgG4-related orbital disease.
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35
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Rollon-Mayordomo A, Avellaneda-Camarena A, Gutierrez-Domingo A, Martinez-Carapeto E, Infante-Cossio P. Synchronous occurrence of IgG4-related sialadenitis and ductal carcinoma of the parotid gland: a case report. Gland Surg 2021; 10:2069-2075. [PMID: 34268092 DOI: 10.21037/gs-21-90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a rare chronic systemic inflammatory pathology that poses a diagnostic challenge since it can simulate malignancy when it affects a salivary gland as a mass-like lesion. Here, the authors report an unusual clinical case of a 42-year-old man who presented with a painless, slow-growing swelling located in the right parotid gland with a 12-month evolution. Based on imaging tests and open biopsy, a diagnosis of chronic parotitis was presumed and oral methylprednisolone was prescribed. Due to poor response to medication, a total parotidectomy preserving the facial nerve was performed. The final pathology described a unilateral IgG4-related sialadenitis (IgG4-RS) in the parotid gland in combination with a poorly differentiated multifocal ductal carcinoma. The postoperative course was uneventful except for a temporary facial paresis (grade III according to the House-Brackmann classification system) that resolved completely within 5 months. There were no systemic manifestations on the whole-body 18F-FDG PET/CT. Adjuvant radiotherapy was administered without complications. Twenty-four months follow-up after surgery showed no recurrence or evidence of systemic involvement. This clinical report highlights the importance of considering the synchronous occurrence of a carcinoma underlying an isolated parotid gland mass in the context of IgG4-RS, especially if there is no response to prior steroid medication.
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Affiliation(s)
- Angel Rollon-Mayordomo
- Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain
| | - Ana Avellaneda-Camarena
- Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain
| | | | - Elena Martinez-Carapeto
- Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain
| | - Pedro Infante-Cossio
- Department of Surgery, School of Medicine, University of Seville, Seville, Spain
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36
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Zhou W, Li Y, Yan C, Zheng L, Liu F, Sun C. The prevalence of extra-salivary gland complications in immunoglobulin G4-related sialadenitis. Oral Dis 2021; 28:1468-1483. [PMID: 34048116 DOI: 10.1111/odi.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the prevalence of extra-glandular lesions in patients with immunoglobulin G4-related sialadenitis (IgG4-RS). METHODS Six electronic databases (PubMed, EMBASE, Science Direct, Scopus, Web of Science, and China National Knowledge Infrastructure) were systematically searched from the date of inception of each database to March 2021. The Strengthening the Reporting of Observational Studies in Epidemiology statement was used to conduct methodological quality assessment, and a random-effect meta-analysis model was applied to estimate the prevalence. Publication bias was visually assessed using a funnel plot and calculated via Begg's and Egger's tests. The Stata 15 software was used to perform data analysis. RESULTS A total of 43 articles comprising 1,864 patients with IgG4-RS were considered to be eligible for this study. The pooled prevalence of extra-salivary gland lesions in IgG4-RS was 76.53% with a confidence interval (CI) of (69.39%, 83.04%). A higher prevalence was associated with studies published before or during 2015 (84.38%, CI [74.23%, 92.58%]) than those published after 2015 (68.55%, CI [58.44%, 77.88%]). Lacrimal gland involvement (54.68%, CI [45.61%, 63.60%]) and lymph node swelling (56.96%, CI [48.16%, 65.56%]) were the most frequent lesions. CONCLUSIONS Extra-glandular lesions were common in patients with IgG4-RS. More high-quality prospective studies with less heterogeneity are required to determine the accurate prevalence.
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Affiliation(s)
- Wanhang Zhou
- Department of Oral Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
| | - Yanfei Li
- Department of Prosthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Cong Yan
- Department of Oral Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
| | - Li Zheng
- Department of Oral Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
| | - Fayu Liu
- Department of Oral Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
| | - Changfu Sun
- Department of Oral Maxillofacial-Head and Neck Surgery, School of Stomatology, Oral Diseases Laboratory of Liaoning, China Medical University, Shenyang, China
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Kaya Akca Ü, Atalay E, Kasap Cüceoğlu M, Şener S, Balık Z, Başaran Ö, Batu ED, Karadağ Ö, Özen S, Bilginer Y. IgG4-related disease in pediatric patients: a single-center experience. Rheumatol Int 2021; 42:1177-1185. [PMID: 33978820 DOI: 10.1007/s00296-021-04885-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Immunoglobulin G4-related disease (IgG4-RD) is a systemic, immune-mediated, and fibroinflammatory disease that can affect almost any organ system. We aimed to present our single-center experience of pediatric patients with IgG4-RD, a rare disease in children. METHODS Pediatric patients diagnosed with IgG4-RD at the Hacettepe University between June 2014 and September 2020 were evaluated retrospectively. Patients with definite, probable, or possible diagnosis of IgG4-RD were included. RESULTS A total of eight patients with a median age of 13.4 (IQR 9.5-15.0) years were included in the study. Clinical presentations were IgG4-related ophthalmic disease in six patients, IgG4-related lymphadenopathy in one patient, and IgG4-related sialadenitis and lymphadenopathy of several lymph nodes accompanied by pancreatitis, ulcerative colitis, and pulmonary manifestations in one patient. Elevated serum IgG4 was detected in three of eight patients (37.5%). The main histopathological feature was fibrosis and lymphoplasmacytic infiltrates. Corticosteroids were used as first-line treatment in almost all patients with or without steroid-sparing agents. Azathioprine, methotrexate and rituximab were used as steroid-sparing agents. Relapse occurred in two of seven patients. Radiotherapy was used as the last resort in one patient with severe orbital disease. CONCLUSION IgG4 RD mainly presents with orbital manifestations in pediatric population but has wide phenotypic clinical variability. Although rare, early recognition and treatment are essential for a better outcome in these patients.
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Affiliation(s)
- Ümmüşen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Müşerref Kasap Cüceoğlu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Şener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ömer Karadağ
- Department of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Jutras G, Wong P, Ferreira J, Leblanc JF. IgG4-associated autoimmune hepatitis and cholangitis: A relatively novel entity to consider in cases of seronegative autoimmune hepatitis. CANADIAN LIVER JOURNAL 2021; 4:99-103. [PMID: 35991763 PMCID: PMC9204940 DOI: 10.3138/canlivj-2020-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/08/2020] [Indexed: 03/12/2024]
Abstract
A 49-year-old woman with no inflammatory bowel disease history presented to our clinic with abnormal liver function tests and right upper quadrant abdominal pain. Blood tests revealed a mixed pattern of liver injury. Abdominal magnetic resonance imaging demonstrated hepatomegaly with periportal edema and hyper-enhancing bile ducts without any sign of biliary obstruction or stricturing. Screening for viral hepatitis and autoimmune liver diseases was negative. An elevated immunoglobulin G (IgG) level suggested the possibility of autoimmune hepatitis (AIH), and a biopsy confirmed the presence of severe interface hepatitis with necrotic areas and focal lymphoid nodular formation. IgG4 staining revealed marked IgG4-positive plasma cell infiltration. A diagnosis of IgG4-associated seronegative AIH was made, and the patient was started on prednisone and azathioprine, with rapid resolution of the enzyme abnormalities. This clinical vignette highlights the potential challenges in establishing a diagnosis of IgG4-associated AIH and cholangitis, as demonstrated by the importance of confirmatory histopathology. Clinicians should maintain a high index of suspicion when confronted with a mixed pattern of liver injury with elevated immunoglobulins but seronegative autoimmune markers.
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Affiliation(s)
| | - Philip Wong
- McGill University Health Centre, Montréal, Québec, Canada
| | - José Ferreira
- Hopital Maisonneuve-Rosemont, Montréal, Québec, Canada
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Parente C, Reis R, Rodrigues D, Cardoso A, Peixoto J. Pseudotumoral Lesion as a Manifestation of Autoimmune Pancreatitis. Cureus 2021; 13:e13931. [PMID: 33868862 PMCID: PMC8049773 DOI: 10.7759/cureus.13931] [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: 11/09/2022] Open
Abstract
Autoimmune pancreatitis is a chronic and benign disease of autoimmune etiology that can occur isolated or constitute a manifestation of immunoglobulin G4 (IgG4)-related disease (types 2 and 1, respectively). It is a pathological condition that can mimic pancreatic cancer by presenting as a mass in imaging studies and provoking symptoms such as obstructive jaundice and dramatic weight-loss. The inflammatory infiltrates in the pancreas can also produce endocrine dysfunction leading to diabetes. The authors report the case of a 68-year-old man that presented with unexplained weight loss and poorly controlled diabetes despite progressive pharmacological adjustments, with a later onset of obstructive jaundice, for which he underwent pancreaticoduodenectomy with the pre-operative diagnosis of pancreatic malignant neoplasm, which was posteriorly identified as type 1 autoimmune pancreatitis. In these cases, the differential diagnosis might be particularly challenging, requiring a high level of suspicion to avoid unnecessary procedures. Corticosteroid therapy can lead to the resolution of symptoms as well as glycemic control, and it is the cornerstone of IgG4-related disease treatment. However, corticosteroid-sparing agents may be of interest to achieve clinical suppression.
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Affiliation(s)
- Catarina Parente
- Internal Medicine Department, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Rúben Reis
- Internal Medicine Department, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Daniela Rodrigues
- Internal Medicine Department, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - António Cardoso
- Internal Medicine Department, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
| | - Joaquim Peixoto
- Internal Medicine Department, Centro Hospitalar Barreiro Montijo, Barreiro, PRT
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Matos T, de Almeida MM, Batista L, do Vale S. IgG4-related disease of the thyroid gland. BMJ Case Rep 2021; 14:14/3/e238177. [PMID: 33649038 PMCID: PMC7929855 DOI: 10.1136/bcr-2020-238177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
IgG4-thyroid-related disease (TRD) represents an uncommon spectrum of diseases, with four subcategories established so far, IgG4-related Hashimoto's thyroiditis, fibrosing variant of Hashimoto's thyroiditis, Riedel's thyroiditis and Graves disease with elevated IgG4 levels. We report the case of a 59-year-old woman presenting with painless cervical swelling and hypothyroidism. Thyroid gland was enlarged and distinctively very hard, with reduced mobility. Neck ultrasonography showed multiple nodularity and diffuse thyroid enlargement, which on CT scan conditioned slight deviation of the airway. Fine-needle aspiration of the biggest nodule was suggestive of lymphocytic thyroiditis. She developed compressive symptoms and was submitted to total thyroidectomy. Histology of the thyroid revealed extensive areas of fibrosis, oncocytic cells and lymphoplasmacytic infiltrates. Immunohistochemistry confirmed the predominance of IgG4-secreting plasma cells. IgG4-TRD is characterised by a rapidly progressive and destructive thyroiditis process. Typical presentation can often mimic malignancy; hence, an opportune recognition of IgG4-TRD may avoid unnecessary burdens.
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Affiliation(s)
- Tânia Matos
- Endocrinology, Diabetes, and Metabolism Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | | | - Lucas Batista
- Surgery Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal,Endocrinology Department, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sónia do Vale
- Endocrinology, Diabetes, and Metabolism Department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal,Endocrinology Department, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Plichta DR, Somani J, Pichaud M, Wallace ZS, Fernandes AD, Perugino CA, Lähdesmäki H, Stone JH, Vlamakis H, Chung DC, Khanna D, Pillai S, Xavier RJ. Congruent microbiome signatures in fibrosis-prone autoimmune diseases: IgG4-related disease and systemic sclerosis. Genome Med 2021; 13:35. [PMID: 33648559 PMCID: PMC7919092 DOI: 10.1186/s13073-021-00853-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/11/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) and systemic sclerosis (SSc) are rare autoimmune diseases characterized by the presence of CD4+ cytotoxic T cells in the blood as well as inflammation and fibrosis in various organs, but they have no established etiologies. Similar to other autoimmune diseases, the gut microbiome might encode disease-triggering or disease-sustaining factors. METHODS The gut microbiomes from IgG4-RD and SSc patients as well as healthy individuals with no recent antibiotic treatment were studied by metagenomic sequencing of stool DNA. De novo assembly-based taxonomic and functional characterization, followed by association and accessory gene set enrichment analysis, were applied to describe microbiome changes associated with both diseases. RESULTS Microbiomes of IgG4-RD and SSc patients distinctly separated from those of healthy controls: numerous opportunistic pathogenic Clostridium and typically oral Streptococcus species were significantly overabundant, while Alistipes, Bacteroides, and butyrate-producing species were depleted in the two diseases compared to healthy controls. Accessory gene content analysis in these species revealed an enrichment of Th17-activating Eggerthella lenta strains in IgG4-RD and SSc and a preferential colonization of a homocysteine-producing strain of Clostridium bolteae in SSc. Overabundance of the classical mevalonate pathway, hydroxyproline dehydratase, and fibronectin-binding protein in disease microbiomes reflects potential functional differences in host immune recognition and extracellular matrix utilization associated with fibrosis. Strikingly, the majority of species that were differentially abundant in IgG4-RD and SSc compared to controls showed the same directionality in both diseases. Compared with multiple sclerosis and rheumatoid arthritis, the gut microbiomes of IgG4-RD and SSc showed similar signatures; in contrast, the most differentially abundant taxa were not the facultative anaerobes consistently identified in inflammatory bowel diseases, suggesting the microbial signatures of IgG4-RD and SSc do not result from mucosal inflammation and decreased anaerobism. CONCLUSIONS These results provide an initial characterization of gut microbiome ecology in fibrosis-prone IgG4-RD and SSc and reveal microbial functions that offer insights into the pathophysiology of these rare diseases.
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Affiliation(s)
| | - Juhi Somani
- Department of Computer Science, Aalto University, 02150, Espoo, Finland
| | | | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program and Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ana D Fernandes
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Cory A Perugino
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Harri Lähdesmäki
- Department of Computer Science, Aalto University, 02150, Espoo, Finland
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Hera Vlamakis
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Daniel C Chung
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Cancer Risk Assessment, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Shiv Pillai
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Ramnik J Xavier
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Center for Microbiome Informatics and Therapeutics, MIT, Cambridge, MA, USA.
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Takeshima K, Li Y, Kakudo K, Hirokawa M, Nishihara E, Shimatsu A, Takahashi Y, Akamizu T. Proposal of diagnostic criteria for IgG4-related thyroid disease. Endocr J 2021; 68:1-6. [PMID: 33311000 DOI: 10.1507/endocrj.ej20-0557] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with IgG4-related disease (IgG4-RD) are diagnosed in Japan by comprehensive or organ-specific diagnostic criteria. To date, organ-specific criteria have been established for several organs, but not for the thyroid. We attempted to establish diagnostic criteria for IgG4-related thyroid disease (IgG4-RTD) based on IgG4-RD research by The Research Program on Intractable Diseases from the Ministry of Health, Labour and Welfare of Japan. These criteria have been publicly reported to members of both the Japan Endocrine Society and the Japan Thyroid Association. Thyroid diseases associated with IgG4 include Hashimoto's thyroiditis, Graves' disease and Riedel's thyroiditis. As a comprehensive definition that includes both systematic and organ-specific forms, we use the broad term 'IgG4-related thyroid disease'. Diagnostic criteria for IgG4-RTD comprise the following five items: I) enlargement of the thyroid, II) hypoechoic lesions in the thyroid by ultrasonography, III) elevated serum IgG4 levels, IV) histopathological findings in the thyroid lesion (IgG4+ plasma cells >20/HPF and IgG4+/IgG+ plasma cell ratio >30%) and V) involvement of other organs. "Definitive" diagnosis of IgG4-RTD is made when I, II, III and IV are all fulfilled, while "probable" diagnosis of IgG4-RTD is when I, II, and IV or V are fulfilled. Patients who fulfill I, II and III criteria are considered as "possible" IgG4-RTD. We believe that the proposed diagnostic criteria contribute to more accurate diagnosis of IgG4-RTD as well as exclusion of mimicry. Furthermore, they may lead to better understanding of the clinical implications and underlying pathogenesis of IgG4-RTD.
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Affiliation(s)
- Ken Takeshima
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yaqiong Li
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, 250021, China
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi 594-0073, Japan
| | | | - Eijun Nishihara
- Department of Internal Medicine, Kuma Hospital, Kobe 650-0011, Japan
| | - Akira Shimatsu
- Advanced Medical Care Center, Kusatsu General Hospital, Kusatsu 525-8585, Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University Hospital, Nara 634-8522, Japan
| | - Takashi Akamizu
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Internal Medicine, Kuma Hospital, Kobe 650-0011, Japan
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Dragan AD, Weller A, Lingam RK. Imaging of IgG4-related disease in the extracranial head and neck. Eur J Radiol 2021; 136:109560. [PMID: 33524920 DOI: 10.1016/j.ejrad.2021.109560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Immunoglobulin G4-related disease (IgG4-RD) is a newly defined fibro-inflammatory multisystemic condition defined by a triad of diagnostic criteria based on clinical presentation, biochemical and histopathological findings. Whereas some subsites of this disease have been well described in the literature so far (e.g. pancreas, kidneys, retroperitoneum, salivary glands), more recently identified anatomical sites of involvement in the head and neck are less well understood (e.g. nose, paranasal sinuses). METHOD This pictorial review details the imaging appearances of extracranial IgG4-RD in the Head & Neck. Multimodality imaging appearance and features are presented, with reference to the published literature to date. RESULTS Following a subsite-based approach, we present both the most common and the more rarely encountered imaging patterns of IgG4-RD in the extracranial head and neck, along with the relevant differential diagnoses to consider. Our institutional experience not only cements what is already known in the existing literature on this topic, but also reveals new imaging features of IgG4-RD, notably in the sinonasal tract. CONCLUSIONS This pictorial review of extracranial head & neck IgG4-RD will enable radiologists to recognise the features of this condition and propose it as a differential diagnosis to include alongside other probable entities. It establishes the place of the radiologist in the diagnosis and management of IgG4-RD.
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Affiliation(s)
- Alina Denisa Dragan
- Radiology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, HA1 3UJ, United Kingdom
| | - Alexander Weller
- Radiology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, HA1 3UJ, United Kingdom
| | - Ravi Kumar Lingam
- Radiology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, London, HA1 3UJ, United Kingdom.
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Sertcelik U, Oncel A, Koksal D. Intrathoracic manifestations of immunoglobulin G4-related disease: A pictorial review. EURASIAN JOURNAL OF PULMONOLOGY 2021. [DOI: 10.4103/ejop.ejop_112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Liu X, Wang R, Li M, Chen G. IgG4-Related Inflammatory Pseudotumor Involving the Clivus: A Case Report and Literature Review. Front Endocrinol (Lausanne) 2021; 12:666791. [PMID: 33995286 PMCID: PMC8120283 DOI: 10.3389/fendo.2021.666791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/06/2021] [Indexed: 12/03/2022] Open
Abstract
IgG4-related inflammatory pseudotumors are very uncommon and are characterized histologically by the presence of inflammatory swellings with increasing IgG4-positive plasma cells and lymphocytes infiltrating the tissues. As reports of intracranial IgG4-related pseudotumors are very rare, we report a case of an IgG4-related inflammatory pseudotumor involving the clivus mimicking meningioma. A 46-year-old male presented with intermittent headache for 2 years and a sudden onset of dysphagia and dysphonia of 7 days' duration along with lower limb weakness. Enhanced magnetic resonance imaging (MRI) of the skull base revealed an isointense signal on T1- and T2-weighted images from an enhanced mass located at the middle of the upper clivus region, for which a meningioma was highly suspected. Then, an endoscopic transsphenoidal approach was adopted and the lesion was partially resected, as the subdural extra-axial lesion was found to be very tough and firm, exhibiting fibrous scarring attaching to the brain stem and basal artery. After the surgery, brain stem and posterior cranial nerve decompression was achieved, and the patient's symptoms, such as dysphagia, dysphonia and lower limb weakness, improved. Pathological findings showed many IgG4-positive plasma cells and lymphocytes surrounded by collagen-rich fibers. The patient was sent to the rheumatology department for further glucocorticoids after the diagnosis of an IgG4-related inflammatory pseudotumor was made. This case highlights the importance of considering IgG4-related inflammatory pseudotumors as a differential diagnosis in patients with lesions involving the clivus presenting with a sudden onset of symptoms of dysphagia and dysphonia along with lower limb weakness when other more threatening causes have been excluded. IgG4-related inflammatory pseudotumors are etiologically enigmatic and unpredictable, and total resection might not be warranted. Glucocorticoids are usually the first line of treatment after diagnosis.
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Affiliation(s)
- Xiaohai Liu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
| | - Renzhi Wang
- Chinese Pituitary Specialists Congress, Beijing, China
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Chinese Pituitary Specialists Congress, Beijing, China
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Choi SJ, Oh JS, Hong S, Lee CK, Yoo B, Hong B, Kim YG. Treatment Response to Idiopathic Retroperitoneal Fibrosis-associated Hydronephrosis With a Focus on IgG4/IgG3 Serum Concentration Ratio. JOURNAL OF RHEUMATIC DISEASES 2021; 28:38-44. [PMID: 37476393 PMCID: PMC10324956 DOI: 10.4078/jrd.2021.28.1.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Hydronephrosis, a common complication of idiopathic retroperitoneal fibrosis (iRPF), may lead to poor renal outcomes unless resolved in a timely manner IgG4-related diseases characterized by elevated serum IgG4 levels are responsible for a few iRPF cases However, the underlying immunologic features of most iRPF cases have not been clearly defined, and these cases exhibit varied responses to medical treatment Thus, we investigated the predictive factors for hydronephrosis-associated outcomes among iRPF patients. METHODS We retrospectively included 18 iRPF patients with hydronephrosis in a tertiary referral hospital from 2012 to 2019 Hydronephrosis improvement was assessed on images taken 6 months after diagnosis Categorical variables were compared using chi-square or Fisher's exact test Continuous variables were compared using Mann-Whitney U-test. RESULTS On follow-up images, 8 patients (444%) showed an improvement in hydronephrosis Patients with improvement more frequently had reverse serum IgG4/IgG3 ratio (875% vs 30%, p=0025), abdominal aorta involvement (875% vs 30%, p=0025) and glucocorticoid treatment administration (875% vs 30%, p=0025) than those without improvement The proportion of elevated serum IgG4 level did not differ between the two groups Even in the 14 cases with normal serum IgG4 levels, reverse serum IgG4/IgG3 ratio was more frequently observed in patients with improvement than in those without improvement (833% vs 125%, p=0026). CONCLUSION The reverse serum IgG4/IgG3 ratio was associated with hydronephrosis improvement in iRPF patients, suggesting it to be a suitable serologic marker for predicting favourable responses to glucocorticoid treatment.
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Affiliation(s)
- Su Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Department of Biomedical Informatics, Asan Medical Center, Seoul, Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Floreani A, Okazaki K, Uchida K, Gershwin ME. IgG4-related disease: Changing epidemiology and new thoughts on a multisystem disease. J Transl Autoimmun 2020; 4:100074. [PMID: 33490938 PMCID: PMC7806798 DOI: 10.1016/j.jtauto.2020.100074] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
IgG4-related disease (IgG4-RD) represents an immune-mediated fibroinflammatory condition with peculiar histopathologic changes that can affect various organs. In 2012 its unified nomenclature was published, which allows to abandon other synonymous names. Up to now, only little is known about its epidemiology around the world. However, although it is generally considered a rare condition, the number of patients with IgG4-RD is increasing enormously. Likewise, the annual number of publications on this subject has increased progressively. The spectrum of clinical manifestations in IgG4-RD is highly variable, depending on the severity of the disease as well as the presence of organ(s) involvement. This review gives an overview on changing epidemiology of IgG4-RD focusing the attention on the large cohorts of patients published in the literature.
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Affiliation(s)
- Annarosa Floreani
- Scientific Consultant IRCCS Negrar, Verona, Italy
- Senior Scholar, University of Padova, Italy
| | - Kazuichi Okazaki
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Kazushige Uchida
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - M. Eric Gershwin
- Division of Rheumatology Allergy and Clinical Immunology, University of California at Davis School of Medicine, Davis, CA, USA
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48
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Inflammatory Involvement of Spermatic Vein in a Patient With Immunoglobulin 4-Related Disease. J Clin Rheumatol 2020; 26:e28-e29. [PMID: 32073522 DOI: 10.1097/rhu.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Quattrocchio G, Barreca A, Demarchi A, Fenoglio R, Ferro M, Del Vecchio G, Massara C, Rollino C, Sciascia S, Roccatello D. Long-term effects of intensive B cell depletion therapy in severe cases of IgG4-related disease with renal involvement. Immunol Res 2020; 68:340-352. [PMID: 33174125 PMCID: PMC7674183 DOI: 10.1007/s12026-020-09163-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022]
Abstract
IgG4-related disease (IgG4-RD) is an immune-mediated disorder often showing elevated serum IgG4 concentrations, dense T and B lymphocyte infiltration, and IgG4-positive plasma cells and storiform fibrosis. We prospectively evaluated for 4 years 5 patients with histologically proven IgG4-RD of whom 3 had tubulointerstitial nephritis (TIN) and 2 had retroperitoneal fibrosis (RPF). They received an intensive B depletion therapy with rituximab. The estimated glomerular filtration rate of TIN patients after 1 year increased from 9 to 24 ml/min per 1.73 m2. IgG/IgG4 dropped from 3236/665 to 706/51 mg/dl, C3/C4 went up from 49/6 to 99/27 mg/dl, and the IgG4-RD responder index fell from 10 to 1. CD20+ B cells decreased from 8.7 to 0.5%. A striking drop in interstitial plasma cell infiltrate as well as normalization of IgG4/IgG-positive plasma cells was observed at repeat biopsy. Both clinical and immunological improvement persisted over a 4-year follow-up. Treating these patients who were affected by aggressive IgG4-RD with renal involvement in an effort to induce a prolonged B cells depletion with IgG4 and cytokine production decrease resulted in a considerable rise in eGFR, with IgG4-RD RI normalization and a noteworthy improvement in clinical and histological features. Furthermore, the TIN subgroup was shown not to need for any maintenance therapy.
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Affiliation(s)
- Giacomo Quattrocchio
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
| | - Antonella Barreca
- Department of Biomedical Sciences, University of Turin, Turin, Italy
| | | | - Roberta Fenoglio
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Michela Ferro
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giulio Del Vecchio
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Carlo Massara
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Cristiana Rollino
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Savino Sciascia
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Dario Roccatello
- Nephrology and Dialysis Universitary Unit, and Center of Research of Immunopathology and Rare Diseases (CMID) San Giovanni Bosco Hospital, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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50
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Wang Y, Zhao Z, Gao D, Wang H, Liao S, Dong C, Luo G, Ji X, Li Y, Wang X, Zhao Y, Li K, Zhang J, Jin J, Zhang Y, Zhu J, Zhang J, Huang F. Additive effect of leflunomide and glucocorticoids compared with glucocorticoids monotherapy in preventing relapse of IgG4-related disease: A randomized clinical trial. Semin Arthritis Rheum 2020; 50:1513-1520. [DOI: 10.1016/j.semarthrit.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/14/2020] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
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