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Ramanathan K, Nair S, Pavithra V, Kumar S, Adoor G, Karjigi U, Shivakumar S. Igg4 Related Disease of Skull Base-A Diagnostic Challenge. Indian J Otolaryngol Head Neck Surg 2022; 74:1057-1060. [PMID: 36452566 PMCID: PMC9702427 DOI: 10.1007/s12070-020-02135-x] [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: 08/16/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022] Open
Abstract
IgG4 related disease (IgG4-RD) is a fibro-inflammatory disease, with tendency to affect any organ of the body. However, few cases affecting the skull base have been reported in literature. We report one such case in an elderly male, who presented us with a mass lesion in the skull base that mimicked nasopharyngeal malignancy. On thorough clinical history, examination, and investigations, IgG4 Related disease was diagnosed and treatment was started for it. The patient responded well to the treatment and is on follow up.
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Affiliation(s)
- Krishna Ramanathan
- Department of ENT-HNS, Apollo Hospitals, Bangalore, 560076 Karnataka India
| | - Satish Nair
- Department of ENT-HNS, Apollo Hospitals, Bangalore, 560076 Karnataka India
| | - V. Pavithra
- Department of ENT-HNS, Apollo Hospitals, Bangalore, 560076 Karnataka India
| | - Savith Kumar
- Department of Interventional Radiology and Neuroradiology, Apollo Hospitals, Bangalore, Karnataka India
| | - Gurucharan Adoor
- Department of Neurology, Apollo Hospitals, Bangalore, Karnataka India
| | - Uma Karjigi
- Department of Rheumatology, Apollo Hospitals, Bangalore, Karnataka India
| | - Swarna Shivakumar
- Department of Pathology, Apollo Hospitals, Bangalore, Karnataka India
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Xiang H, Wang T, Tang S, Wang Y, Xiao N. A novel hydrazone-based fluorescent "off-on-off" probe for relay sensing of Ga 3+ and PPi ions. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 267:120510. [PMID: 34689093 DOI: 10.1016/j.saa.2021.120510] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
A novel hydrazone-based fluorescent probe (E)-3-((2-(benzo[d]thiazol-2-yl)hydrazono)methyl)-4H-chromen-4-one (BTC) has been rationally designed and synthesized. BTC can subsequently detect Ga3+ and PPi ions through the absorption and emission off-on-off response with high specificity. Importantly, fluorescent probe BTC can well discriminate Ga3+ from Al3+ and In3+. The association constant (K) was calculated as 2.06 × 104M-1, and the limit of detection (LOD) was calculated as 4.88 × 10-2μM. Competitive binding studies also illustrated good results of the probe BTC towards Ga3+. Job's plot and HRMS results substantiated the 1:1 stoichiometry between BTC and Ga3+ ion. The interaction binding mode of BTC with Ga3+ was proposed by HRMS, 1H NMR spectral titration, UV-vis absorption and fluorescence spectral measurements. The combination of the restraint of the photo-induced electron transfer (PET) process and the chelation enhanced fluorescence (CHEF) process is responsible for the fluorescence enhancement of this probe. The in situ chelated BTC-Ga3+ could further monitor pyrophosphate ion (PPi) by demetallization process with quenching fluorescence emission. Additionally, the BTC and BTC-Ga3+ showed good cell permeability and could detect Ga3+ and PPi ions in onioninner epidermal cells, respectively.
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Affiliation(s)
- Hanyue Xiang
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, School of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China
| | - Tianran Wang
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, School of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China
| | - Sixian Tang
- School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Yujie Wang
- School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Nao Xiao
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, School of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China.
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Behzadi F, Suh CH, Jo VY, Shanmugam V, Morgan EA, Guenette JP. Imaging of IgG4-Related Disease in the Head and Neck: A Systematic Review, Case Series, and Pathophysiology Update. J Neuroradiol 2021; 48:369-378. [PMID: 33516733 DOI: 10.1016/j.neurad.2021.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 12/26/2022]
Abstract
This systematic review aims to clarify and comprehensively detail the sometimes variable published imaging features as well as the pathogenesis, clinical diagnostic criteria, and treatment options of IgG4-Related Diseases (IgG4-RD) in the head and neck to aid the radiologist in diagnosing relapse and new sites of disease. A literature search in PubMed and EMBASE for reported cases of IgG4-RD was performed in December 2019. Case reports or series of IgG4-RD in the head and neck in adults that included sufficient imaging and pathology findings were included. This yielded 50 reports. IgG4-RD locations included the orbits, thyroid, pituitary gland, paranasal sinuses, salivary and parotid glands, larynx, pharynx, cervical lymph nodes, meninges, and skull base. Most lesions demonstrated non-specific homogenous CT attenuation, diffuse enhancement, isointense/low T2 signal intensity, and low T1 signal intensity. 6 cases from our institution followed previously reported imaging patterns.
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Affiliation(s)
- Fardad Behzadi
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vignesh Shanmugam
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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Park BJ, Starks R, Kirby P, Menezes AH, Dlouhy BJ. IgG4-Related Disease of the Craniovertebral Junction. World Neurosurg 2020; 134:264-271. [DOI: 10.1016/j.wneu.2019.10.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/28/2022]
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Arao K, Mase T, Iwanami K, Nakai M, Sekiguchi H, Abe Y, Kawakami M. IgG4-related Pericarditis in which Oral Corticosteroid Therapy Was Effective. Intern Med 2019; 58:1119-1122. [PMID: 30626813 PMCID: PMC6522423 DOI: 10.2169/internalmedicine.1403-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IgG4-related diseases (IgG4-RDs) have recently been reported in many organs other than the salivary, pancreatic and hepatobiliary systems. A 64-year-old woman was referred to our department for her abdominal fullness and cardiomegaly on chest X-ray. After draining the pericardial fluid, her symptom promptly diminished, and pericardial friction rubbing became clearly audible. Elevated serum levels of IgG and IgG4 and ureteral wall thickening on computed tomography suggested IgG4-RD. After the initiation of oral corticosteroid therapy, the pericardial effusion was resolved, and she has been in a steady-state condition for the past two years.
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Affiliation(s)
- Kenshiro Arao
- Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Japan
| | - Takaaki Mase
- Division of Cardiovascular Medicine, Nerima-Hikarigaoka Hospital, Japan
| | - Keiichi Iwanami
- Division of Rheumatology, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
| | - Mori Nakai
- Division of Internal Medicine, Nerima-Hikarigaoka Hospital, Japan
| | | | - Yasunori Abe
- Division of Internal Medicine, Nerima-Hikarigaoka Hospital, Japan
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Abstract
INTRODUCTION IgG4-Related Disease is a newly recognized condition which is increasingly diagnosed by practitioners due to improvement in clinical awareness. Men and women have been found to be affected by this disease in various organs, more commonly with involvement of the salivary and lacrimal glands as well as pancreas and liver. Areas covered: The diagnosis and management of this condition remain challenging as biomarkers and therapies are being investigated. Hallmark features on histology are still the gold standard for confirmation of diagnosis, whereas serum IgG4 level has been shown to be neither necessary nor sufficient for the diagnosis. Glucocorticoids remain the most effective initial management for this condition while there are limited clinical trials on the effectiveness of maintenance therapy. Expert commentary: This review serves as an update on approaches for diagnosis and management of IgG4-RD. Most of the known data in this field comes from retrospective cohort studies and expert consensus guidelines but new ongoing prospective studies, clinical trials and better understanding of the pathogenesis of this condition are promising.
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Affiliation(s)
- Mary Abraham
- a Department of Medicine, Division of Rheumatology , Emory University School of Medicine , Atlanta , GA , USA
| | - Arezou Khosroshahi
- a Department of Medicine, Division of Rheumatology , Emory University School of Medicine , Atlanta , GA , USA
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Baptista B, Casian A, Gunawardena H, D'Cruz D, Rice CM. Neurological Manifestations of IgG4-Related Disease. Curr Treat Options Neurol 2017; 19:14. [PMID: 28374231 PMCID: PMC5378735 DOI: 10.1007/s11940-017-0450-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT IgG4-related disease (IgG4-RD) is a multisystem inflammatory disorder. Early recognition of IgG4-RD is important to avoid permanent organ dysfunction and disability. Neurological involvement by IgG4-RD is relatively uncommon, but well recognised-hypertrophic pachymeningitis and hypophysitis are the most frequent manifestations. Although the nervous system may be involved in isolation, this more frequently occurs in conjunction with involvement of other systems. Elevated circulating levels of IgG4 are suggestive of the condition, but these are not pathognomonic and exclusion of other inflammatory disorders including vasculitis is required. Wherever possible, a tissue diagnosis should be established. The characteristic histopathological changes include a lymphoplasmacytoid infiltrate, storiform fibrosis and obliterative phlebitis. IgG4-RD typically responds well to treatment with glucocorticoids, although relapse is relatively common and treatment with a steroid-sparing agent or rituximab may be required. Improved understanding of the pathogenesis of IgG4-RD is likely to lead to the development of more specific disease treatments in the future.
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Affiliation(s)
| | - Alina Casian
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Harsha Gunawardena
- Department of Rheumatology, Brunel Building, Southmead Hospital, Bristol, UK
- Musculoskeletal Research Unit, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - David D'Cruz
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
- Division of Immunology, Infection and Inflammatory Diseases, King's College London, New Hunt's House, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
| | - Claire M Rice
- School of Clinical Sciences, Level 1, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
- Department of Neurology, Brunel Building, Southmead Hospital, Bristol, UK.
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