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Kasashima S, Matsumoto Y, Kawashima A, Kurose N, Ozaki S, Yamamoto H, Kasashima F, Takemura H, Ikeda H. Clinicopathological features of immunoglobulin G4-related constrictive pericarditis. Cardiovasc Pathol 2024; 72:107665. [PMID: 38825060 DOI: 10.1016/j.carpath.2024.107665] [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: 03/13/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024] Open
Abstract
AIM Constrictive pericarditis (CP) is characterised by scarring fibrosis and a loss of pericardial elasticity, which causes heart failure. IgG4 (immunoglobulin G4)-related disease (IgG4-RD) is a systemic fibro-inflammatory disease characterised by the infiltration of IgG4-immunopositive plasmacytes and high serum IgG4 levels that frequently shape tumorous lesions. Although pericardial involvement of IgG4-RD is rare, with indications of CP, pericardial effusion and irregular masses, the clinical and pathological features remain unclear. In this study, we examined the relationship between CP and IgG4-RD. METHODS Among 35 thick-walled CP cases (histologically pericardial thickening ≥2 mm), eight cases were aetiology identified. Using the diagnostic criteria for IgG4-RD, 11 cases were classified as IgG4-CP, whereas the remainder were considered true idiopathic CP (16 cases) and the clinical pathological features were evaluated. RESULTS Compared with the other groups, the IgG4-CP group was more common in men and associated with low-grade fever and massive pericardial effusion with frequent recurrence. Deaths resulting from heart failure occurred in a few cases of the IgG4-CP group, but not in other groups. An increase in C-reactive protein and a high positivity rate of anti-nuclear antibodies frequently occurred in the IgG4-CP group. Histologically, the IgG4-CP group included lymphoid follicle, eosinophil infiltration and few calcifications. CONCLUSIONS Pericardial IgG4-RD occurs not only as nodular lesions, but also as thick-walled CP, and accounts for approximately 40% of thick-walled CP cases of unknown cause. The predominant clinical characteristic was refractory and recurrent pericardial effusion. Recognising IgG4-RD as a cause of CP is important to initiate appropriate therapy.
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Affiliation(s)
- Satomi Kasashima
- Department of Clinical Laboratory Science, Graduate School of Health Science, Kanazawa University, Kanazawa, Japan; Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan; Department of Clinical Laboratory, Kanazawa Medical Center, Kanazawa, Japan.
| | - Yasushi Matsumoto
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Atsuhiro Kawashima
- Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan; Department of Clinical Laboratory, Kanazawa Medical Center, Kanazawa, Japan
| | - Nozomu Kurose
- Department of Pathology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan; Department of Clinical Laboratory, Kanazawa Medical Center, Kanazawa, Japan
| | - Satoru Ozaki
- Department of Clinical Laboratory Science, Graduate School of Health Science, Kanazawa University, Kanazawa, Japan
| | - Hinako Yamamoto
- Department of Clinical Laboratory Science, Graduate School of Health Science, Kanazawa University, Kanazawa, Japan
| | - Fuminori Kasashima
- Department of Cardiovascular Surgery, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroko Ikeda
- Department of Pathology, Kanazawa University Hospital, Kanazawa, Japan
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Hua T, Du J, Guo X, Peng L, Zhou J, Nie Y, Man D, Li M, Pan L, Zhang W. Coronary periarteritis and pericarditis are rare but distinct manifestations of heart involvement in IgG4-related disease: a retrospective cohort study. Orphanet J Rare Dis 2024; 19:266. [PMID: 39010060 PMCID: PMC11247878 DOI: 10.1186/s13023-024-03266-y] [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: 11/26/2023] [Accepted: 06/21/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The heart can be involved in immunoglobulin (Ig)-G4-related disease (IgG4-RD). This study aimed to summarize the clinical features and efficacy of treatment for IgG4-RD patients with heart involvement. METHODS We conducted a retrospective study enrolling 42 IgG4-RD patients with heart involvement from the IgG4-RD cohorts of the Peking Union Medical College Hospital and Beijing An Zhen Hospital, from 2010 to 2022. Clinical, laboratory, radiological data were collected, and treatment responses to glucocorticoids and immunosuppressants were analyzed. RESULTS IgG4-related cardiac involvement is a rare part of the IgG4-RD spectrum. The incidences of coronary periarteritis and pericarditis were 1.2%(13/1075) and 3.1%(33/1075), respectively in our cohort. Valvular disease possibly related to IgG4-RD was detected in two patients. None of the patients with myocardial involvement were identified. The average age was 58.2 ± 12.8 years, with a male predominance (76.7%). Coronary artery CT revealed that mass-like and diffuse wall-thickening lesions were the most frequently observed type of coronary periarteritis. Pericarditis presented as pericardial effusion, localized thickening, calcification and mass. After treatment with glucocorticoid and immunosuppressants, all patients achieved a reduced IgG4-RD responder index score and achieved radiological remission. Two patients with coronary peri-arteritis experienced clinical relapses during the maintenance period. CONCLUSIONS Cardiac involvement in IgG4-RD is rare and easily overlooked since many patients are asymptomatic, and the diagnosis relies on imaging. Patients showed a satisfactory response to glucocorticoid based treatment.
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Affiliation(s)
- Tianrui Hua
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
- Department of Rheumatology, Peking Union Medical College Hospital National Clinical Research Center for Dermatologic and Immunologic Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Juan Du
- Beijing AnZhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Linyi Peng
- Department of Rheumatology, Peking Union Medical College Hospital National Clinical Research Center for Dermatologic and Immunologic Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiaxin Zhou
- Department of Rheumatology, Peking Union Medical College Hospital National Clinical Research Center for Dermatologic and Immunologic Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yuxue Nie
- Department of Rheumatology, Peking Union Medical College Hospital National Clinical Research Center for Dermatologic and Immunologic Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dafu Man
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital National Clinical Research Center for Dermatologic and Immunologic Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Lili Pan
- Beijing AnZhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Wen Zhang
- Department of Rheumatology, Peking Union Medical College Hospital National Clinical Research Center for Dermatologic and Immunologic Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
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Sugawara H, Takahashi T, Kimura Y, Matsui A, Matsumoto T, Nishisato K, Nishimura M. IgG4-Related Pericarditis Diagnosed by Accumulated Pericardial Effusion. Case Rep Cardiol 2023; 2023:9223342. [PMID: 38045861 PMCID: PMC10691889 DOI: 10.1155/2023/9223342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 12/05/2023] Open
Abstract
IgG4-related pericarditis has rarely been reported. Here, we report a case of IgG4-related disease that presented with pericardial effusion. A 67-year-old female who presented with palpitations and chest pain was admitted because of a large amount of pericardial effusion that required drainage. The patient underwent pericardial drainage, and the symptoms were gradually alleviated. IgG4 levels were elevated in the serum and pericardial effusions. A biopsy specimen of 18F-FDG accumulated in the submandibular gland showed lymphocyte infiltration with IgG4-positive cells. The patient was diagnosed with IgG4-related pericarditis. Glucocorticoids resolved serological and imaging abnormalities. Prompt treatment improves the disease status.
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Affiliation(s)
- Hirohito Sugawara
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1, Chigasakichuo, Tsuzuki-ku, Yokohama, Japan 2248503
| | - Tomokazu Takahashi
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Yukishige Kimura
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Azumi Matsui
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Tamaki Matsumoto
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Kimio Nishisato
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
| | - Mitsuhiro Nishimura
- Department of Cardiology, Tenshi Hospital, 1-1 North-12 East-3, Higashi-ku, Sapporo, Hokkaido, Japan 0658611
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Doumen M, Vankelecom B, Westhovens R, Michiels S. Pericarditis as a manifestation of IgG4-related disease. Rheumatol Int 2021; 42:1287-1295. [PMID: 34255183 DOI: 10.1007/s00296-021-04946-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
IgG4-related disease (IgG4-RD) is a systemic, immune-mediated fibro-inflammatory disease that can affect virtually every organ system. It is usually insidious in onset and often mimics malignant or other inflammatory disorders. Diagnosis frequently requires a combination of clinical, serological, radiographic, and histopathological features, including increased serum-IgG4 levels and tissue infiltration of IgG4-positive plasma cells with associated fibrosis. Unlike more frequently affected sites, including the hepatobiliary system, salivary glands and retroperitoneum, pericardial involvement of IgG4-RD has only rarely been described. We report the case of a 76-year-old woman presenting with refractory pericarditis and imminent cardiac tamponade, successfully treated with therapeutic pericardiectomy. A diagnosis of IgG4-RD was made based on elevated serum-IgG4 levels and the presence of typical pericardial histopathological findings, meeting all 3 of the 2011 comprehensive diagnostic criteria for IgG4-RD. Following pericardiectomy, the patient remained in remission without a need for glucocorticoids or additional immunosuppressive therapy. Adding to this case, we reviewed the literature for previously described cases of IgG4-RD presenting with pericarditis and described their characteristics and the available treatment options. Our case-based literature review provides a clear overview of the diagnostic process for IgG4-RD and the need to apply classification criteria with the necessary caution, particularly in the case of rare disease manifestations, including pericarditis.
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Affiliation(s)
- Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, ON IV Herestraat 49-bus 805, 3000, Leuven, Belgium. .,Rheumatology, University Hospitals Leuven, Leuven, Belgium.
| | | | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, ON IV Herestraat 49-bus 805, 3000, Leuven, Belgium.,Rheumatology, University Hospitals Leuven, Leuven, Belgium
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Yamamoto H, Ohta-Ogo K, Isogai J, Ishibashi-Ueda H, Nakamura Y. Epicardial Nodules as the Initial Manifestation of Immunoglobulin G4-Related Pericarditis. JACC Case Rep 2020; 2:1505-1509. [PMID: 34317006 PMCID: PMC8302172 DOI: 10.1016/j.jaccas.2020.05.092] [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: 11/27/2019] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 06/13/2023]
Abstract
Immunoglobulin G4 (IgG4)-related pericarditis, an immune-mediated fibro-inflammatory condition, is a rare yet life-threatening disease presenting with constrictive pericarditis. We describe a case of IgG4-related pericarditis presenting with epicardial nodules successfully treated with corticosteroids. This case highlights the clinical significance of assessing IgG4-related pericarditis in the diagnostic workup of pericardial masses. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | | | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
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Yuriditsky E, Dwivedi A, Narula N, Axel L, Horowitz JM, Vaynblat M. Constrictive Pericarditis Caused by IgG4-Related Disease Requiring Pericardiectomy After Partial Response to Corticosteroids. JACC Case Rep 2020; 2:1558-1563. [PMID: 34317017 PMCID: PMC8302180 DOI: 10.1016/j.jaccas.2020.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 01/13/2023]
Abstract
Immunoglobulin G4-related disease is a systemic fibroinflammatory disease; pericardial involvement has occasionally been reported in publications. A 79-year-old man with biopsy-proven immunoglobulin G4-related disease with pleural involvement was admitted in acute heart failure, with imaging and hemodynamic studies consistent with constrictive pericarditis. He was treated with corticosteroids for 2 months with partial response manifest by decreases in pericardial thickening and immunoglobulin G4 levels. However, persistent constriction required pericardiectomy, leading to significant symptomatic improvement. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, New York
- Address for correspondence: Dr. Eugene Yuriditsky, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, 530 First Avenue, Skirball 9R, New York, New York 10016.
| | - Aeshita Dwivedi
- Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Navneet Narula
- Department of Pathology and Laboratory Medicine, NYU Langone Medical Center, New York, New York
| | - Leon Axel
- Department of Radiology, NYU Langone Medical Center, New York, New York
| | - James M. Horowitz
- Division of Cardiology, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Mikhail Vaynblat
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York
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7
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Elevated Serum IgG4 Levels in a Young Patient with Polyserositis and Necator americanus Infection. Case Reports Immunol 2018; 2018:2974756. [PMID: 29666725 PMCID: PMC5831313 DOI: 10.1155/2018/2974756] [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: 08/31/2017] [Revised: 12/29/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022] Open
Abstract
IgG4-related disease is a fibroinflammatory systemic condition characterized by tumefactive lesions, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and elevated serum IgG4 concentrations. It has been described in virtually every organ system. Autoimmunity and infectious agents are potential immunologic triggers in IgG4-related disease. Herein, we describe a peculiar case of effusive-constrictive pericarditis in an 18-year-old boy with polyserositis and concomitant Necator americanus infection.
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8
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9
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Serosal involvement in IgG4-related disease: report of two cases and review of the literature. Rheumatol Int 2016; 36:1033-41. [PMID: 27207156 DOI: 10.1007/s00296-016-3501-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/16/2016] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) is a recently described entity characterized by lymphoplasmacytic infiltrates, usually mimicking tumors, affecting almost every organ or system. Nevertheless, serosal involvement has been rarely reported. In this article, we report two cases of IgG4-RD with serosal involvement and review the literature. Because of the varied clinical pictures found in our review, we suggest a new terminology for the description of IgG4-RD with serosal involvement.
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10
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Immunoglobulin G4-related disease: some missing pieces in a still unsolved complex puzzle. Cardiovasc Pathol 2016; 25:90-2. [DOI: 10.1016/j.carpath.2015.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 12/24/2022] Open
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Luo WQ, Fang F, Zhen WJ, Ouyang XK, Wang HB, Wang Z, Zhong Y. A case of immunoglobulin G4-related constrictive pericarditis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:57. [PMID: 26904579 DOI: 10.3978/j.issn.2305-5839.2016.01.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 47-year-old man was admitted with a complaint of upper abdominal distension and shortness of breath. The constrictive pericarditis was diagnosed based on the transthoracic echocardiogram (TTE) and chest CT scan. Pathology revealed it is immunoglobulin (Ig) G4-related constrictive pericarditis. Likely, this is the first case of IgG4-related constrictive pericarditis reported in China.
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Affiliation(s)
- Wen-Qi Luo
- 1 Department of Cardiovascular Surgery, 2 Department of Pathology, 3 Department of Cardiology, Beijing Hospital, Beijing 100730, China
| | - Fang Fang
- 1 Department of Cardiovascular Surgery, 2 Department of Pathology, 3 Department of Cardiology, Beijing Hospital, Beijing 100730, China
| | - Wen-Jun Zhen
- 1 Department of Cardiovascular Surgery, 2 Department of Pathology, 3 Department of Cardiology, Beijing Hospital, Beijing 100730, China
| | - Xiao-Kang Ouyang
- 1 Department of Cardiovascular Surgery, 2 Department of Pathology, 3 Department of Cardiology, Beijing Hospital, Beijing 100730, China
| | - Huai-Bin Wang
- 1 Department of Cardiovascular Surgery, 2 Department of Pathology, 3 Department of Cardiology, Beijing Hospital, Beijing 100730, China
| | - Zi Wang
- 1 Department of Cardiovascular Surgery, 2 Department of Pathology, 3 Department of Cardiology, Beijing Hospital, Beijing 100730, China
| | - You Zhong
- 1 Department of Cardiovascular Surgery, 2 Department of Pathology, 3 Department of Cardiology, Beijing Hospital, Beijing 100730, China
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Sendo S, Saegusa J, Morinaga Y, Kawakami F, Kogata Y, Kageyama G, Morinobu A. IgG4-related disease manifesting as pericarditis with elevated adenosine deaminase and IL-10 levels in pericardial fluid. Mod Rheumatol 2015; 27:894-897. [PMID: 25867228 DOI: 10.3109/14397595.2015.1039628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A 78-year-old female with massive pericardial effusion fulfilled diagnostic criteria for immunoglobulin G4 (IgG4)-related disease. Although her adenosine deaminase (ADA) level in the pericardial effusion was high, all the tests for tuberculosis infection were negative. Immunostaining of the pericardium biopsy specimen revealed remarkably increased IgG4-positive cells. This is the first report describing IgG4-related pericarditis with elevated ADA level. We also demonstrate the elevated interleukin-10 (IL-10) level in pericardial fluid and IL-10-producing T-cells in the pericardium.
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Affiliation(s)
- Sho Sendo
- a Department of Rheumatology and Clinical Immunology , Kobe University Graduate School of Medicine , Chuo-ku, Kobe , Japan
| | - Jun Saegusa
- a Department of Rheumatology and Clinical Immunology , Kobe University Graduate School of Medicine , Chuo-ku, Kobe , Japan
| | - Yukiko Morinaga
- b Department of Diagnostic Pathology , Kobe University Graduate School of Medicine , Chuo-ku, Kobe , Japan
| | - Fumi Kawakami
- b Department of Diagnostic Pathology , Kobe University Graduate School of Medicine , Chuo-ku, Kobe , Japan
| | - Yoshinori Kogata
- a Department of Rheumatology and Clinical Immunology , Kobe University Graduate School of Medicine , Chuo-ku, Kobe , Japan
| | - Goichi Kageyama
- a Department of Rheumatology and Clinical Immunology , Kobe University Graduate School of Medicine , Chuo-ku, Kobe , Japan
| | - Akio Morinobu
- a Department of Rheumatology and Clinical Immunology , Kobe University Graduate School of Medicine , Chuo-ku, Kobe , Japan
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Seo J, Song IJ, Lee S, Jeong HJ, Kim HM, Koh BS, Park SH. A Case of Constrictive Pericarditis due to Immunoglobulin G4-Related Disease. Korean Circ J 2015; 45:161-4. [PMID: 25810739 PMCID: PMC4372983 DOI: 10.4070/kcj.2015.45.2.161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/25/2014] [Accepted: 07/13/2014] [Indexed: 12/24/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) can involve any organ. The majority of reported cases involve IgG4-RD of the biliary tract or pancreas, while only two cases of pericarditis have been reported. A 58-year-old man visited the outpatient clinic of our institution with a seven-day history of progressive dyspnea. Based on his transthoracic echocardiogram and transesophageal echocardiogram, he was diagnosed with constrictive pericarditis. The histopathology of his pericardiectomy revealed the cause of constrictive pericarditis to be IgG4-RD. Prednisolone (40 mg) was initiated after the pericardiectomy. As the patient's symptoms resolved, he was discharged and followed-up on an outpatient basis. This is the first case report of constrictive pericarditis caused by IgG4-RD in Korea.
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Affiliation(s)
- Jiwon Seo
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - In Ji Song
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Joo Jeong
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Min Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Koh
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ha Park
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
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Matsumiya R, Hosono O, Yoshikawa N, Uehara M, Kobayashi H, Oda A, Matsubara E, Tanada S, Shintani Y, Nagayama K, Nakajima J, Tanaka H. Elevated Serum IgG4 Complicated by Pericardial Involvement with a Patchy (18)F-FDG Uptake in PET/CT: Atypical Presentation of IgG4-related Disease. Intern Med 2015; 54:2337-41. [PMID: 26370858 DOI: 10.2169/internalmedicine.54.4340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IgG4-related pericardial involvement has rarely been reported and its clinical features remain unknown. We herein report a case of a 50-year-old woman with pericarditis who presented with a fever, elevated C-reactive protein levels, elevated serum IgG4 concentrations, and thickened pericardium with a patchy (18)F-fluorodeoxyglucose (FDG) uptake. A biopsy specimen of (18)F-FDG accumulated in the mediastinal lymph nodes revealed an abundant infiltration of IgG4-bearing plasma cells without fibrosis. Moderate-dose glucocorticoids promptly resolved the physical, serological, and imaging abnormalities, thus indicating a relatively acute and reversible nature of IgG4-related pericardial involvement.
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Affiliation(s)
- Ryo Matsumiya
- Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
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Yanagi H, Yamazaki I, Shimizu S, Himeno H, Suzuki SI, Masuda M. Constrictive Pericarditis Caused by Immunoglobulin G4–Related Disease. Ann Thorac Surg 2014; 97:e71-4. [DOI: 10.1016/j.athoracsur.2013.10.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 09/18/2013] [Accepted: 10/11/2013] [Indexed: 01/18/2023]
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