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Vu DL, Thieu-Thi TM, Pham MT, Le-Thi M, Nguyen HA, Nguyen MD. A case report of Mikulicz’s disease. Pan Afr Med J 2020; 37:252. [PMID: 33598067 PMCID: PMC7864275 DOI: 10.11604/pamj.2020.37.252.26835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
Mikulicz's disease is a unique condition involving the enlargement of the lacrimal and salivary glands, similar to that observed in Sjogren's syndrome; however, Mikulicz's disease is clinically characterized by infrequent autoimmune reactions and responsiveness to glucocorticoid treatment. The ultrasound features of the lacrimal and salivary glands in patients with IgG4-Mikulicz's disease were characterized by multiple hypoechoic areas of varying sizes within the enlarged glands. IgG4 serum level was also elevated, in contrast to the detection of normal levels in Sjogren's syndrome. In this article, we intended to illustrate a case of Mikulicz's disease with clinical and imaging features.
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Affiliation(s)
- Dang Luu Vu
- Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam
- Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam
| | - Tra My Thieu-Thi
- Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam
| | - Minh Thong Pham
- Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam
- Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam
| | - My Le-Thi
- Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam
| | - Huu An Nguyen
- Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam
| | - Minh Duc Nguyen
- Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
- Corresponding author: Minh Duc Nguyen, Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
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Pineda-Galindo LF, Vera-Lastra OL, Carrazco-Ibarra L, Carrasco-Gómez A, Becerril-Ángeles M, Ramos-Salazar P, Martínez-Solano J. [IgG4-related disease: a case report]. Rev Med Inst Mex Seguro Soc 2017; 55:796-800. [PMID: 29190875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
IgG4-related disease is an inflammatory condition characterized by high levels of IgG4. It affects salivary and lacrimal glands, pancreas, lymph nodes, lungs or kidney. The diagnosis is based on identifying a histological pattern with a dense lymphocyte and plasmacyte infiltration, focal fibrosis or phlebitis, finding more than 10 IgG4 positive cells per high power field and/or IgG4/IgG ratio in plasma higher than 40%. We present a patient with Mikulicz's disease who meets histological findings required for the diagnosis of IgG4 related disease.
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Affiliation(s)
- Luis Francisco Pineda-Galindo
- Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Abstract
BACKGROUND The clinical picture of IgG4-related sclerosing disease (IgG4-RSD) may mimic lymphoma, and should be in the differential diagnosis of patients with this clinical picture. CASE SUMMARY A 32-year-old female had recurrent swelling of both eyelids for more than 15 years. Examination revealed elastic, firm, swollen lacrimal glands about 2-3 cm in diameter that was not painful. Head and orbits magnetic resonance imaging (MRI) showed mass lesions over the bilateral lacrimal glands, submandibular glands, and left foramen of ovale. The differential diagnosis included lymphoid tissue, inflammatory masses, and lymphoma. Gallium single-photon emission computed tomography/computed tomography (SPECT/CT) showed uptake in the bilateral lacrimal glands, right parotid and bilateral submandibular glands, bilateral perirenal region, mediastinal, prevertebral, paraaortic, lumbar, bilateral pelvic (including internal iliac chain) lymph nodes, anterior aspect of right 3rd rib, and lateral aspect of left 6th rib. CT showed multiple enlarged lymph nodes in the mediastinum, right pulmonary hilum, prevertebral space of the thoracolumbar spine, retroperitoneal paraaortic area, bilateral parailiac areas, and bilateral perirenal spaces. Antinuclear and anti-SSA/SSB antibodies were negative, and the serum IgG4 level was 740 mg/dL (normal, 8-140 mg/dL). Right parotid gland biopsy showed abundant IgG4-positive plasma cells. Mikulicz disease (IgG4-related sclerosing disease) was diagnosed and she received glucocorticoid treatment. Follow-up CT and MRI showed with resolved eyelid swelling and perirenal mass lesions. Follow-up gallium scan was normal. CONCLUSION Gallium SPECT/CT can be a useful tool for initial and follow-up evaluation of IgG4-RSD.
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Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine
- School of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Bao-Bao Hsu
- Department of Allergy, Immunology and Rheumatology
| | - Chen-Lin Chi
- Department of Pathology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Yuh-Feng Wang
- Department of Nuclear Medicine
- School of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
- Correspondence: Yuh-Feng Wang, Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi 622, Taiwan, R.O.C. (e-mail: )
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Coloma-González I, Ceriotto A, Flores-Preciado J, Corredor-Casas S, Salcedo-Casillas G. [Comparative study of clinical features between unilateral and bilateral orbital IgG4-related disease]. Arch Soc Esp Oftalmol 2015; 90:407-413. [PMID: 25865652 DOI: 10.1016/j.oftal.2015.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 02/09/2015] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Descriptive and comparative study of patients with orbital IgG4-related disease. MATERIAL AND METHODS A review and analysis of the cases diagnosed with inflammatory orbital lesion related to IgG4 by the Ophthalmic Pathology Service in the Dr. Luis Sánchez Bulnes Hospital. RESULTS A total of 9 cases were found, in which 66% were women, and with a mean age of 48 years and time to diagnosis of 2 years. Unilateral involvement was observed in 56% of cases. All the females experienced pain, and there was an optimal response to corticosteroid treatment in 100% of patients who required medical treatment (one case showed spontaneous resolution). In bilateral cases (44%), only 25% were female, and none had pain as a presenting symptom. Furthermore, 25% of these patients required a combination with immunosuppressants to control inflammation. CONCLUSIONS Clinical presentation of patients with unilateral orbital IgG4-related disease differs from those with bilateral involvement.
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Affiliation(s)
- I Coloma-González
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México.
| | - A Ceriotto
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - J Flores-Preciado
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - S Corredor-Casas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
| | - G Salcedo-Casillas
- Servicio de Órbita, Párpados y Vía Lagrimal, Hospital Dr. Luis Sánchez Bulnes, Asociación para Evitar la Ceguera IAP, México D.F. México
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Okazaki K, Saito T. [112th Scientific Meeting of the Japanese Society of Internal Medicine: Symposium: Recent Progress in IgG4-related Disease: Introduction]. Nihon Naika Gakkai Zasshi 2015; 104:1831. [PMID: 30160919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Deng C, Li W, Chen S, Zhang W, Li J, Hu C, Wen X, Zhang F, Li Y. Histopathological diagnostic value of the IgG4+/IgG+ ratio of plasmacytic infiltration for IgG4-related diseases: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2015; 94:e579. [PMID: 25738476 PMCID: PMC4553963 DOI: 10.1097/md.0000000000000579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This article aims to perform a meta-analysis to evaluate the diagnostic value of the immunoglobulin G (IgG)4/IgG ratio of plasmacytic infiltration for IgG4-related diseases.Four databases-EMBASE, ISI Web of Knowledge, PubMed, and the Cochrane Library-were systematically searched. Approximately 200 participants from several studies were included in this research. STATA 11.2 software (Stata Corporation, College Station, TX) and Meta-DiSc 1.4 (Unit of Clinical Biostatistics, Ramon y Cajal Hospital, Madrid, Spain) were used to perform the meta-analysis.Nine studies were included in the meta-analysis. The pooled diagnostic odds ratio was 18.94 [95% confidence interval (CI), 2.89-124.30]. The sensitivity was 58.80% (95% CI, 50.90-66.30) and the specificity was 90.20% (95% CI, 81.20-95.80). The positive and negative likelihood ratios were 3.12 (95% CI, 1.07-9.16) and 0.26 (95% CI, 0.09-0.70), respectively. The area under the curve of the summary receiver-operating characteristic was 0.88.To conclude, the IgG4/IgG ratio of plasmacytic infiltration is modestly effective in diagnosing IgG-related disease.
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Affiliation(s)
- Chuiwen Deng
- From the Department of Rheumatology and Clinical Immunology (CD, SC, WZ, JL, CH, XW, FZ, YL), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; and Department of Rheumatology (WL), China-Japan Friendship Hospital, Beijing, China
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Himi T, Takano K, Nomura K, Abe A, Yamamoto M, Takahashi Y. [IgG4 associated disorder involved with otorhinolaryngologic diseases]. Nihon Jibiinkoka Gakkai Kaiho 2014; 117:1438-1447. [PMID: 26298878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Zhang Y, Du Y, Li K, He J. IgG4-related Mikulicz's disease associated with thyroiditis: a case report and review of the literature. Eye Sci 2014; 29:47-52. [PMID: 26016066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report an unusual case of IgG4-related Mikulicz's disease associated with thyroiditis. CASE REPORT We describe a 25-year-old Chinese man who presented with bilateral, painless swellings of the lachrymal glands, parotid glands, and thyroid nodules. The patient underwent left-sided dacryoadenectomy and the diagnosis of IgG4-related Mikulicz's disease was pathologically confirmed. The size of the right-sided lachrymal gland and parotid glands recovered fundamentally after one month of glucocorticoid therapy. CONCLUSION IgG4-related Mikulicz's disease associated with thyroiditis should be considered in the differential diagnosis of bilateral swellings of lachrymal glands, salivary glands, and thyroid nodules. Surgical excision is recommended in order to treat the tumor and to ensure the pathological diagnosis. Glucocorticoid therapy should be considered in association with surgery after removal.
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Qu LM, Liu YH, Brigstock DR, Wen XY, Liu YF, Li YJ, Gao RP. IgG4-related autoimmune pancreatitis overlapping with Mikulicz’s disease and lymphadenitis: A case report. World J Gastroenterol 2013; 19:9490-9494. [PMID: 24409081 PMCID: PMC3882427 DOI: 10.3748/wjg.v19.i48.9490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/06/2013] [Indexed: 02/06/2023] Open
Abstract
Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis that is categorized as type 1 or type 2 according to the clinical profile. Type 1 AIP, which predominantly presents in a few Asian countries, is a hyper-IgG4-related disease. We report a case of IgG4-related AIP overlapping with Mikulicz’s disease and lymphadenitis, which is rare and seldom reported in literature. A 63-year male from Northeast China was admitted for abdominal distension lasting for one year. He presented symmetric swelling of the parotid and submandibular glands with slight dysfunction of salivary secretion for 6 mo. He had a 2-year history of bilateral submandibular lymphadenopathy without pain. He underwent surgical excision of the right submandibular lymph node one year prior to admission. He denied any history of alcohol, tobacco, or illicit drug use. Serological examination revealed high fasting blood sugar level (8.8 mmol/L) and high level of IgG4 (15.2 g/L). Anti-SSA or anti-SSB were negative. Computed tomography of the abdomen showed a diffusely enlarged pancreas with loss of lobulation. Immunohistochemical stain for IgG4 demonstrated diffuse infiltration of IgG4-positive plasma cells in labial salivary gland and lymph node biopsy specimens. The patient received a dose of 30 mg/d of prednisone for three weeks. At this three-week follow-up, the patient reported no discomfort and his swollen salivary glands, neck lymph node and pancreas had returned to normal size. The patient received a maintenance dose of 10 mg/d of prednisone for 6 mo, after which his illness had not recurred.
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Kihara M, Sugihara T, Hosoya T, Miyasaka N. Clinical significance of complement as a biomarker of disease activity in 4 cases of IgG4-related disease with retroperitoneal fibrosis. Clin Exp Rheumatol 2013; 31:947-949. [PMID: 24021494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/30/2013] [Indexed: 06/02/2023]
Abstract
Hypocomplementaemia is frequently observed in IgG4-related diseases, however the clinical significance is unclear. We describe herein the clinical courses of 4 patients with IgG4-related disease with hypocomplementaemia. Our cases showed autoimmune pancreatitis, retroperitoneal fibrosis, Mikulicz's disease, interstitial lung disease, lymphadenopathy and mesenteric fibrosis around the aorta. A decrease in serum complement preceded deterioration of the disease and clinical improvement was observed in accordance with normalisation of serum complement. These clinical courses suggest that serum complement is a biomarker of the disease activity.
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Affiliation(s)
- Mari Kihara
- Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan, Department of Medicine and Rheumatology, Tokyo Medical and Dental University, Tokyo, Japan.
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Takagi Y, Nakamura H, Origuchi T, Miyashita T, Kawakami A, Sumi M, Nakamura T. IgG4-related Mikulicz's disease: ultrasonography of the salivary and lacrimal glands for monitoring the efficacy of corticosteroid therapy. Clin Exp Rheumatol 2013; 31:773-775. [PMID: 23806290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES IgG4-related Mikulicz's disease (IgG4-MD) has been recently established as a subtype of IgG4-related diseases involving the salivary and lacrimal glands, and the diseased glands are characteristically and highly responsive to corticosteroid therapy. We retrospectively evaluated ultrasonography (US) of the salivary and lacrimal glands for monitoring the efficacy of corticosteroid treatment in patients with IgG4-MD. METHODS US features of the salivary and lacrimal glands were assessed and compared with the serum IgG4 levels in 8 patients with IgG4-MD before and at various stages after initiation of oral corticosteroids. RESULTS US features of the lacrimal and salivary glands of patients with IgG4-MD were characterised by multiple hypoechoic areas in enlarged glands. The submandibular glands were most frequently involved by the disease, and bilateral glands of the same type were similarly affected exhibiting the same hypoechoic pattern. Alleviations of abnormal gland architecture and size in response to corticosteroid therapy were effectively detected with US. The US findings of the involved glands were proportional to the serum IgG4 level before and during the corticosteroid therapy. CONCLUSIONS US helps monitor the efficacy of corticosteroid treatment in patients with IgG4-MD.
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Affiliation(s)
- Yukinori Takagi
- Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan.
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Lin W, Chen H, Wu QJ, Zheng WJ, Shi Q, Leng XM, Xu D, Shen M, Zhang W, Zhao Y, Zeng XF, Zhang FC. [Clinical research of immunoglobin 4-related Mikulicz's disease]. Zhonghua Yi Xue Za Zhi 2013; 93:973-975. [PMID: 23886257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the clinical features of immunoglobin (IgG4)-related Mikulicz's disease (MD). METHODS Since December 2010, a prospective cohort study of IgG4 related disease (IgG4RD) was performed our hospital. A total of 42 IgG4RD patients were recruited along with 18 MD patients. Their clinical, laboratory and histopathological features and response to treatment were analyzed. RESULTS The 18 MD patients accounted for 42.9% of IgG4RD. There were 10 males and 8 females with a mean age of (48 ± 14) years. The mean follow-up period was 8.18 months. All of them had an involvement of salivary and lacrimal glands. Fifteen cases suffered other organs' damage, including autoimmune pancreatitis (n = 7), sclerosing cholangitis (n = 4) and lymph nodes (n = 6). And 10 patients complained of a history of allergies. All serum levels of IgG4 subclass significantly increased. Histological examinations in 16 patients revealed massive infiltration of lymphocytes and IgG4 positive plasma cells with obvious tissue fibrosis. Glucocorticoid and immunosuppressive therapies were effective for MD. CONCLUSION As an IgG4-related systemic disease involving predominantly lacrimal and salivary glands without autoantibodies, MD is treated optimally with a combination therapy of glucocorticoid and immunosuppressive drugs.
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Affiliation(s)
- Wei Lin
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100032, China
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Yao Q, Wu G, Hoschar A. IgG4-related Mikulicz's disease is a multiorgan lymphoproliferative disease distinct from Sjögren's syndrome: a Caucasian patient and literature review. Clin Exp Rheumatol 2013; 31:289-294. [PMID: 23406780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/06/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This paper aims to report a case of IgG4-related Mikulicz's disease with a systematic review. METHODS The relevant English literature was searched using the keywords 'Mikulicz's disease' and 'IgG4'. Original and review articles were reviewed, and the clinical scenarios were exemplified with a case report. RESULTS A 49-year-old Caucasian man presented with axillary lymphadenopathy and bilateral parotid/submandibular enlargement. A chest computerized tomography showed mediastinal lymphadenopathy, with low metabolic activity on the position emission tomography. A histopathological study showed an IgG4/IgG ratio of 75% in the plasma cells of the submandibular glands, associated with high levels of total serum IgG and IgG4. He had dry mouth, but minor salivary gland biopsy was negative without xerophthalmia. He had nasal obstruction and dyspnea, notably with supine position/cervical rotation, which substantially improved with glucocorticoid treatment. He had newly diagnosed diabetes mellitus with hyperlipasaemia and diffuse pancreatic swelling supportive of autoimmune pancreatitis. CONCLUSIONS Our case report supports the literature that there are similarities between IgG4-related Mikulicz's disease and Sjögren's syndrome, but the differences are significant. IgG4-related Mikulicz's disease is a multi-organ lymphoproliferative disease distinct from Sjögren's syndrome.
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Affiliation(s)
- Qingping Yao
- Department of Rheumatic and Immunologic Disease, Cleveland Clinic, Cleveland, OH, USA.
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Hourseau M. [Head and neck IgG4 related disease]. Ann Pathol 2012; 32:S75-7. [PMID: 23127947 DOI: 10.1016/j.annpat.2012.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Muriel Hourseau
- Département de pathologie, site Bichat-Claude-Bernard, hôpitaux Paris Nord Val-de-Seine (HUPNVS), 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
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Imoto M, Watanabe K, Tatsumi Y, Nakae K, Kamisako T. [Divergence between measured values of total IgG and subclass IgGs (sum of IgG1-IgG4) in IgG4-related disease]. Rinsho Byori 2012; 60:1053-1057. [PMID: 23383573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In systemic IgG4-related disease, an elevation of the serum IgG4 level(IgG4: 135 mg/dl or higher) and IgG4-positive plasma cell infiltration occurs. Since the total IgG and sum of subclasses, IgG1 through IgG4, were markedly different in a patient suspected of having Mikuliez's disease, we investigated the relationship between total IgG and sum of IgG subclasses. The subjects were healthy individuals, and low IgG4, high IgG4, hyper-gamma globulinemia and hypo-y globulinemia groups. Total IgG was measured using 'N-assay TIA IgG-SH' (Nittobo) and Hitachi 7700, and IgG subclasses were measured using BS-NIA reagent (Binding Site) and BN II (Siemens). Designation of total IgG and the sum of IgG subclasses was established in the healthy control subjects. However the total IgG level and sum of IgG1-4 levels were different when the balance among the IgG subclasses was lost. In case such as :1) the IgG4 level was high and 2) IgG1-type M protein was present. These results indicate that the reevaluation of measured data is necessary when the IgG4 concentration is high and the difference between total IgG concentration and the sum of IgG subclasses is large.
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Affiliation(s)
- Mayumi Imoto
- Department of Central Clinical Laboratory, Kinki University Hospital, Osaka-sayama 589-8511, Japan.
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Delle Sedie A, Baldini C, Donati V, Mosca M. Mikulicz's disease: a long-term follow-up case report. Clin Exp Rheumatol 2012; 30:596. [PMID: 22931586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 08/29/2012] [Indexed: 06/01/2023]
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Yamamoto M, Takahashi H, Ishigami K, Yajima H, Shimizu Y, Tabeya T, Matsui M, Suzuki C, Naishiro Y, Imai K, Shinomura Y. Relapse patterns in IgG4-related disease. Ann Rheum Dis 2012; 71:1755. [PMID: 22589378 DOI: 10.1136/annrheumdis-2012-201694] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Uehara T, Ikeda SI, Hamano H, Kawa S, Moteki H, Matsuda K, Kaneko Y, Hara E. A case of Mikulicz's disease complicated by malignant lymphoma: a postmortem histopathological finding. Intern Med 2012; 51:419-23. [PMID: 22333380 DOI: 10.2169/internalmedicine.51.5713] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 66-year-old Japanese man with an 11-year history of Mikulicz's disease (MD) received continuous corticosteroid administration. At age 58, a left renal pelvic mass was identified and diagnosed as an IgG4-related inflammatory pseudotumor. The patient underwent an operation to remove the tumor. Subsequently, he contracted repeated pulmonary infections and eventually died of severe gastrointestinal bleeding. Autopsy revealed systemic lymph node swelling and infiltration in some organs, and diffuse large B-cell lymphoma (DLBCL) was diagnosed. These findings suggest that an IgG4-related disease can be causally related to the development of malignant lymphoma through the occurrence of mucosa-associated lymphoid tissue lymphoma.
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Affiliation(s)
- Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, Japan.
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Takenaka K, Takada K, Kobayashi D, Moriguchi M, Harigai M, Miyasaka N. A case of IgG4-related disease with features of Mikulicz's disease, and retroperitoneal fibrosis and lymphadenopathy mimicking Castleman's disease. Mod Rheumatol 2011; 21:410-4. [PMID: 21243399 DOI: 10.1007/s10165-010-0410-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 12/13/2010] [Indexed: 01/07/2023]
Abstract
A 51-year-old man developed painless enlargement of the bilateral submandibular and lacrimal glands without xerostomia or xerophthalmia in the absence of autoantibodies to SS-A (Ro) and SS-B (La). In a few years, he developed generalized lymphadenopathy, with markedly elevated serum IgG4, and a computed tomography scan revealed soft-tissue-density lesions around the abdominal aorta, a finding consistent with retroperitoneal fibrosis. Biopsy of the cervical lymph node showed an expansion of the interfollicular area by heavily infiltrating plasma cells, consistent with multicentric Castleman's disease. Immunohistochemical analysis revealed that the IgG4-positive/IgG-positive plasma cell ratio was 80%, leading us to a single diagnosis of IgG4-related disease. High-dose corticosteroid treatment resulted in prompt resolution of the physical, serological, and imaging abnormalities. Although IgG4-related disease can mimic multicentric Castleman's disease, as in our patient, the two diseases have effective but distinct treatments, and thus measurement of serum IgG4 levels and specific immunohistochemical analysis for determining the IgG4-positive/IgG-positive plasma cell ratio are recommended if IgG4-related disease is suspected.
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Affiliation(s)
- Kenchi Takenaka
- Department of Medicine and Rheumatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Takano KI, Yamamoto M, Takahashi H, Shinomura Y, Imai K, Himi T. Clinicopathologic similarities between Mikulicz disease and Küttner tumor. Am J Otolaryngol 2010; 31:429-34. [PMID: 20015799 DOI: 10.1016/j.amjoto.2009.08.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 07/09/2009] [Accepted: 08/30/2009] [Indexed: 12/15/2022]
Abstract
PURPOSE Recent studies have revealed that Mikulicz disease (MD) differs from Sjögren syndrome and is an immunoglobulin G(4) (IgG(4))-related systemic disease. Küttner tumor (KT) is also reported to be an IgG(4)-related disease. In this study, we examined the clinicopathologic and serologic findings in MD (39 patients) and KT (6 patients) and attempted to discern the similarities between MD and KT. MATERIALS AND METHODS We diagnosed 39 patients with MD and 6 patients with KT. We analyzed the clinicopathologic and serologic findings (IgG subclasses) in 39 patients with MD and 6 patients with KT. Submandibular and labial salivary gland specimens obtained from patients with MD and KT were stained with anti-IgG(4) antibodies. RESULTS The mean IgG(4) concentration (±SD) was 931.1 ± 796.2 mg/dL in patients with MD and 756.2 ± 449.2 mg/dL in patients with KT. Abundant infiltration of IgG(4)-positive plasmacytes into the salivary glands was observed in both patients with MD and patients with KT. CONCLUSION The serologic and histopathologic findings in MD and KT are very similar, and these 2 conditions may be IgG(4)-related systemic diseases.
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Affiliation(s)
- Ken-ichi Takano
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan.
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Yamamoto M, Takahashi H, Shinomura Y. [IgG4-related systemic disease/systemic IgG4-related disease]. Rinsho Byori 2010; 58:454-465. [PMID: 20560455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
IgG4-related systemic disease/systemic IgG4-related disease has been established as a new systemic disease entity. It is characterized by high serum IgG4 concentrations and abundant IgG4-bearing plasma cell infiltration in the involved organs. The chronic inflammation can attack lacrimal glands, salivary glands, the thyroid, lung, pancreas, kidney, and prostate. The concept includes Mikulicz's disease, Riedel's thyroiditis, pulmonary fibrosis, pulmonary pseudotumor, autoimmune pancreatitis, a part of tubulointerstitial nephritis, and chronic prostatitis. It is important to note that these lesions can occur at different times and sites. So, it is necessary to reconfirm the disease definition and entity in each specialized field. The diagnosis of this disease is confirmed by the above serological and histopathological characteristics. There are clinical diagnostic criteria of Mikulicz's disease (the Japanese Medical Society for Sjögren's Syndrome) and autoimmune pancreatitis (the Japanese Ministry of Health, Labour and Welfare, and the Japan Pancreas Society). They are convenient and useful. Glucocorticoid improves the physical abnormalities, and the initial dose of prednisolone is 30 mg/day, tapered in 5-mg reductions every two weeks. Nevertheless, there are some cases unable to achieve complete remission.
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Affiliation(s)
- Motohisa Yamamoto
- First Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan.
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Tsuda T, Kobayashi K, Seki K, Yashiro S, Ino T, Kato K, Hanawa T. The effect of a Japanese traditional medicine, hachimijiogan (kampo), on regulatory CD4+CD25+T cells in Mikulicz's disease. Altern Ther Health Med 2010; 16:60-63. [PMID: 20232620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Tokutaro Tsuda
- Department of Oriental Medicine, Kitasato University Graduate School, Kanagawa, Japan.
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Yamamoto M, Takahashi H, Suzuki C, Tabeya T, Ohara M, Naishiro Y, Yamamoto H, Imai K, Shinomura Y. Analysis of serum IgG subclasses in Churg-Strauss syndrome--the meaning of elevated serum levels of IgG4. Intern Med 2010; 49:1365-70. [PMID: 20647649 DOI: 10.2169/internalmedicine.49.3532] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Mikulicz's disease (MD) is characterized by symmetrical and persistent enlargement of the lacrimal and salivary glands. Recently it has been categorized as an 'Ig (immunoglobulin) G4-related disease.' It presents with elevated serum levels of IgG4 and abundant infiltration of IgG4-bearing plasmacytes in involved organs. Allergic symptoms are often observed in patients with IgG4-related disease. On the other hand, allergic diseases are often complicated with Churg-Strauss syndrome (CSS). Here we focused on CSS and analyzed the relation of IgG4 in its pathogenesis. MATERIALS AND METHODS We analyzed five patients (2 men and 3 women) with CSS and 51 patients (20 men and 31 women) with MD who presented at Sapporo Medical University Hospital since 2001. We measured the serum concentrations of IgG subclasses in the patients with MD and CSS, and evaluated renal specimens from CSS patients, staining them for anti-IgG4 antibody. RESULTS We surprisingly found elevated serum levels of IgG4 not only in MD but also in CSS patients. The renal specimens in CSS patients revealed the infiltration of IgG4-positive plasmacytes. CONCLUSION IgG4-bearing plasmacytes may be involved in the pathogenesis of CSS, and it is possible that an allergic reaction plays an important role in the pathogenesis of IgG4-related disease.
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Affiliation(s)
- Motohisa Yamamoto
- The First Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
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Vasil'ev VI, Pal'shina SG, Simonova MV, Logvinenko OA, Sedyshev SK, Mitrikov BV, Probatova NA, Kokosadze NV, Safonova TN, Aleksandrova EN, Nasonov EL. [The first experience of using rituximab in Mikulicz disease]. TERAPEVT ARKH 2010; 82:62-66. [PMID: 20731115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The paper describes a case of Mikulicz's disease (MD) in a young woman (aged 19 years) with symmetrical large salivary gland lesion concurrent with the enlarged lacrimal glands. Immunomorphological and molecular studies of parotid gland biopsy specimens revealed the formation of MALT tissue without signs of B-cell clonality of an infiltrate. The diagnosis of lacrimal sac lymphoma was ruled out. MD was diagnosed. The use of rituximab in therapy for MD has first demonstrated a positive result in Russian and worldwide practice.
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Abstract
Since Hamano et al. have first reported serum IgG4 elevation in sclerosing pancreatitis in 2001, various systemic disorders have been reported to be related to elavated IgG4, and many names have been proposed from the point of view of the systemic condition. Despite similarities in the organs damaged in IgG4-related Mikulicz's disease and Sjögren's syndrome, there are marked clinical and pathological differences between the two entities. IgG4-related Mikulicz's disease and Küttner's tumor are related diseases and complete differentiation is very difficult. The majority of cases diagnosed with autoimmune pancreatitis in Japan are IgG4-related sclerosing pancreatitis, and it should be recognized that this is distinct from the western type. There is a likelihood that cases once diagnose as Castleman's disease that showed good responsiveness to glucocorticoid treatment may have been IgG4-related lymphadenopathy, and should be re-assessed in light of recent findings. Diagnosis of IgG4-related disease is defined by both 1) Elevated serum IgG4 (>135 mg/dl) and 2) Histopathological features including lymphocyte and IgG4(+) plasma cell infiltration (IgG4(+) plasma cells/IgG(+) plasma cells >50% on a highly-magnified slide checked in five points), however differential diagnosis from other distinct disorders, such as sarcoidosis, Castleman's disease, Wegener's granulomatosis, lymphoma, cancer, and other existing conditions is necessary. To avoid diagnostic confusion, simpler and more scientific names should be used where disease-specific pathogenesis or markers have been ascertained.
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Yamamoto M, Naishiro Y, Suzuki C, Kokai Y, Suzuki R, Honda S, Abe T, Takahashi H, Shinomura Y. Proteomics analysis in 28 patients with systemic IgG4-related plasmacytic syndrome. Rheumatol Int 2009. [PMID: 19609529 DOI: 10.1007/s00296-009-1030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
It is considered that autoimmune pancreatitis (AIP), Mikulicz's disease (MD) and IgG4-related tubulointerstitial nephritis (TIN) comprise systemic IgG4-related plasmacytic syndrome (SIPS), of which the origin remains unknown. We analyzed these patients with focus on serological aspects to invest whether there are autoantigens in SIPS. We evaluated 28 patients with SIPS who presented at Sapporo Medical University Hospital and the collaborated institutions. They were mainly middle-aged (eight male), and consisted of 26 patients with MD and two patients with AIP. The three among 26 patients diagnosed with MD were complicated to AIP, and another three patients had IgG4-related TIN. As a control, healthy volunteers and the patients with Sjögren's syndrome were examined. At first, we measured the levels of serum complements and circulating immune complexes in these patients. Next, immune complexes were collected from the serum of patients and healthy controls by immunoprecipitation. They were divided into immunoglobulin and the antigens by glycine-HCl solution. The divided samples including the antigens were analyzed by surface-enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS). Nine patients had hypocomplementemia and 15 had elevated levels of circulating immune complexes in the group of SIPS. In the groups of healthy volunteers and SS, all showed that the levels of serum complements and circulating immune complexes were normal. SELDI-TOF-MS detected a 13.1-kDa protein from all samples of SIPS, and not in normal control and SS. It is possible that the 13.1-kDa protein is one of the autoantigens of SIPS.
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Yamamoto M, Takahashi H, Ohara M, Suzuki C, Naishiro Y, Yamamoto H, Shinomura Y, Imai K. A new conceptualization for Mikulicz's disease as an IgG4-related plasmacytic disease. Mod Rheumatol 2006; 16:335-40. [PMID: 17164992 PMCID: PMC2785894 DOI: 10.1007/s10165-006-0518-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 07/12/2006] [Indexed: 02/07/2023]
Abstract
Mikulicz's disease (MD) has been included within the diagnosis of primary Sjögren's syndrome (SS), but it represents a unique condition involving persistent enlargement of the lacrimal and salivary glands characterized by few autoimmune reactions and good responsiveness to glucocorticoids, leading to the recovery of gland function. Mikulicz's disease was recently reported to be associated with elevated immunoglobulin G4 (IgG4) concentrations in the serum and prominent infiltration of plasmacytes expressing IgG4 into the lacrimal and salivary glands. The following features were used for diagnosis: (1) visual confirmation of symmetrical and persistent swelling in more than two lacrimal and major salivary glands; (2) prominent mononuclear cell infiltration of lacrimal and salivary glands; and (3) exclusion of other diseases that present with glandular swelling, such as sarcoidosis and lymphoproliferative disease. These features are not observed in most SS cases. The complications of MD include autoimmune pancreatitis, retroperitoneal fibrosis, tubulointerstitial nephritis, autoimmune hypophysitis, and Riedel's thyroiditis, all of which show IgG4 involvement in their pathogenesis. Mikulicz's disease thus differs from SS and may be a systemic IgG4-related plasmacytic disease.
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Affiliation(s)
- Motohisa Yamamoto
- First Department of Internal Medicine, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan.
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Yamamoto M, Suzuki C, Naishiro Y, Takahashi H, Shinomura Y, Imai K. [The significance of disease-independence in Mikulicz's disease--revival interests in Mikulicz's disease]. ACTA ACUST UNITED AC 2006; 29:1-7. [PMID: 16505597 DOI: 10.2177/jsci.29.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mikulicz's disease represents a unique condition involving enlargement of the lacrimal and salivary glands. Mikulicz's disease has been considered part of primary Sjögren's syndrome because both diseases were histologically similar. However, the gland swellings in Mikulicz's disease are persistent, and its decreased secretional function is good responsiveness to glucocorticoid. Serologically, Mikulicz's disease is characterized by few autoantibody including anti-SS-A and anti-SS-B antibodies. Recently, it is revealed elevated IgG4 concentrations in the serum and prominent infiltration by plasmacytes expressing IgG4 in the lacrimal and salivary glands in Mikulicz's disease. Prominent IgG4-positive plasma cells are also detected in systemic lymph tissues. We cannot detect the phenomenon in Sjögren's syndrome. In complications with Mikulicz's disease, there are autoimmune pancreatitis, retroperitoneal fibrosis, tubulointerstitial nephritis, autoimmune hypophysitis, Riedel's thyroiditis, which are related to IgG4 in its pathogenesis. Mikulicz's disease is different from Sjögren's syndrome, and may be a systemic IgG4-related plasmacytic disease.
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Affiliation(s)
- Motohisa Yamamoto
- First Department of Internal Medicine, Sapporo Medical University School of Medicine
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Yamamoto M, Takahashi H, Sugai S, Imai K. Clinical and pathological characteristics of Mikulicz's disease (IgG4-related plasmacytic exocrinopathy). Autoimmun Rev 2004; 4:195-200. [PMID: 15893711 DOI: 10.1016/j.autrev.2004.10.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Accepted: 10/15/2004] [Indexed: 02/06/2023]
Abstract
Mikulicz's disease (MD) has been considered part of primary Sjogren's syndrome (SS) since Morgan's report in 1953. MD represents a unique condition involving enlargement of the lacrimal and salivary glands, as is also seen in SS; however, MD is characterized by few autoimmune reaction and its good responsiveness to glucocorticoid. Recent reports have shown that the frequency of apoptosis in glands of MD patients is lower when compared with SS. This phenomenon reflects the histologically reversible gland secretion in MD. Elevated IgG4 concentrations in the serum and prominent infiltration by plasmacytes expressing IgG4 in the lacrimal and salivary glands have also been confirmed in MD. Plasma cells expressing IgG4 are also detected in lymph nodes and bone marrow. MD may be a systemic disease, rather than a lacrimal and salivary gland disease. We here propose the new entity "IgG4-related plasmacytic exocrinopathy" and expect future development with regard to its relationship with autoimmune pancreatitis, which similarly presents elevated serum IgG4 levels.
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Affiliation(s)
- Motohisa Yamamoto
- First Department of Internal Medicine, Sapporo Medical University, School of Medicine, South 1-West 16, Chuo-ku, Sapporo, Hokkaido 0608543, Japan.
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Yamamoto M, Harada S, Ohara M, Suzuki C, Naishiro Y, Yamamoto H, Takahashi H, Imai K. Clinical and pathological differences between Mikulicz's disease and Sjögren's syndrome. Rheumatology (Oxford) 2004; 44:227-34. [PMID: 15509627 DOI: 10.1093/rheumatology/keh447] [Citation(s) in RCA: 219] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Mikulicz's disease (MD) has been included within the diagnosis of primary Sjögren's syndrome (SS), but represents a unique condition involving enlargement of the lachrymal and salivary glands and characterized by few autoimmune reactions and good responsiveness to glucocorticoids. We have previously described elevated immunoglobulin (Ig) G4 in the serum of four patients with MD. In this paper, we accumulated more MD cases and undertook clinical and histopathological analysis of these patients to clarify differences between MD and SS. METHODS We diagnosed seven patients with MD according to the following criteria: (i) visual confirmation of symmetrical and persistent swelling in more than two lachrymal and major salivary glands; (ii) prominent mononuclear infiltration of lachrymal and salivary glands; and (iii) exclusion of other diseases that present with glandular swelling, such as sarcoidosis and lymphoproliferative disease. We summarized the clinical and serological characteristics (IgG subclasses and IFN-gamma/IL-4 ratio) of seven patients with MD, compared with SS with glandular swelling (SSw) and without glandular swelling (SSo). After steroid administration, we analysed changes in IgG subclasses in MD. Labial salivary gland specimens in MD, SSw and SSo were stained with anti-IgG4 antibodies. RESULTS The concentration (+/-s.d.) of IgG4 was 1169.7 +/- 892.2 mg/dl in MD, 24.4 +/- 7.0 mg/dl in SSw (P<0.005) and 82.6 +/- 189.7 mg/dl in SSo (P<0.005). The IFN-gamma/IL-4 ratio was 0.392 +/- 0.083 (0.78 +/- 0.23/2.14 +/- 0.31 IU/pg) in MD, 0.004 +/- 0.002 (0.20 +/- 0.07/57.02 +/- 14.05 IU/pg) in SSw (P<0.05) and 0.012 +/- 0.009 (0.58 +/- 0.86/116.24 +/- 207.65 IU/pg) in SSo (P<0.05). The concentration (+/-s.d.) of IgG4 in MD decreased to 254.0 +/- 50.3 mg/dl (P<0.05) after glucocorticoid treatment. Histopathologically, only MD was associated with prominent infiltration of IgG4-positive plasmacytes into lachrymal and salivary glands. CONCLUSION Mikulicz's disease is quite different from SS clinically and histopathologically. MD is suggested to be an IgG4-related systemic disease.
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Affiliation(s)
- M Yamamoto
- First Department of Internal Medicine, Sapporo Medical University School of Medicine, South 1-West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
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Abstract
Benign lymphoepithelial lesion (BLL) is an autoimmune process characterized by swelling and diffuse inflammation of the major salivary glands. Autoantibodies have been isolated from lymphocyte cultures obtained from affected salivary glands, but the pathogenesis is still unknown. Previous studies have shown that the predominant population of inflammatory cells is represented by helper T cells, with only brief mention of the B cell population. Twenty-five surgical specimens from patients with BLL were studied immunohistochemically. Antisera used included monoclonal antibodies LN-1 and LN-2 for B cells, LN-3 for cells expressing human leukocyte antigen-DR (HLA-DR) antigens, UCHL-1 for T cells, Leu-7 for natural killer (NK) cells, and T suppressor lymphocytes and the polyclonal antibody to S100 protein for dendritic cells. A peculiar distribution of the inflammatory infiltrate was observed in all cases, characterized by the presence of very irregular "germinal centers" with pseudopod-like extensions surrounding epimyoepithelial islands. Lymphoid cells in this location were reactive with LN-1 and LN-2 antibodies. These structures were surrounded by a "mantle" of mixed small B and T lymphocytes. A well-defined "interfollicular" zone was composed of cells strongly reactive with UCHL-1 and LN-3 antibodies, indicating the presence and activation of T cells. Dendritic cells defined by S100 and LN-2 reactivity were intermixed with epimyoepithelial cells, and were identified in 18 cases. Epithelial expression of HLA-DR antigens was restricted to inflamed areas. In contrast to previous reports denying the presence of Leu-7-positive cells in these lesions, cells reactive for this antibody were identified in 13 of 20 cases, predominantly within germinal centers. The presence of dendritic cells, complex organization of the inflammatory infiltrate into well-defined B cell proliferation centers and activated interfollicular T areas, and the abnormal expression of HLA-DR antigens in epithelial cells support an antibody-mediated destruction of the epithelial cells in this disease.
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Affiliation(s)
- R E Andrade
- Department of Laboratory Medicine and Pathology, University of Minnesota Hospital, Minneapolis 55455
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Matina VN, Krivolutskaia EG, Kolesnikova EN, Khazenson LB. [Immunologic changes in patients with chronic nontumorous diseases of the parotid glands]. Stomatologiia (Mosk) 1986; 65:42-5. [PMID: 3466429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Schroeder HE, Müller-Glauser W, Sallay K. Pathomorphologic features of the ulcerative stage of oral aphthous ulcerations. Oral Surg Oral Med Oral Pathol 1984; 58:293-305. [PMID: 6384873 DOI: 10.1016/0030-4220(84)90058-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Macroscopic, histopathologic, and immunohistochemical features of eight 1- to 7-day-old minor (Mikulicz) aphthae, one herpetiform ulcer, and one ulcer from a patient with Behcet's syndrome were studied. In addition to light and electron microscopy, methods included the peroxidase-antiperoxidase (PAP) technique to disclose binding of IgA, IgG, IgM, Clq, and C3. Observations revealed the presence and distribution of extravasates of erythrocytes at and around the ulcers, extravascular neutrophilic granulocytes undermining the oral epithelium of the ulcer margin, the presence of numerous macrophages loaded with phagolysosomes containing debris of neutrophilic granulocytes, particular pathomorphologic features of a Behcet lesion and a herpetiform lesion, and the occurrence in diseased and normal oral mucosa of particular stratum spinosum cells binding nonselectively all immune components tested in this study, probably by leakage and passive diffusion of serum proteins. The observations fit the concept of immune complex vasculitis being essential in the pathogenesis of oral aphthous ulcerations.
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López-Enriquez E, Ceballos L, Cintrón J, González E. Malignant transformation in Mikulicz's disease. Bol Asoc Med P R 1980; 72:1-6. [PMID: 6928774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Romero RW, Nesbitt LT, Ichinose H. Mikulicz disease and subsequent lupus erythematosus development. JAMA 1977; 237:2507-10. [PMID: 576964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In a 12-year-old boy with clinical and histologic features of Mikulicz disease, systemic lupus erythematosus (SLE) developed two years later. Atrophic plaques and nodules in the skin along with substantial increase in salivary gland enlargement characterized the onset of SLE. There was lack of renal and joint manifestations, and no evidence of keratoconjunctivitis sicca or xerostomia was seen. Histopathologic changes in the skin lesions included mucinous infiltrates, chronic vasculitis, and dermal-epidermal junction findings typical of SLE. Direct immunofluorescene studies of skin lesions and normal-appearing skin showed granular deposition of immunoglobulins and complement at the dermal-epidermal junction zone. Level of anti-DNA antibodies was noticeably elevated, and the serum C3 value was depressed. The patient's response to systemic corticosteroid therapy was dramatic.
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Abstract
The frequency of HL-A phenotypes has been investigated in 64 patients who had recurrent aphthous ulcers and 100 subjects who did not. The HL-A phenotypes were determined by a two-step microcytotoxicity test on peripheral blood lymphocytes, incubating these cells with a range of defined antiserums and complement and subsequently assessing lymphocyte viability by dye exclusion. There were no significant differences between the frequency of individual HL-A antigens in the patients with aphthous ulceration and those of subjects without aphthous ulceration. Similarly, no differences in numbers of shared antigens could be demonstrated. The distribution of HL-A antigens was essentially similar in subdivisions of patients with aphthous ulceration, grouped on the basis of sex, family history, age at onset, and maximum number of concurrent ulcers and their duration before healing.
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Bascones Martínez A, Carrión Lacalle F, Diaz Fernández A, Ramon y Cajal S. [Mikulicz' syndrome]. An Esp Odontoestomatol 1975; 34:365-84. [PMID: 1059344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
The incidence of the antinuclear factor in serum of patients with Mikulicz's recurrent oral aphthae (MROA) was compared with that in control serum. The absence of any difference between the two groups suggests that MROA is not an autoimmune disease arising from a central immunologic fault, but could be a local immune response against an antigenically altered mucosa.
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Monier JC, Thivolet J. Patterns of antinuclear antibody fluorescence in leucocytes and hepatocytes. Rev Eur Etud Clin Biol 1972; 17:582-91. [PMID: 4567345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Dolby AE. Mikulicz's recurrent oral aphthae. The effect of hydrocortisone succinate sodium upon the in vitro lymphocyte cytotoxicity. Br Dent J 1970; 128:579-80. [PMID: 5270335 DOI: 10.1038/sj.bdj.4802503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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