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Mizushima I, Morikage N, Ito E, Kasashima F, Matsumoto Y, Sawa N, Yoshifuji H, Saeki T, Shintani-Domoto Y, Shimada S, Takayama T, Amiya E, Ozawa M, Takahashi M, Fujinaga Y, Katsumata T, Obitsu Y, Izawa A, Kanno H, Oyama-Manabe N, Ishizaka N, Nagasawa T, Takahashi H, Ohki T, Kawano M, Kasashima S. Validation of the Diagnostic Criteria for IgG4-Related Periaortitis/Periarteritis and Retroperitoneal Fibrosis (IgG4PA/RPF) 2018, and Proposal of a Revised 2023 Version for IgG4-Related Cardiovascular/Retroperitoneal Disease. Circ J 2024; 88:1679-1688. [PMID: 38494710 DOI: 10.1253/circj.cj-24-0026] [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] [Indexed: 03/19/2024]
Abstract
BACKGROUND In 2018, diagnostic criteria were introduced for IgG4-related periaortitis/periarteritis and retroperitoneal fibrosis (PA/RPF). This study assessed the existing criteria and formulated an improved version. METHODS AND RESULTS Between August 2022 and January 2023, we retrospectively analyzed 110 Japanese patients diagnosed with IgG4-related disease (IgG4-RD) involving cardiovascular and/or retroperitoneal manifestations, along with 73 non-IgG4-RD patients ("mimickers") identified by experts. Patients were stratified into derivation (n=88) and validation (n=95) groups. Classification as IgG4-RD or non-IgG4-RD was based on the 2018 diagnostic criteria and various revised versions. Sensitivity and specificity were calculated using experts' diagnosis as the gold standard for the diagnosis of true IgG4-RD and mimickers. In the derivation group, the 2018 criteria showed 58.5% sensitivity and 100% specificity. The revised version, incorporating "radiologic findings of pericarditis", "eosinophilic infiltration or lymphoid follicles", and "probable diagnosis of extra-PA/-RPF lesions", improved sensitivity to 69.8% while maintaining 100% specificity. In the validation group, the original and revised criteria had sensitivities of 68.4% and 77.2%, respectively, and specificities of 97.4% and 94.7%, respectively. CONCLUSIONS Proposed 2023 revised IgG4-related cardiovascular/retroperitoneal disease criteria show significantly enhanced sensitivity while preserving high specificity, achieved through the inclusion of new items in radiologic, pathological, and extra-cardiovascular/retroperitoneal organ categories.
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Affiliation(s)
- Ichiro Mizushima
- Department of Nephrology and Rheumatology, Kanazawa University Hospital
| | - Noriyasu Morikage
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | | | | | - Naoki Sawa
- Department of Nephrology and Rheumatology, Toranomon Hospital
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | - Takako Saeki
- Department of Internal Medicine, Nagaoka Red Cross Hospital
| | | | - Shogo Shimada
- Department of Cardiac Surgery, The University of Tokyo
| | - Toshio Takayama
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Makiko Ozawa
- Department of Internal Medicine, Matsumoto Dental University Hospital
| | | | | | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University
| | - Yukio Obitsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | | | - Hiroyuki Kanno
- Department of Pathology, Shinshu University School of Medicine
| | | | | | - Tasuku Nagasawa
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital
| | - Hiroki Takahashi
- Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Mitsuhiro Kawano
- Department of Nephrology and Rheumatology, Kanazawa University Hospital
| | - Satomi Kasashima
- Department of Clinical Laboratory Science, Graduate School of Health Science, Kanazawa University
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Manoharan B, Gaspar BL. Cryo-transbronchial lung biopsy in the diagnosis of IgG4-related lung disease. Med J Armed Forces India 2023; 79:S288-S291. [PMID: 38144610 PMCID: PMC10746792 DOI: 10.1016/j.mjafi.2021.10.014] [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: 05/18/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
IgG4-related lung disease is a diagnostic challenge as the presenting patterns can mimic other commonly seen pulmonary diseases like infections, interstitial pneumonia, malignancy, etc. The diagnosis of IgG4-related disease requires a correlation of clinical, radiological, biochemical, and histopathological features. Especially, an adequate tissue sample is necessary to diagnose this disease confidently. Conventionally surgical lung biopsy was needed for histopathology. But with the availability of the new less invasive technique-transbronchial cryo lung biopsy, adequate tissue can be obtained to clinch the diagnosis via bronchoscopy, thereby avoiding surgery. We report a case of IgG4-related interstitial lung disease diagnosed with the help of this technique in a tertiary care center in South India. Clinicoradiological features were inconclusive. Transbronchial cryo-lung biopsy helped to achieve the diagnosis.
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3
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Wang G, Tu P, Su J, Wu W, Zhang C, Wang W, Li W. An 8-year follow-up of IgG4-related skin disease presented with generalized ALHE-like eruptions: successful treatment of glucocorticoid and cyclophosphamide. J DERMATOL TREAT 2023; 34:2279899. [PMID: 38010938 DOI: 10.1080/09546634.2023.2279899] [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: 10/15/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
Immunoglobulin gamma (IgG) type 4-related disease (IgG4-RD) is a chronic immunologic systemic disorder that could affect multiple organs, which may cause irreversible organ damage or even death. Skin involvement is rare and associated especially with systemic disease. The dermatologist must be equipped to recognize IgG4-RD to prevent delayed identification and treatment. This case reports a very rare case of IgG4-related skin disease (IgG4-RSD) presenting with a generalized angiolymphoid hyperplasia with eosinophilia (ALHE)-like lesions in a middle-aged male patient with no other organ involvement. He was treated with oral glucocorticoid and cyclophosphamide, which resulted in complete remission. No relapse and disease progression were seen with a follow-up for 8 years.
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Affiliation(s)
- Guanyu Wang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Ping Tu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - Jing Su
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Wenting Wu
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Chunlei Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Wenhui Wang
- Department of Dermatology, Peking University Third Hospital, Beijing, China
| | - Weiwei Li
- Department of Dermatology, Peking University Third Hospital, Beijing, China
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4
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Yu Y, Wang QQ, Jian L, Yang DC. Infrequent organ involvement in immunoglobulin G4-related prostate disease: A case report. World J Clin Cases 2023; 11:7485-7491. [PMID: 37969446 PMCID: PMC10643058 DOI: 10.12998/wjcc.v11.i30.7485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/26/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Immunoglobulin G4-related prostate disease (IgG4-RPD) characterized by a high count of IgG4-positive plasma cells has distinctive serological and radiological findings. Here we report a case of a patient who was successfully treated for IgG4-RPD, which manifested as frequent micturition, dysuric, and systemic lymphadenopathy. CASE SUMMARY The patient was a 33-year-old man who was referred to our hospital because of urinary tract symptoms that had persisted for 4 years. A physical examination revealed systemic lymphadenopathy and blood tests showed hyperglobulinemia with an IgG level of 18.90 g/L and an IgG4 level of 18.40 g/L. Computed tomography (CT) revealed bilateral lacrimal gland, right parotid gland and prostatic enlargement. Based on these findings, IgG4-RD was suspected, and further pathological examination and follow-up results showed expected results. Finally, the patient was diagnosed with IgG4-RPD based on clinical symptoms, pathological examination, therapeutic effects, and follow-up results. He received 50 mg oral prednisolone (the dose was gradually reduced and a low dose was used for long-term maintenance) in combination with cyclophosphamide 1.0 g via an intravenous drip for 6 mo. One year after the treatment was initiated, he was free of urinary or other complaints and his serum IgG4 level normalized. CONCLUSION In IgG4-RPD with severe urinary tract symptoms, radiological findings should be carefully examined. IgG4-RPD prognosis is good because the disease responds well to glucocorticoids. Furthermore, it is urgent for clinicians and pathologists to improve their understanding of IgG4-RPD.
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Affiliation(s)
- Yi Yu
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Qian-Qian Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Li Jian
- Department of Critical Care Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Deng-Can Yang
- Anesthesiology Department, The Central Hospital of Shaoyang, Shaoyang 422000, Hunan Province, China
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5
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Kapila AT, Ray S, Lal V. Tolosa-Hunt Syndrome and IgG4 Diseases in Neuro-Ophthalmology. Ann Indian Acad Neurol 2022; 25:S83-S90. [PMID: 36589035 PMCID: PMC9795703 DOI: 10.4103/aian.aian_457_22] [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: 05/21/2022] [Revised: 05/22/2025] [Accepted: 05/23/2022] [Indexed: 01/04/2023] Open
Abstract
Tolosa-Hunt syndrome (THS) remains a challenging diagnosis for many neurologists. Often believed to be a rare presentation, the classical presentation is known to involve cranial nerves and tissues surrounding the cavernous sinus. Traditionally, a diagnosis of THS is considered when all secondary conditions have been ruled out. Yet, newer findings have elaborated a complex pathogenetic process with some overlap from the IgG4 spectrum of disorders, with which it shares many phenotypic similarities. In this narrative review, we present an updated picture of the condition focusing on the latest developments in the pathogenesis, diagnosis, and clinical management of these two conditions and use illustrative examples to highlight the salient features of this rare presentation.
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Affiliation(s)
| | | | - Vivek Lal
- Department of Neurology, PGIMER, Chandigarh, India
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Zhang P, Wang M, Chen Y, Li J, Liu Z, Lu H, Fei Y, Feng R, Zhao Y, Zeng X, Zhang W. Expanded CD4+CXCR5-PD-1+ peripheral T helper like cells and clinical significance in IgG4-related disease. Clin Immunol 2022; 237:108975. [PMID: 35276322 DOI: 10.1016/j.clim.2022.108975] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/03/2021] [Accepted: 03/05/2022] [Indexed: 11/03/2022]
Abstract
To identify the phenotypic features and clinical significance of peripheral T helper (Tph) like cells in IgG4-RD, 54 untreated IgG4-RD patients and 57 healthy controls (HCs) were enrolled. Flow cytometry analysis, ELISA and correlation analysis were performed. Results indicated that percentages of CD4 + CXCR5-PD-1+ Tph like cells in the peripheral blood of IgG4-RD patients were significantly higher than those of HCs (2.27% ± 1.99% vs 1.12% ± 0.98%, P < 0.001). Expression of CD38, CD25, and TIGIT was higher, whereas that of CCR7, CD127 was lower in the Tph like cells from the IgG4-RD patients than in those from the HCs. The IgG4-RD patients with affected internal organs had higher circulating Tph like cell levels than those without (2.69% ±1.99% vs 1.23% ± 0.93%, respectively, P = 0.003). In addition, Tph like cells correlated with serum IgG and IgG4 and peripheral plasmablast levels which could be a promising biomarker for disease activity monitoring.
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Affiliation(s)
- Panpan Zhang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China; Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, China
| | - Mu Wang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, China
| | - Yu Chen
- Department of Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jieqiong Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Zheng Liu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Hui Lu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Yunyun Fei
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Ruie Feng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH); Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
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7
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Isolated IgG4-related cutaneous pseudo-lymphoma with crystal-storing histiocytosis. Pathology 2021; 54:640-642. [DOI: 10.1016/j.pathol.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
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8
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Mizushima I, Yamano T, Kawahara H, Hibino S, Nishioka R, Zoshima T, Hara S, Ito K, Fujii H, Nomura H, Kawano M. Positive disease-specific autoantibodies have limited clinical significance in diagnosing IgG4-related disease in daily clinical practice. Rheumatology (Oxford) 2021; 60:3317-3325. [PMID: 33313857 DOI: 10.1093/rheumatology/keaa783] [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: 06/21/2020] [Revised: 10/21/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The 2019 ACR/EULAR classification criteria for IgG4-related disease (IgG4-RD) have exclusion criteria including positive disease-specific autoantibodies, and these have been documented to have a high specificity. This study aimed to further validate these criteria as well as identify characteristics of patients showing false-negative results. METHODS We retrospectively analysed 162 IgG4-RD patients and 130 mimickers. The sensitivity, specificity and fulfilment rates for each criterion were calculated, and intergroup comparisons were performed to characterize the false-negative cases. RESULTS Both the IgG4-RD patients and mimickers were aged ≥65 years with male predominance. The final diagnoses of mimickers were mainly malignancy, vasculitis, sarcoidosis and aneurysm. The classification criteria had a sensitivity of 72.8% and specificity of 100%. Of the 44 false-negative cases, one did not fulfil the entry criteria, 20 fulfilled one exclusion criterion and 27 did not achieve sufficient inclusion criteria scores. The false-negative cases had fewer affected organs, lower serum IgG4 levels, and were less likely to have received biopsies than the true-positive cases. Notably, positive disease-specific autoantibodies were the most common exclusion criterion fulfilled in 18 patients, only two of whom were diagnosed with a specific autoimmune disease complicated by IgG4-RD. In addition, compared with the true-positive cases, the 18 had comparable serum IgG4 levels, number of affected organs, and histopathology and immunostaining scores despite higher serum IgG and CRP levels. CONCLUSIONS The ACR/EULAR classification criteria for IgG4-RD have an excellent diagnostic specificity in daily clinical practice. Positive disease-specific autoantibodies may have limited clinical significance for the diagnosis of IgG4-RD.
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Affiliation(s)
- Ichiro Mizushima
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takahiro Yamano
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroyuki Kawahara
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Shinya Hibino
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Ryo Nishioka
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takeshi Zoshima
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Satoshi Hara
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Kiyoaki Ito
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroshi Fujii
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hideki Nomura
- Department of General Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
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9
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Vasudevan AK, Kumar GA, Rajesh S, Ahamed MZ. IgG4-Related Coronary Aneurysm in a Child. Indian J Pediatr 2021; 88:593. [PMID: 33864603 DOI: 10.1007/s12098-021-03743-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/16/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Anu K Vasudevan
- Department of Pediatrics, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, 695029, India.
| | - G Asok Kumar
- Department of Pediatrics, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, 695029, India
| | - S Rajesh
- Department of Rheumatology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - M Zulfikar Ahamed
- Department of Pediatric Cardiology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
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Abstract
IgG4-related disease is a rheumatological disorder, affecting multiple organ systems, and displaying dense lymphoplasmacytic inflammatory infiltrate and storiform fibrosis on histology. The pulmonary manifestations of IgG4-related disease are varied. Most commonly, bronchovascular consolidation and perilymphatic parenchymal thickening occur. IgG4-related disease can present as a solitary parenchymal mass and is often mistaken for a primary pulmonary or haematological malignancy. This report presents a case of IgG4-related disease in a patient with 6 months reported haemoptysis symptomatology and CT findings of perihilar lymphadenopathy, multiple pulmonary parenchymal nodules and a single parenchymal mass. Clinician cognisance of the histopathological presentation of IgG4-disease is important. It should be considered as a differential in patients for which investigations have ruled out malignancy, as it is responsive to glucocorticoids in the majority of cases.
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Affiliation(s)
- Natalie Louise Simon
- Respiratory Medicine Department, Bedford Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, Bedfordshire, UK
| | - Mostafa Negmeldin
- Respiratory Medicine Department, Bedford Hospital, Bedfordshire Hospitals NHS Foundation Trust, Bedford, Bedfordshire, UK
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Umehara H, Okazaki K, Kawa S, Takahashi H, Goto H, Matsui S, Ishizaka N, Akamizu T, Sato Y, Kawano M. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol 2021; 31:529-533. [PMID: 33274670 DOI: 10.1080/14397595.2020.1859710] [Citation(s) in RCA: 230] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
IgG4-related disease (IgG4-RD) is a fascinating clinical entity first reported in this century in Japan, and includes a wide variety of diseases, such as formerly named Mikulicz's disease (MD), autoimmune pancreatitis (AIP), interstitial nephritis, prostatitis and retroperitoneal fibrosis. The Japanese IgG4 team organized by the Ministry of Health, Labor and Welfare (MHLW) of Japan has published the first criteria, comprehensive diagnostic (CD) criteria for IgG-RD 2011. Thereafter, IgG4-RD has been accepted widely and many cases have been reported from all over the world. Several problems have arisen in clinical practice, however, including the difficulty obtaining biopsy samples, and the sensitivity and specificity in cut off level of serum IgG4 and impaired immunostaining of IgG4. Given these situations, the Japanese IgG4 team has updated the 2011 comprehensive diagnostic criteria for IgG4-RD and propose the 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD, which consists of 3 domains; 1) Clinical and radiological features, 2) Serological diagnosis and 3) Pathological diagnosis. In addition, the new pathological diagnosis is composed by three sub-items including storiform fibrosis and obliterative phlebitis.
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Affiliation(s)
- Hisanori Umehara
- Center for RA and Autoimmune Diseases, Nagahama City Hospital, Shiga, Japan
| | - Kazuichi Okazaki
- Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Shigeyuki Kawa
- Faculty of Dentistry, Matsumoto Dental University, Nagano, Japan
| | - Hiroki Takahashi
- Department of Rheumatology and Clinical Immunolog, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Shoko Matsui
- Health Administration Center,University of Toyama, Toyama, Japan
| | | | - Takashi Akamizu
- Department of Rheumatology and Clinical Immunology,Wakayama Medical University, Wakayama, Japan
| | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
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12
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Wang S, Xu X, Bai Z, Yi F, Wang R, Guo X, Qi X. IgG4-related disease with multiple organs involvement was effectively controlled by glucocorticoids: a case report. AME Case Rep 2020; 4:22. [PMID: 33178994 PMCID: PMC7608720 DOI: 10.21037/acr-20-43] [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: 02/22/2020] [Accepted: 06/28/2020] [Indexed: 02/05/2023]
Abstract
Immunoglobulin G4 (IgG4) related disease is a rare autoimmune disease involving multiple organs and tissues. A diagnosis of IgG4-related disease (IgG4-RD) is mainly based on serum IgG4 concentration, imaging, pathology, and effective glucocorticoids therapy. In this paper, we report a 53-year-old male with typical signs and symptoms of IgG4-RD successfully treated with glucocorticoids. This patient had experienced bilateral mumps for more than 8 months and intermittent abdominal pain spreading to his lower back for 2 months before his admission. During his hospitalization, based on the characteristic appearance of magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and computed tomography with positron emission tomography, a diagnosis of autoimmune pancreatitis (AIP), cholangitis with biliary obstruction, lachrymal adenitis, and submandibular adenitis was made. A high serum IgG4 concentration further supported a diagnosis of IgG4-RD. Then, the treatment was promptly initiated with corticosteroids. MRI, MRCP, and IgG4 concentration were re-examined during his follow up, suggesting that glucocorticoid treatment resulted in a resolution of his disease. The dosage of glucocorticoid had been gradually decreased. Now, he is stable with oral low-dose glucocorticoids. Certainly, long-term follow up of this patient with such a rare disease is very essential to observe the possibility of disease recurrence and glucocorticoids related complications.
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Affiliation(s)
- Shuo Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Xiangbo Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhaohui Bai
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Fangfang Yi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Ran Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, China
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13
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Koneczny I. Update on IgG4-mediated autoimmune diseases: New insights and new family members. Autoimmun Rev 2020; 19:102646. [PMID: 32801046 DOI: 10.1016/j.autrev.2020.102646] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/08/2020] [Indexed: 12/23/2022]
Abstract
Antibodies of IgG4 subclass are exceptional players of the immune system, as they are considered to be immunologically inert and functionally monovalent, and as such may be part of classical tolerance mechanisms. IgG4 antibodies are found in a range of different diseases, including IgG4-related diseases, allergy, cancer, rheumatoid arthritis, helminth infection and IgG4 autoimmune diseases, where they may be pathogenic or protective. IgG4 autoimmune diseases are an emerging new group of diseases that are characterized by pathogenic, antigen-specific autoantibodies of IgG4 subclass, such as MuSK myasthenia gravis, pemphigus vulgaris and thrombotic thrombocytopenic purpura. The list of IgG4 autoantigens is rapidly growing and to date contains 29 candidate antigens. Interestingly, IgG4 autoimmune diseases are restricted to four distinct organs: 1) the central and peripheral nervous system, 2) the kidney, 3) the skin and mucous membranes and 4) the vascular system and soluble antigens in the blood circulation. The pathogenicity of IgG4 can be validated using our classification system, and is usually excerted by functional blocking of protein-protein interaction.
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Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
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14
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Napodano C, Marino M, Stefanile A, Pocino K, Scatena R, Gulli F, Rapaccini GL, Delli Noci S, Capozio G, Rigante D, Basile U. Immunological Role of IgG Subclasses. Immunol Invest 2020; 50:427-444. [PMID: 32522062 DOI: 10.1080/08820139.2020.1775643] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The loss of tolerance to self-antigens is the unequivocal "red line" of autoimmunity: both development of autoreactive T and B cells and production of polyclonal autoantibodies represent seminal keys to the pathogenesis of protean autoimmune diseases. Most of these autoantibodies are immunoglobulins G (IgG), functionally distinguished in four subclasses named IgG1, IgG2, IgG3, and IgG4, due to structural differences in the hinge and heavy chain constant regions. Different studies analyzed serum levels of IgG subclasses in the course of different disorders, showing that they might have a pathogenic role by regulating interactions among immunoglobulins, Fc-gamma receptors, and complement. To date, the mechanisms promoting different IgG subclasses distribution during the natural history of most autoimmune diseases remain somewhat unclear. Evidence from the medical literature shows that the serum IgG profile is peculiar for many autoimmune diseases, suggesting that different subclasses could be specific for the underlying driving autoantigens. A better knowledge of IgG subsets may probably help to elucidate their pathological task, but also to define their relevance for diagnostic purposes, patients' personalized management, and prognosis assessment.
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Affiliation(s)
- Cecilia Napodano
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - MariaPaola Marino
- Institute of General Pathology, Dipartimento Di Medicina E Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Annunziata Stefanile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Krizia Pocino
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Roberto Scatena
- Dipartimento Di Medicina Di Laboratorio, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Francesca Gulli
- Dipartimento Di Medicina Di Laboratorio, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Gian Lodovico Rapaccini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Delli Noci
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giovanna Capozio
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Donato Rigante
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Life Sciences and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Umberto Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Vasilyev VI, Palshina SG, Pavlovskaya AI, Kokosadze NV, Chaltsev BD, Shornikova LA. [Idiopathic multicentric Castleman's disease]. TERAPEVT ARKH 2020; 92:78-84. [PMID: 32598779 DOI: 10.26442/00403660.2020.05.000440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 11/22/2022]
Abstract
Idiopathic multicentric Castlemans disease is a rare lymphoproliferative disorder that has many similar laboratory, radiological, clinical and pathological manifestations with various conditions, including IgG4-related disease. Increased activity of cytokines, especially interleukin-6, leads to systemic inflammatory symptoms with the development of lymphadenopathy and rarely extranodal lesions. Histological changes in the lymph nodesin hyaline vascular and plasma cell variants of Castlemans disease are hardly distinguishable from the pattern of reactive, tumor and IgG4-related lymphadenopathy. Idiopathic multicentric Castlemans disease can be diagnosed only when infection with human herpesvirus-8 type and human immunodeficiency virus is excluded. In the article, the authors describe two cases of idiopathic multicentric Castlemans disease, including the first world literature description of extranodal damage of the hip muscle in this disorder. In addition, the authors gave a review of the literature on the main clinical, laboratory and morphological manifestations, which allow confirming the diagnosis of Castlemans disease.
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Affiliation(s)
| | | | | | - N V Kokosadze
- Blokhin National Medical Research Center of Oncology
| | | | - L A Shornikova
- Yevdokimov Moscow State University of Medicine and Dentistry
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16
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Kawashima H, Utsugi A, Shibamiya A, Iida K, Mimura N, Ohashi H, Hase R, Kawakami M, Yanagisawa T, Hiraguri M. Consideration concerning similarities and differences between ANCA-associated vasculitis and IgG-4-related diseases: case series and review of literature. Immunol Res 2019; 67:99-107. [PMID: 30734199 DOI: 10.1007/s12026-019-9070-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and immunoglobulin G4-related diseases (IgG4-RD) are regarded as entirely different disease types with different etiological mechanisms. However, we experienced two cases that had clinical features of both AAV and IgG4-RD. The first case is an 81-year-old woman who showed periaortitis and retroperitoneal fibrosis and periarteritis with elevation of myeloperoxidase-anti-neutrophil cytoplasmic antibody and IgG4 levels. The second case is a 63-year-old woman who had dura mater, ear, nose, lung, and kidney involvement with serum negative for ANCA and elevated IgG4. Renal biopsy revealed tubulointerstitial nephritis involving IgG4+ plasma cells (IgG4+/IgG+ cell ratio of ≥ 40%). On the other hand, lung biopsy showed features of granulomatosis with polyangiitis (GPA). These two cases suggested that AAV and IgG4-RD might overlap. To investigate the similarities and differences between AAV and IgG4-RD, we retrospectively analyzed 13 cases of typical GPA, a subtype of AAV, and 13 cases of typical IgG4-RD at our hospital for comparison of clinical features and found some differences that can be useful in the differential diagnosis between the two diseases. Although AAV and IgG4-RD are distinguishable based on characteristic findings in many cases, the diagnosis can be unclear in rare cases, in which clinicians should consider possible coexistence of AAV and IgG4-RD when performing further workup. Here, we discuss the similarities and differences between AAV and IgG4-RD on the basis of our results and past literature.
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Affiliation(s)
- Hirotoshi Kawashima
- Department of Rheumatology and Allergy, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan.
| | - Atsunari Utsugi
- Department of Rheumatology and Allergy, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Asuka Shibamiya
- Department of Rheumatology and Allergy, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Kazuma Iida
- Department of Rheumatology and Allergy, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Norihiro Mimura
- Department of Rheumatology and Allergy, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Hirohumi Ohashi
- Department of Nephrology, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Ryota Hase
- Department of Infectious Diseases, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Makio Kawakami
- Department of Pathology, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Takao Yanagisawa
- Department of Rheumatology and Allergy, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
| | - Masaki Hiraguri
- Department of Rheumatology and Allergy, Japanese Red Cross Society Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba, 286-8523, Japan
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17
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Ashoka Menon V, Tong E, Slape DRML, Phan TA, Chan RCF. Cutaneous manifestation of IgG4‐related disease mimicking dermatitis artefacta. Australas J Dermatol 2019; 61:e97-e99. [DOI: 10.1111/ajd.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Vivek Ashoka Menon
- Anatomical Pathology Department NSW Health Pathology Concord Repatriation General Hospital Concord New South Wales Australia
| | - Elissa Tong
- Dermatology Department NSW Health Concord Repatriation General Hospital Concord New South Wales Australia
| | | | - Tai Anh Phan
- Dermatology Department NSW Health Concord Repatriation General Hospital Concord New South Wales Australia
| | - Renee CF Chan
- Anatomical Pathology Department NSW Health Pathology Concord Repatriation General Hospital Concord New South Wales Australia
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18
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Nakamura T, Satoh-Nakamura T, Nakajima A, Kawanami T, Sakai T, Fujita Y, Iwao H, Miki M, Masaki Y, Okazaki T, Ishigaki Y, Kawano M, Yamada K, Matsui S, Saeki T, Kamisawa T, Yamamoto M, Hamano H, Origuchi T, Hirata S, Tanaka Y, Tsuboi H, Sumida T, Okazaki K, Tanaka M, Chiba T, Mimori T, Umehara H. Impaired expression of innate immunity-related genes in IgG4-related disease: A possible mechanism in the pathogenesis of IgG4-RD. Mod Rheumatol 2019; 30:551-557. [PMID: 31116057 DOI: 10.1080/14397595.2019.1621475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: IgG4-related disease (IgG4-RD) is characterized by elevated serum IgG4 and tissue infiltration by IgG4-positive plasma cells. The pathogenesis of this disease is not clear. Transcriptome analysis was performed to identify genes over- and under-expressed in patients with IgG4-RD.Method: DNA microarray analysis was performed using RNA from peripheral blood mononuclear cells of two patients with IgG4-RD and four healthy individuals. Genes showing a greater than threefold change in expression in IgG4-RD patients following steroid therapy were identified. Four genes related to innate immunity such as transcobalamin I (TCN1), secretory leukocyte peptidase inhibitor (SLPI), bactericidal/permeability-increasing protein (BPI) and lactotransferrin (LTF) were assessed by real-time PCR in 15 IgG4-RD patients and 13 healthy individuals.Result: DNA microarray analysis identified 30 genes showing a greater than threefold change in expression in IgG4-RD patients following steroid therapy. Real-time RT-PCR showed that the levels of mRNAs encoding TCNI and SLPI, except for BPI and LTF, were significantly lower in patients with IgG4-RD than in healthy people. The levels of all four mRNAs in patients with IgG4-RD were significantly increased after steroid treatment.Conclusion: These results indicate that reduction in expression of innate immunity-related genes may participate in the pathogenesis of IgG4-RD that steroid treatment may rectify impaired innate immunity as well as acquired immunity.
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Affiliation(s)
- Takuji Nakamura
- Department of Rheumatology and Immunology, Nagahama City Hospital, Shiga, Japan.,Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Tomomi Satoh-Nakamura
- Department of Rheumatology and Immunology, Nagahama City Hospital, Shiga, Japan.,Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Akio Nakajima
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan.,Division of Rheumatology, Kudo General Hospital, Ishikawa, Japan
| | - Takafumi Kawanami
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Tomoyuki Sakai
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Yoshimasa Fujita
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Haruka Iwao
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Miyuki Miki
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Yasufumi Masaki
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Toshiro Okazaki
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Yasuhito Ishigaki
- Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Mitsuhiro Kawano
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Kazunori Yamada
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Shoko Matsui
- Health Administration Center, University of Toyama, Toyama, Japan
| | - Takako Saeki
- Department of Internal Medicine, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Motohisa Yamamoto
- Department of Rheumatology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Hideaki Hamano
- Medical Informatics Division and Department of Internal Medicine, Gastroenterology, Shinshu University School Hospital, Nagano, Japan
| | - Tomoki Origuchi
- First Department of Internal Medicine, Department of Immunology and Rheumatology, Nagasaki Graduate School of Health Sciences, Nagasaki, Japan
| | - Shintaro Hirata
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.,Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuichi Okazaki
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Masao Tanaka
- Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan.,Department of Clinical Immunology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Tsutomu Chiba
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuneyo Mimori
- Department of Clinical Immunology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Hisanori Umehara
- Department of Rheumatology and Immunology, Nagahama City Hospital, Shiga, Japan.,Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
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19
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Yang WT, Tsai KY. A rare case of oral tumor presenting as first sign of immunoglobulin G4-related disease. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e187-e190. [PMID: 31076326 DOI: 10.1016/j.oooo.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 11/28/2022]
Abstract
Immunoglobulin G4 (IgG4)-related disease is an idiopathic autoimmune disease characterized by elevated serum and tissue IgG4 levels, organ enlargement, and a clinical response to immunosuppressants. We present such a case in a 39-year-old female, whose lesion was located in the right buccal space involving the minor salivary gland. After the tumorlike growth was removed, diagnosis was confirmed with histopathologic slides showing lymphoid cell infiltration, dense fibrotic stroma, and IgG4-positive plasma cells. The patient underwent steroid therapy, and there has been no recurrence since. Rarely do we see IgG4-related sclerosing disease involve the buccal minor salivary gland in its early stages. Thus, it is important to include IgG4-related disease in the differential diagnosis when considering autoimmune diseases with oral manifestations.
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Affiliation(s)
- Wan-Ting Yang
- Oral and Maxillofacial Department, Yunlin Christian Hospital, Yunlin County, Taiwan.
| | - Kuo-Yang Tsai
- Oral and Maxillofacial Department, Changhua Christian Hospital, Changhua City, Taiwan
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20
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Mizushima I, Kasashima S, Fujinaga Y, Kawano M, Ishizaka N. IgG4-related periaortitis/periarteritis: An under-recognized condition that is potentially life-threatening. Mod Rheumatol 2019; 29:240-250. [DOI: 10.1080/14397595.2018.1546367] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ichiro Mizushima
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
- Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Satomi Kasashima
- Department of Clinical Laboratory Science, Kanazawa University, Kanazawa, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuhiro Kawano
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
- Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Japan
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21
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Sangha Brar JS, Gupta S, Haja Mohideen SM, Liauw L, Lath N. The pancreatic and extrapancreatic manifestations of IgG4-related disease. ACTA ACUST UNITED AC 2018. [PMID: 29467115 DOI: 10.5152/dir.2018.14319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The association between immunoglobulin IgG4 and autoimmune pancreatitis was first shown in 2001. Since then many previously established fibrosclerotic diseases demonstrating synchronous or metachronous multiorgan involvement have been included within the ambit of IgG4-related disease. Diagnostic criteria have been proposed involving 1) serum IgG4 level elevated beyond 135 mg/dL, 2) IgG4+ to IgG+ plasma cell ratio > 40% and >10 IgG4+ cells per high power field of biopsy sample and 3) a constellation of imaging features which involve a variety of organ systems. We present a pictorial essay demonstrating the spectrum of imaging findings for IgG4-related disease, including dacryosialadenitis, variety of renal lesions, tumefactive thickening of the extraocular muscles and orbital nerve, sclerosing cholangitis, and type I pancreatitis. Imaging plays an important role in diagnosis, screening for multiorgan involvement, and follow-up of the disease.
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Affiliation(s)
| | - Saurav Gupta
- Department of Diagnostic Radiology, Ng Teng Fong General Hospital, Jurong East, Singapore
| | | | - Lishya Liauw
- Diagnostic Radiology Service, Singapore General Hospital, Outram Road, Singapore
| | - Narayan Lath
- Diagnostic Radiology Service, Singapore General Hospital, Outram Road, Singapore
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22
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Abstract
IgG4-related disease is a heterogeneous immune-mediated fibroinflammatory condition that can affect every single organ. This disease is more prevalent in the elderly (the mean age of patients is above 60 years) and the prevalence rate is estimated to be over 4.6 per 100,000 population. Before making a diagnosis, the exclusion of malignancies, lymphoma, anti-neutrophil cytoplasmic antibody-associated vasculitis, multicentric Castleman disease, and other mimickers is crucial for appropriate treatment. Broad management guidelines have been published emphasizing the need for prompt treatment and the use of glucocorticoids as first-line drug therapy for induction of remission. However, the toxic effects of glucocorticoids are problematic because IgG4-related disease is more prevalent in patients above 60 years of age, a population with frequent comorbid conditions and polypharmacy. Immunosuppressants (cyclophosphamide, methotrexate, leflunomide, and tacrolimus) and targeted immunomodulators (rituximab, XmAb5871, and abatacept) are appealing to overcome potential toxic effects of glucocorticoids and as emerging glucocorticoid-sparing and/or maintenance treatments. In this review, we provide an overview of our understanding of the pathophysiology of the disease (T follicular helper cells, CD4+ cytotoxic T cells, plasmablasts, and alternatively activated M2 macrophages) and clinical characteristics, and highlight the potential targets for treatment intervention.
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Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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23
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Umehara H, Kawano M. Response to: 'Serum complement factor C5a in IgG4-related disease' by Fukui et al. Ann Rheum Dis 2018; 78:e66. [PMID: 29875098 DOI: 10.1136/annrheumdis-2018-213729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Hisanori Umehara
- Division of RA and Autoimmune Diseases, Nagahama City Hospital, Shiga, Japan
| | - Mitsuhiro Kawano
- Division of Rheumatology, Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
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24
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Fukui S, Fujita Y, Origuchi T, Maeda T, Kawakami A. Serum complement factor C5a in IgG4-related disease. Ann Rheum Dis 2018; 78:e65. [DOI: 10.1136/annrheumdis-2018-213705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/06/2018] [Indexed: 12/24/2022]
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25
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The many faces of IgG4-related disease: report of a case with inaugural recurrent aortic aneurism ruptures and literature review. Rheumatol Int 2018; 38:1565-1570. [DOI: 10.1007/s00296-018-4046-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/08/2018] [Indexed: 12/24/2022]
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26
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Abstract
IgG4 autoimmune diseases are characterized by the presence of antigen-specific autoantibodies of the IgG4 subclass and contain well-characterized diseases such as muscle-specific kinase myasthenia gravis, pemphigus, and thrombotic thrombocytopenic purpura. In recent years, several new diseases were identified, and by now 14 antigens targeted by IgG4 autoantibodies have been described. The IgG4 subclass is considered immunologically inert and functionally monovalent due to structural differences compared to other IgG subclasses. IgG4 usually arises after chronic exposure to antigen and competes with other antibody species, thus "blocking" their pathogenic effector mechanisms. Accordingly, in the context of IgG4 autoimmunity, the pathogenicity of IgG4 is associated with blocking of enzymatic activity or protein-protein interactions of the target antigen. Pathogenicity of IgG4 autoantibodies has not yet been systematically analyzed in IgG4 autoimmune diseases. Here, we establish a modified classification system based on Witebsky's postulates to determine IgG4 pathogenicity in IgG4 autoimmune diseases, review characteristics and pathogenic mechanisms of IgG4 in these disorders, and also investigate the contribution of other antibody entities to pathophysiology by additional mechanisms. As a result, three classes of IgG4 autoimmune diseases emerge: class I where IgG4 pathogenicity is validated by the use of subclass-specific autoantibodies in animal models and/or in vitro models of pathogenicity; class II where IgG4 pathogenicity is highly suspected but lack validation by the use of subclass specific antibodies in in vitro models of pathogenicity or animal models; and class III with insufficient data or a pathogenic mechanism associated with multivalent antigen binding. Five out of the 14 IgG4 antigens were validated as class I, five as class II, and four as class III. Antibodies of other IgG subclasses or immunoglobulin classes were present in several diseases and could contribute additional pathogenic mechanisms.
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Affiliation(s)
- Inga Koneczny
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
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27
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Akiyama M, Yasuoka H, Yoshimoto K, Takeuchi T. CC-chemokine ligand 18 is a useful biomarker associated with disease activity in IgG4-related disease. Ann Rheum Dis 2017; 77:1386-1387. [PMID: 29030359 PMCID: PMC6104677 DOI: 10.1136/annrheumdis-2017-212110] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/12/2017] [Accepted: 10/06/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Mitsuhiro Akiyama
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hidekata Yasuoka
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Keiko Yoshimoto
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tsutomu Takeuchi
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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28
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Greenbaum A, Yadak N, Perez S, Rajput A. Surgical management of isolated mesenteric autoimmune disease: addressing the spectrum of IgG 4-related disease and sclerosing mesenteritis. BMJ Case Rep 2017; 2017:bcr-2017-220400. [PMID: 28596203 DOI: 10.1136/bcr-2017-220400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IgG4-related disease (IgG4-RD) is a rare form of autoimmune sclerosing disease, characterised by elevated serum IgG4 and tissue IgG4 levels, specific histopathological findings, multiorgan involvement and adequate response to glucocorticoid treatment. The low incidence and the heterogeneous nature of the disease has made consensus on diagnostic criteria for IgG4-RD difficult. Whether sclerosing mesenteritis (SM) is considered a manifestation of IgG4-RD is strongly debated. We present the case of a patient with a history of rheumatoid arthritis who presented with a calcified abdominal mass. She was found to have an isolated, pedunculated mesenteric mass positive for IgG4 and concurrently elevated serum IgG4 levels. Clinical features did not classify her disease as either SM or IgG4-RD as currently described in consensus statements. Concurrent diagnoses of IgG4-RD, SM and other autoimmune disorders, as well as postoperative recommendations for resected isolated IgG4-positive masses, are discussed.
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Affiliation(s)
- Alissa Greenbaum
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Nour Yadak
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Steven Perez
- Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Ashwani Rajput
- Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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