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Dragos C, Joseph C, Elwell H, Dey M, Kouranloo K. Pulmonary manifestations, treatments and outcomes of IgG4-related disease-a systematic literature review. Rheumatol Int 2024; 44:1875-1886. [PMID: 38769126 PMCID: PMC11393110 DOI: 10.1007/s00296-024-05611-7] [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: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a multisystem fibroinflammatory condition. A consistent feature of many cases is pulmonary infiltrates, or respiratory failure. This systematic literature review aims to summarise the pulmonary manifestations of IgG4-RD, including clinical outcomes and treatment. This review was registered on PROSPERO (CRD42023416410). Medline, Embase and Cochrane databases were searched for articles discussing IgG4-RD syndrome. Information was extracted on demographics, type and prevalence of pulmonary manifestations, treatment and clinical outcomes. Initially, after deduplication, 3123 articles were retrieved with 18 ultimately included. A pooled total of 724 patients with IgG4-RD were included, 68.6% male, mean age 59.4 years (SD 5.8) at disease onset. The most frequently described pulmonary manifestation was mediastinal lymphadenopathy (n = 186, 48.8%), followed by pulmonary nodules (n = 151, 39.6%) and broncho-vascular thickening (n = 85, 22.3%). Where treatment was reported, the majority of patients received glucocorticoids (n = 211, 93.4%). Other immunosuppressive therapy included cyclophosphamide (n = 31), azathioprine (n = 18), with mycophenolate mofetil (n = 6), rituximab (n = 6), methotrexate (n = 5) and other unspecified immunomodulators (50). Clinical outcomes were reported in 263 patients, where 196 patients had remission of their disease, 20 had relapse, 35 had stable disease, four had progression and eight patients died from complications of IgG4-RD. This systematic review summarises pulmonary manifestations, treatments and outcomes in patients with IgG4-RD. Pulmonary involvement in IgG4-RD is relatively common, leading to high levels of morbidity and mortality. Glucocorticoids remain the mainstay of treatment, but further work is required to explore the management of patients with pulmonary manifestations in association with IgG4-RD.
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Affiliation(s)
- Cristina Dragos
- Liverpool University NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK
| | - Clerin Joseph
- Liverpool University NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK
| | - Helen Elwell
- British Medical Association Library, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - Mrinalini Dey
- Centre for Rheumatic Diseases, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK
| | - Koushan Kouranloo
- School of Medicine, Cedar House, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK.
- Department of Rheumatology, University Hospital Lewisham, High Street, Lewisham, London, SE13 6LH, UK.
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2
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Parente H, Carones A, Silva A, Silva B, Costa C, Soares CD, Santos I, Bernardes JM, Silvério-António M, Torres RP, Teixeira F. Managing IgG4-related disease - the Portuguese rheumatology cohort. ARP RHEUMATOLOGY 2024; 3:70-72. [PMID: 38558068 DOI: 10.63032/duxg5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Hugo Parente
- Rheumatology, Unidade Local de Saúde do Alto Minho
| | | | - Augusto Silva
- Rheumatology, Centro Hospitalar universitário Lisboa Norte
| | - Bruna Silva
- Rheumatology, Centro Hospitalar Universitário do São João
| | - Carlos Costa
- Rheumatology, Centro Hospitalar de Trás-Os-Montes e Alto Douro
| | | | - Inês Santos
- Rheumatology, Centro Hospitalar Tondela - Viseu
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3
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Lai KKH, Aljufairi FMAA, Sebastian JU, Yip CCY, Wei Y, Jia R, Cheuk W, Cheng ACO, Chin JKY, Chu CY, Kwong CH, Yip NKF, Li KKW, Chan WH, Yip WWK, Young AL, Chan E, Ko CKL, Chan CKM, Yuen HKL, Chen LJ, Tham CCY, Pang CP, Chong KKL. Systemic Involvement in Immunoglobulin G4-Related Ophthalmic Disease. Ocul Immunol Inflamm 2023:1-7. [PMID: 38055933 DOI: 10.1080/09273948.2023.2280709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) poses clinical challenges due to its heterogeneous ocular and systemic manifestations. We aim to report the systemic involvement and the clinical, serological and radiological associations of a cohort of Chinese patients. METHODS A territory-wide, biopsy-proven, Chinese cohort. A retrospective, masked chart review of medical records, orbital images, and histopathology reports. RESULTS A total of 122 (65 male) patients with a follow-up of 81 ± 49 (24 to 84) months were reviewed. Ninety (74%) patients presented bilaterally. Subacute upper eyelid swelling was the commonest presentation (82/122, 67%). During follow-up, 91/122 patients (75%) underwent extra-orbital imaging including computer tomography (692 films), ultrasonography (182 films), magnetic resonance imaging (76 films) and whole body FDG-PET scan (33 films). Eighty-six (95%) of these 91 patients had extra-orbital involvement radiologically (2.7 ± 1.6 regions, range: 0 to 9). Lymph node was the most prevalent (N = 60,66%), followed by salivary gland (N = 51,56%), lung (N = 49,54%), kidney (N = 22, 24%), hepatobiliary tree (N = 18, 20%) and pancreas (N = 17, 19%). Other organs include thyroid, aorta, meninges/brain and skin. Twenty-eight (23%) patients had allergic diseases (19 asthma, 16 allergic rhinitis, and 6 eczemas). Fifty-seven (48%) patients had paranasal sinusitis. Serum eosinophilia was associated with a higher number (3.24 versus 2.52, P = 0.0304) of organ involvement. Patients with deep organ involvement was associated with a higher age of IgG4-ROD onset (70 ± 12 versus 56 ± 13, P < 0.0001). CONCLUSIONS 95% of the patients who underwent systemic imaging in our cohort had systemic organ involvement. An early physicians' assessment and radiological imaging are recommended after the diagnosis of IgG4-ROD.
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Affiliation(s)
- Kenneth K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fatema Mohamed Ali Abdulla Aljufairi
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Manama, Bahrain
| | - Jake Uy Sebastian
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology, Vicente Sotto Memorial Medical Center, Cebu City, Philippines
| | - Carson C Y Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yingying Wei
- Department of Statistics, The Chinese University of Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Ruofan Jia
- Department of Statistics, The Chinese University of Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Andy C O Cheng
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region, China
| | - Joyce K Y Chin
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Chung Yin Chu
- Department of Ophthalmology, Grantham Hospital, Hong Kong Special Administrative Region, China
| | - Chi Ho Kwong
- Department of Ophthalmology, Caritas Medical Center, Hong Kong Special Administrative Region, China
| | - Nelson K F Yip
- Department of Ophthalmology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, Hong Kong Special Administrative Region, China
| | - W H Chan
- Department of Ophthalmology, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
| | - Wilson W K Yip
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Edwin Chan
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Callie K L Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Hunter K L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Clement C Y Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Ophthalmology and Visual Sciences, Princes of Wales Hospital, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
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Patel U, Saxena A, Patel D, Ayesha IE, Monson NR, Klair N, Yu AK. Therapeutic Uses of Rituximab and Clinical Features in Immunoglobulin G4-Related Disease: A Systematic Review. Cureus 2023; 15:e45044. [PMID: 37701160 PMCID: PMC10494991 DOI: 10.7759/cureus.45044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 09/14/2023] Open
Abstract
This research presents a systematic review focusing on rituximab's therapeutic applications in immunoglobulin G4 (IgG4)-related disease (IgG4-RD), a rare condition characterized by immune-mediated systemic inflammation and tissue fibrosis, as well as the clinical features of IgG4-RD. While the disease commonly affects organs such as the bile ducts, lymph nodes, retroperitoneum, pancreas, and salivary glands, it can potentially involve other organs. This intricacy often leads to diagnostic challenges due to clinical overlaps with cancer, infections, and other autoimmune disorders. The diagnosis of IgG4-RD necessitates a comprehensive approach involving laboratory tests, imaging studies, and clinical assessments. Symptoms can vary, ranging from lymphadenopathy to jaundice, affecting multiple organs. Although elevated blood IgG4 levels and findings of tissue involvement and fibrosis on imaging can be suggestive, they lack the specificity for a definitive diagnosis. Early diagnosis is crucial for initiating corticosteroids and immunosuppressive to prevent further damage from IgG4-RD. This study highlights the therapeutic role of rituximab in managing this condition. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, the research identifies and evaluates relevant literature across various electronic databases, including PubMed, ScienceDirect, and Google Scholar. This review includes 14 selected publications, comprising three systematic reviews, three observational studies, four narrative reviews, and four case reports. The study design ensures a comprehensive evaluation of rituximab's potential efficacy in treating IgG4-RD and its associated clinical characteristics. Based on this study, it can be concluded that IgG4-RD can potentially be treated with rituximab, particularly in cases of relapse and maintaining remission.
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Affiliation(s)
- Utkarsh Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ayushi Saxena
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dhara Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ismat E Ayesha
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Neetha R Monson
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nimra Klair
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ann Kashmer Yu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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5
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Wang W, Kang X, Ding Y, Mao L, Dilinuer A, Li W. IgG4-Related Disease Manifested as Cutaneous Plasmacytosis: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:1997-2004. [PMID: 37554302 PMCID: PMC10404591 DOI: 10.2147/ccid.s406199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/08/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a rare fibroinflammatory disease that has a high tendency to misdiagnosis in clinics. CASE PRESENTATION A 48-year-old man developed a rash with progressive itching 3 years ago after hormone therapy for an ocular "inflammatory pseudotumor". The disease condition of this patient involved multiple organs which involved the skin. The patient was misdiagnosed with other diseases during the period of hospitalization, leading to poor therapeutic effects and repeated skin lesions. The dermatopathological report indicated plasma cell proliferative disorder, with IgG4/IgG exceeding 40% and abnormally elevated serum IgG4 levels. After the patient was diagnosed with IgG4-RD, a series of treatments improved skin lesions, relieved other symptoms, and decreased serum IgG4 levels. CONCLUSION IgG4-RD is a highly misdiagnosed disease that deserves the attention of physicians. The patient we reported could be considered a representative case of IgG4-RD that presents with skin lesions. For patients with suspected IgG4-RD, serum IgG4 testing should be performed, and further imaging, serological tests, and pathology examinations are needed to exclude malignancy, infection, and autoimmune diseases.
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Affiliation(s)
- Weijia Wang
- Department of Dermatology and Venereology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, People’s Republic of China
- Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Urumqi, People’s Republic of China
| | - Xiaojing Kang
- Department of Dermatology and Venereology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, People’s Republic of China
- Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Urumqi, People’s Republic of China
| | - Yuan Ding
- Department of Dermatology and Venereology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, People’s Republic of China
- Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Urumqi, People’s Republic of China
| | - Lidan Mao
- Department of Dermatology and Venereology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, People’s Republic of China
- Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Urumqi, People’s Republic of China
| | - Abudureyimu Dilinuer
- Department of Dermatology and Venereology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, People’s Republic of China
- Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Urumqi, People’s Republic of China
| | - Wenzheng Li
- Department of Dermatology and Venereology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, People’s Republic of China
- Xinjiang Key Laboratory of Dermatology Research (XJYS1707), Urumqi, People’s Republic of China
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Yasuda MA, Sandelski M, Borrowdale R. IgG4-RD in a Unilateral Parotid Mass: A Rare Manifestation and Review of the Literature. Cureus 2023; 15:e35689. [PMID: 37012957 PMCID: PMC10066708 DOI: 10.7759/cureus.35689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
IgG4 related disease (IgG4-RD) is a rare, immune-mediated inflammatory disease that varies widely in its presentation because it can affect nearly any organ. We present a case of a 73-year-old male who presented with an ill-defined mass of the parotid gland, found to be IgG4-RD, after several months of work up and tissue sampling. Most cases of salivary gland involvement in IgG4-RD present as bilateral swelling of the submandibular glands. We present this case as a unique manifestation of salivary gland disease in IgG4-RD as a persistent, non-discrete unilateral mass in the parotid gland. It is critical that clinicians who regularly treat salivary gland pathologies are familiar with this rare disease and its potential manifestations in the oral cavity.
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7
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Pucar D, Hinchcliff M. FDG PET vascular imaging in IgG4-RD: Potential and challenges. J Nucl Cardiol 2022; 29:2934-2937. [PMID: 34964084 DOI: 10.1007/s12350-021-02887-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Darko Pucar
- Section of Nuclear Medicine, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06511, USA.
| | - Monique Hinchcliff
- Department of Rheumatology, Allergy and Immunology, Yale University School of Medicine, New Haven, CT, USA
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8
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Aoki S, Morinaga S, Kawai N, Tanaka H, Kanematsu K, Tsuchiya N, Nonomura S, Ozawa A, Imai R, Takahashi R, Sawada T, Futamachi R, Yamada Y. Immunoglobulin G4-related disease diagnosed by prostate biopsy: a case report. J Med Case Rep 2022; 16:345. [PMID: 36176004 PMCID: PMC9524035 DOI: 10.1186/s13256-022-03611-4] [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: 07/26/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Immunoglobulin G4-related disease is characterized by swelling of various organs throughout the body and nodules/hypertrophic lesions. However, its cause remains unknown. We report a case of immunoglobulin G4-related disease that was diagnosed based on the histopathological findings of prostate biopsy. Case presentation A 72-year-old Japanese man had been treated by a nearby doctor for hypertension, but subsequently developed lower urinary tract symptoms and was prescribed an α1 blocker for 1 year. However, the patient was subsequently referred to our department because his symptoms did not improve. Prostate-specific antigen was 1.258 ng/ml; however, the nodule was palpable in the right lobe on digital rectal examination, and magnetic resonance imaging suggested Prostate Imaging and Reporting and Data System category 3. Therefore, transrectal prostate needle biopsy (12 locations) under ultrasound was performed. Histopathological examination revealed no malignant findings, although infiltration of lymphocytes and plasma cells, and partial fibrosis were observed. No remarkable findings of obstructive phlebitis were observed. Immunoglobulin G4-related disease was suspected, and immunoglobulin and immunoglobulin G4 immunostaining was performed. Immunoglobulin G4 positive plasma cells were observed in a wide range, immunoglobulin G4 positive cells were noted at > 10 per high-power field, and the immunoglobulin G4 positive/immunoglobulin G positive cell ratio was > 40%. Serum immunoglobulin G4 levels were high at 1600 mg/dl. Enhanced abdominal computed tomography findings suggested periaortitis. Additionally, multiple lymphadenopathies were observed around the abdominal aorta. The patient was accordingly diagnosed with immunoglobulin G4-related disease definite, diagnosis group (definite). We proposed steroid treatment for periaortic soft tissue lesions and lower urinary tract symptoms; however, the patient was refused treatment. A computed tomography scan 6 months after diagnosis revealed no changes in the soft tissue lesions around the aorta. Follow-up computed tomography examinations will be performed every 6 months. Conclusion If immunoglobulin G4-related disease is suspected and a highly invasive examination is required for histopathological diagnosis, this can be performed by a relatively minimally invasive prostate biopsy for patients with lower urinary tract symptoms. Further evidence is needed to choose an optimal candidate for prostate biopsy for lower urinary tract symptoms patients with suspicion of immunoglobulin G4-related disease. For patients with lower urinary tract symptoms with immunoglobulin G4-related disease or a history, performing a prostate biopsy may avoid unnecessary treatment. However, if steroid therapy is ineffective, surgical treatment should be considered.
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Affiliation(s)
- Shigeyuki Aoki
- The Department of Urology, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Shingo Morinaga
- The Department of Urology, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Naoki Kawai
- The Department of Clinical Laboratory, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Haruna Tanaka
- The Department of Clinical Laboratory, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Keiko Kanematsu
- The Department of Clinical Laboratory, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Nanami Tsuchiya
- The Division of Nursing, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Sayuri Nonomura
- The Division of Nursing, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Akiko Ozawa
- The Division of Nursing, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Rie Imai
- The Division of Nursing, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Ryoko Takahashi
- The Division of Nursing, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Tomoko Sawada
- The Division of Hospital and Clinic Coordination, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Ruriko Futamachi
- The Division of Hospital and Clinic Coordination, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan
| | - Yoshiaki Yamada
- The Department of Urology, Japan Community Health Care Organization Kani Tono Hospital, Gifu, Japan.
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Meli M, Arrabito M, Salvatorelli L, Soma R, Presti S, Licciardello M, Miraglia V, Scuderi MG, Belfiore G, Magro G, Russo G, Di Cataldo A. Report of Two Cases of Pediatric IgG4-Related Lymphadenopathy (IgG4-LAD): IgG4-Related Disease (IgG4-RD) or a Distinct Clinical Pathological Entity? CHILDREN (BASEL, SWITZERLAND) 2022; 9:1472. [PMID: 36291407 PMCID: PMC9600987 DOI: 10.3390/children9101472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
IgG4-related disease (IgG4-RD) is a recently discovered immune-mediated fibroinflammatory condition, uncommon in the pediatric population, that could involve multiple organs and induce cancer-like lesions and organ damage. Its main features are multiple injuries in different sites, a dense lymphoplasmacytic infiltrate rich in IgG4 plasma cells, storiform fibrosis, and often high serological concentrations of IgG4. Autoimmune pancreatitis is the most common manifestation, mainly in adults. Two cases of IgG4-RD in children with lymph node localization of disease are reported. Localized or systemic lymph node involvement is common, but lymph node enlargement as the first and only manifestation of IgG4-RD is unusual, and therefore, hard to differentiate from other diseases. IgG4-related lymphadenopathy (IgG4-LAD) is most likely a distinct disease, described as isolated lymphadenopathy, related to the presence of elevated numbers of IgG4-positive plasma cells. Both disorders are likely to be misdiagnosed in children because they are characterized by rare and polymorphic features. IgG4-RD and IgG4-LAD should be considered in the differential diagnosis of disorders characterized by lymphadenopathy of uncertain etiology.
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Affiliation(s)
- Mariaclaudia Meli
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Marta Arrabito
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Lucia Salvatorelli
- Anatomic Pathology Unit, University Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Rachele Soma
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Santiago Presti
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Maria Licciardello
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Vito Miraglia
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Maria Grazia Scuderi
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia, University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Giuseppe Belfiore
- Unit of Paediatric Radiology, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Gaetano Magro
- Anatomic Pathology Unit, University Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia University of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Giovanna Russo
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Andrea Di Cataldo
- Hematology-Oncology Unit, Department of Clinical and Experimental Medicine, G. F. Ingrassia University Hospital of Catania, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
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10
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Lorenzon M, Spina E, Tulipano Di Franco F, Giovannini I, De Vita S, Zabotti A. Salivary Gland Ultrasound in Primary Sjögren’s Syndrome: Current and Future Perspectives. Open Access Rheumatol 2022; 14:147-160. [PMID: 36072437 PMCID: PMC9444027 DOI: 10.2147/oarrr.s284763] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michele Lorenzon
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
- Correspondence: Michele Lorenzon, Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy, Tel +39 0432 559232, Email
| | - Erica Spina
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
| | | | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
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Polianskis M, Ivaška J, Dadonienė J, Lengvenis G, Besusparis J, Rauba D, Morozas A, Ivaškienė T, Lesinskas E. Immunoglobulin G4-Related Disease Presenting as Temporal Bone Lesion with Facial Nerve Palsy. ORL J Otorhinolaryngol Relat Spec 2022; 84:473-479. [PMID: 35671746 DOI: 10.1159/000522612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/30/2022] [Indexed: 12/24/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic condition which could present as local infiltration of skull base structures. We report a case of IgG4-RD with infiltration of the temporal bone and surrounding structures in a patient with systemic vasculitis on systemic steroids. A 31-year-old woman presented with right-sided facial weakness, headache, and right ear hearing loss. On examination, redness and retraction of the right tympanic membrane and facial paresis (House-Brackman IV) were noted. Computed tomography imaging showed mastoiditis, temporal lobe stroke, and brain abscess. Magnetic resonance imaging (MRI) showed infiltration in the infratemporal fossa, nasopharynx, spreading along the Eustachian tube and perineurally along the branches of CN V and CN VII intracranially, forming a dural based mass in the middle cranial fossa. Intracranial mass compressed the temporal lobe of the brain, causing perifocal brain edema. Endoscopic biopsy of the nasopharynx was chosen as the least invasive method. It showed marked fibrosis of the tissue, dense lymphoplasmacytic infiltrates, and an increased number of IGG4-positive plasma cells. Serum IgG4 levels were below the diagnostic criteria of IgG4-RD, but histological characteristics of IgG4-RD were met. The patient was treated with high-dose oral prednisolone. Resolution of symptoms, including facial nerve paresis, was observed and infiltration in the nasopharynx, infratemporal fossa decreased on subsequent MRI tests. No recurrence was noted on the follow-up of 16 months. The case presented itself as a diagnostic challenge for a multidisciplinary team to differentiate pathology caused by either IgG4-RD, systemic vasculitis, or atypic mastoiditis. MRI and histological reports were essential to establish a correct diagnosis.
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Affiliation(s)
- Marius Polianskis
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justinas Ivaška
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Dadonienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Givi Lengvenis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justinas Besusparis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Darius Rauba
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arnoldas Morozas
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tatjana Ivaškienė
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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12
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Immunoglobulin G4-related disease: Current status. Presse Med 2022; 51:104118. [DOI: 10.1016/j.lpm.2022.104118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/20/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
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Roa Esparza Í, Soto-Peleteiro A, Aberasturi Plata Y, Gendive Martín N. IgG4 related disease as a mimicker of metastatic pancreatic cancer. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:505-507. [DOI: 10.17235/reed.2022.8737/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Cho Y, Anderson EW, Guevara SJ, Miyara SJ, Maria N, Metz CN, Zafeiropoulos S, Giannis D, Wang J, Abidoye O, Mumford JM, Aronsohn J, Molmenti E, Sohail H. Diagnostic Dilemma of Paraneoplastic Rheumatic Disorders: Case Series and Narrative Review. Cureus 2021; 13:e19993. [PMID: 34984145 PMCID: PMC8715838 DOI: 10.7759/cureus.19993] [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] [Accepted: 11/29/2021] [Indexed: 11/27/2022] Open
Abstract
Paraneoplastic rheumatic disorder (RD) is a disorder that may present before, concurrent with, or after the diagnosis of malignancy. Paraneoplastic RDs are a clinical expression of occult cancer that is not directly related to a tumor or metastasis and manifests as rheumatoid symptoms. The RD is determined by the organ system affected by articular, muscular, cutaneous, vascular, or miscellaneous symptoms. Each case is challenging to diagnose because cancer may present with similar symptoms as a common rheumatic disorder. Of note, the majority of cases have minimal responsiveness or no responsiveness to standard rheumatoid treatment. Therefore, it is imperative to recognize and treat the underlying cancer accordingly. Herein, we present four different diagnostic dilemma cases of RD: case #1 - leukocytoclastic vasculitis and C3 glomerulopathy, case #2 - scleroderma, case #3 - Raynaud’s syndrome and possible lupus-like syndrome, and case #4 - inflammatory myositis. Institutional IRB approval was obtained for this case series. We will discuss and review the literature on each topic. In addition, we will mention a review of paraneoplastic rheumatoid arthritis. As rheumatic disease is associated with the use of immune checkpoint inhibitors (ICIs) for cancer treatment, we will briefly discuss some of the most common rheumatic presentations in the setting of these drugs. This case review aims to inform clinicians about the atypical presentation of paraneoplastic RD and to highlight the need for interdisciplinary management between rheumatologists, oncologists, and primary care practitioners.
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Pötter-Lang S, Ba-Ssalamah A, Bastati N, Messner A, Kristic A, Ambros R, Herold A, Hodge JC, Trauner M. Modern imaging of cholangitis. Br J Radiol 2021; 94:20210417. [PMID: 34233488 PMCID: PMC9327751 DOI: 10.1259/bjr.20210417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/07/2022] Open
Abstract
Cholangitis refers to inflammation of the bile ducts with or without accompanying infection. When intermittent or persistent inflammation lasts 6 months or more, the condition is classified as chronic cholangitis. Otherwise, it is considered an acute cholangitis. Cholangitis can also be classified according to the inciting agent, e.g. complete mechanical obstruction, which is the leading cause of acute cholangitis, longstanding partial mechanical blockage, or immune-mediated bile duct damage that results in chronic cholangitis.The work-up for cholangitis is based upon medical history, clinical presentation, and initial laboratory tests. Whereas ultrasound is the first-line imaging modality used to identify bile duct dilatation in patients with colicky abdominal pain, cross-sectional imaging is preferable when symptoms cannot be primarily localised to the hepatobiliary system. CT is very useful in oncologic, trauma, or postoperative patients. Otherwise, magnetic resonance cholangiopancreatography is the method of choice to diagnose acute and chronic biliary disorders, providing an excellent anatomic overview and, if gadoxetic acid is injected, simultaneously delivering morphological and functional information about the hepatobiliary system. If brush cytology, biopsy, assessment of the prepapillary common bile duct, stricture dilatation, or stenting is necessary, then endoscopic ultrasound and/or retrograde cholangiography are performed. Finally, when the pathologic duct is inaccessible from the duodenum or stomach, percutaneous transhepatic cholangiography is an option. The pace of the work-up depends upon the severity of cholestasis on presentation. Whereas sepsis, hypotension, and/or Charcot's triad warrant immediate investigation and management, chronic cholestasis can be electively evaluated.This overview article will cover the common cholangitides, emphasising our clinical experience with the chronic cholestatic liver diseases.
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Affiliation(s)
- Sarah Pötter-Lang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Nina Bastati
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alina Messner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Antonia Kristic
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raphael Ambros
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jacqueline C. Hodge
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Yelamanchi R, Yadav E, Gupta N, Durga CK. Idiopathic Retractile Calcific Mesenteritis: a Rare Cause of Small Bowel Obstruction. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02537-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shor N, Sené T, Zuber K, Zmuda M, Bergès O, Savatovsky J, Lecler A. Discriminating between IgG4-related orbital disease and other causes of orbital inflammation with intra voxel incoherent motion (IVIM) MR imaging at 3T. Diagn Interv Imaging 2021; 102:727-734. [PMID: 34326025 DOI: 10.1016/j.diii.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this prospective study was to determine the capabilities of intravoxel incoherent motion (IVIM) MRI at 3 Tesla in discriminating between IgG4-related orbital disease (IgG4-ROD) and other causes of orbital inflammation. MATERIALS AND METHODS Main selection criteria for the patients enrolled in this prospective study were age over 18 years and histopathologicaly proven orbital inflammatory lesion. MRI examinations were performed prior to surgery and treatment in all patients with suspected orbital inflammation. Two neuroradiologists, blinded to clinical data, independently analyzed structural MRI examinations and IVIM sequences obtained with 15 b values ranging from 0 to 2000 s/mm². Apparent diffusion coefficient (ADC), "true" diffusion coefficient (D), perfusion fraction (f) and pseudodiffusion coefficient (D*) values were calculated from all orbital lesions. Diagnostic capabilities of IVIM parameters were assessed using receiver operating-characteristic (ROC) curves and area under the curve (AUC). Sensitivity, specificity, and accuracy of IVIM parameters were calculated for the best threshold values and reported with their corresponding 95% confidence intervals (CI). RESULTS Thirty-five patients (21 women and 14 men; mean age, 49.2 ± 13.75 [SD] years; age range: 23-77 years) with 48 orbital lesions were enrolled in the study. Fifteen patients (15/35; 43%) had IgG4-ROD and 20 (20/35; 57%) had other causes of orbital inflammation. Median D value was significantly greater in patients with IgG4-ROD (1 × 10-3 mm2/s; interquartile range [IQR]: 0.9 × 10-3; 1.2 × 10-3) as compared to patients with non IgG4-ROD (0.80 × 10-3 mm2/s; IQR: 0.7 × 10-3; 1 × 10-3) (P = 0.04). There was no significant difference for ADC, f or D*. Area under the curve were of 0.54, 0.73, 0.63 and 0.56 for ADC, D, f and D*, respectively. Optimal threshold derived from ROC curves for D was 0.87 × 10-3 mm2/s, yielding 92% sensitivity (95% CI: 62-100%) and 71% specificity (95% CI: 44-90%) for the diagnosis of IgG4-ROD. No differences in standard morphological MRI criteria were found between IgG4-ROD and non IgG4-ROD. CONCLUSION Our study shows that IVIM MRI is a useful imaging technique to distinguish IgG4-ROD from other causes of orbital inflammation.
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Affiliation(s)
- Natalia Shor
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France; Department of Neuroradiology, Pitié-Salpêtriére Hospital, Assistance Publique-Hopitaux de Paris, 75013 Paris, France.
| | - Thomas Sené
- Department of Internal Medicine, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Kevin Zuber
- Department of Clinical Research, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Mathieu Zmuda
- Department of Orbitopalpebral Surgery, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Olivier Bergès
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, Fondation Adolphe de Rothschild Hospital, 75019 Paris, France
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Abstract
BACKGROUND The IgG4-related systemic disease as well as the homonymous variant IgG4-related orbital disease were first described less than 15 years ago. The mostly subacute clinical symptoms can be multifarious and the classical case is characterized by an orbital inflammatory condition with a bilateral enlargement of the lacrimal glands; however, any other orbital tissue with the exception of the eyeball can be affected by the lymphocytic inflammatory infiltration. MATERIAL AND METHODS Based on the current literature the clinical picture, epidemiology, pathogenesis and treatment options are described. A focus is on the differential diagnostic demarcation from other inflammatory processes of the orbit. CONCLUSION The IgG4-related orbital disease is an important differential diagnosis of inflammatory diseases of the orbit. The condition can exhibit considerable clinical and imaging similarity to idiopathic inflammation of the orbit, to the specific inflammations seen in systemic diseases, to Graves' orbitopathy and to lymphoproliferative diseases and lymphoma. After histopathologic confirmation the interdisciplinary clarification and treatment consensus are indispensable.
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Affiliation(s)
- Susanne Pitz
- Bürgerhospital, Augenklinik - Orbitazentrum, Nibelungenallee 37-41, 60318, Frankfurt, Deutschland.
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19
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Rasmussen KF, Sprogøe U, Nielsen C, Shalom DB, Assing K. Time-related variation in IgG subclass concentrations in a group of healthy Danish adults. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:1009-1015. [PMID: 34080322 PMCID: PMC8342227 DOI: 10.1002/iid3.464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/10/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022]
Abstract
Introduction Immunoglobulin G subclass measurements are important for the diagnostic work‐up of immunodeficiencies and immunoglobulin G4 (IgG4) related diseases. It is currently unknown whether a single sampling is truly representative for an individual's IgG subclass concentrations. This study aimed to investigate whether IgG and IgG subclass concentrations in healthy individuals are stable over time. Method With a span of median 42 weeks, four samples from each of 54 (34M, 20F) healthy adult volunteers (24–66 years) were analyzed for IgG and IgG1–4 using turbidimetry. Concentrations were compared within and between individuals. Results IgG and IgG subclass concentrations followed either a normal (IgG, IgG1, and IgG3) or log normal (IgG2 and IgG4) distribution. Immunoglobulin 4 demonstrated by far the widest range of concentrations between individuals (670‐fold: 0.004–2.68 g/L). Immunoglobulin G subclass variations within individuals were expressed as pooled standard deviations (PSD). These ranged from 0.056 (IgG4) to 0.955 g/L (IgG) and correlated with mean concentration of IgG or the particular IgG subclass. As a consequence, the relative PSDs (i.e., PSD divided by mean IgG or IgG subclass concentration) fell within a narrow range: 5.82%–10.1%. Based on these numbers, the 95%‐upper one‐sided confidence limits for intraindividual IgG and IgG subclass variation was calculated to range from 9.82% (IgG2) to 16.9% (IgG4). Conclusion The study documents that IgG or IgG subclass concentrations within healthy individuals are very stable over at least 42 weeks. The expected variation for IgG4 concentrations at a 95% confidence level does not exceed ±16.9%.
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Affiliation(s)
| | - Ulrik Sprogøe
- Department of Clinical Immunology, University Hospital, Odense, Denmark
| | - Christian Nielsen
- Department of Clinical Immunology, University Hospital, Odense, Denmark
| | - Dana-Bar Shalom
- Department of Clinical Immunology, University Hospital, Odense, Denmark.,Department of Oncology, University Hospital, Odense, Denmark
| | - Kristian Assing
- Department of Clinical Immunology, University Hospital, Odense, Denmark
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Kaya Akca Ü, Atalay E, Kasap Cüceoğlu M, Şener S, Balık Z, Başaran Ö, Batu ED, Karadağ Ö, Özen S, Bilginer Y. IgG4-related disease in pediatric patients: a single-center experience. Rheumatol Int 2021; 42:1177-1185. [PMID: 33978820 DOI: 10.1007/s00296-021-04885-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Immunoglobulin G4-related disease (IgG4-RD) is a systemic, immune-mediated, and fibroinflammatory disease that can affect almost any organ system. We aimed to present our single-center experience of pediatric patients with IgG4-RD, a rare disease in children. METHODS Pediatric patients diagnosed with IgG4-RD at the Hacettepe University between June 2014 and September 2020 were evaluated retrospectively. Patients with definite, probable, or possible diagnosis of IgG4-RD were included. RESULTS A total of eight patients with a median age of 13.4 (IQR 9.5-15.0) years were included in the study. Clinical presentations were IgG4-related ophthalmic disease in six patients, IgG4-related lymphadenopathy in one patient, and IgG4-related sialadenitis and lymphadenopathy of several lymph nodes accompanied by pancreatitis, ulcerative colitis, and pulmonary manifestations in one patient. Elevated serum IgG4 was detected in three of eight patients (37.5%). The main histopathological feature was fibrosis and lymphoplasmacytic infiltrates. Corticosteroids were used as first-line treatment in almost all patients with or without steroid-sparing agents. Azathioprine, methotrexate and rituximab were used as steroid-sparing agents. Relapse occurred in two of seven patients. Radiotherapy was used as the last resort in one patient with severe orbital disease. CONCLUSION IgG4 RD mainly presents with orbital manifestations in pediatric population but has wide phenotypic clinical variability. Although rare, early recognition and treatment are essential for a better outcome in these patients.
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Affiliation(s)
- Ümmüşen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Müşerref Kasap Cüceoğlu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Şener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ömer Karadağ
- Department of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Zhan L, Fan M, Cai N, Cai B. Combination of autoimmune pancreatitis and peripheral neuropathy on an IgG4-related disease patient with 4 years following-up. J Neuroimmunol 2020; 348:577378. [PMID: 32949993 DOI: 10.1016/j.jneuroim.2020.577378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 12/22/2022]
Abstract
Type1 autoimmune pancreatitis (AIP) is the first recognized and the most common manifestation of IgG4-related disease. However, AIP patient presented with neuropathy in the extremities have not been reported previously. We reported a rare combination of autoimmune pancreatitis and peripheral neuropathy on an IgG4-related disease patient based on histological features to expand the clinical spectrum of IgG4-related disease.
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Affiliation(s)
- Lingling Zhan
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350005, China
| | - Mengting Fan
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350005, China
| | - Naiqing Cai
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350005, China
| | - Bin Cai
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350005, China.
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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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Zala A, Berhane T, Juhlin CC, Calissendorff J, Falhammar H. Riedel Thyroiditis. J Clin Endocrinol Metab 2020; 105:5873864. [PMID: 32687163 DOI: 10.1210/clinem/dgaa468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023]
Abstract
CONTEXT Riedel thyroiditis (RT) is a rare inflammatory autoimmune disease that is often a clinically diagnostic dilemma because of its insidious presentation and nonspecific symptoms. OBJECTIVE The aim of the present systematic review and meta-analysis is to clarify the presentation, management, and outcomes of RT. STUDY SELECTION A systematic search of PubMed/MEDLINE and Web of Science was conducted to identify relevant reports published up to September 2019. DATA EXTRACTION First author, country, patient sex, ethnicity, presentation, biochemical status, duration of symptoms, histology, treatment, follow-up duration, and short- and long-term outcomes. DATA SYNTHESIS Data from 212 RT patients were retrieved. The mean age was 47 years with a predominantly female population (81%). Neck swelling (89%), dyspnea (50%), and neck pain (41%) were the most common presenting symptoms. Inflammatory markers were elevated in 70% to 97% and thyroid antibody positivity was present in less than 50%. Up to 82% underwent surgical intervention, with the most common being total thyroidectomy in 34% of individuals. Glucocorticoids were used in 70% of individuals with median duration 3 months. Prognosis was reasonable with 90% having resolution or improvement of symptoms. CONCLUSIONS This analysis is the largest and most comprehensive to date of RT and provides clinicians with vital information on the common presentation features that may alert to the diagnosis and highlight management options.
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Affiliation(s)
- Aakansha Zala
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
- Department of Endocrinology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Thomas Berhane
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research, Darwin, Northern Territory, Australia
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Strainiene S, Sarlauskas L, Savlan I, Liakina V, Stundiene I, Valantinas J. Multi-organ IgG4-related disease continues to mislead clinicians: A case report and literature review. World J Clin Cases 2020; 8:3267-3279. [PMID: 32874981 PMCID: PMC7441269 DOI: 10.12998/wjcc.v8.i15.3267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/07/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a multisystemic mass forming immune-mediated disease that affects almost every organ and is a diagnostic challenge for every clinician. There is a lack of adequate epidemiological data worldwide, and evidence-based treatment recommendations are not yet established. We report the first case of IgG4-RD from Lithuania and the Baltic Sea region presented with thyroiditis, orbital myositis, orbitopathy, uveitis, scleritis, sialadenitis, autoimmune pancreatitis and prostatitis.
CASE SUMMARY A 54-year-old Caucasian male was admitted to our tertiary Centre complaining of severe weight loss, diarrhoea, abdominal pain, salivary gland swelling, sicca symptoms and diplopia. On examination, bilateral palpable masses in the projection of major salivary glands, severe protrusion of the left eyeball and cachexia were noted. The patient was previously diagnosed with autoimmune thyroiditis and endocrine ophthalmopathy. The magnetic resonance imaging (MRI) of the head revealed enlarged extraocular muscles indicating orbital myositis. The biopsy from the salivary gland mass indicated sialadenitis. Abdominal MRI showed signs of autoimmune pancreatitis, and a serological test revealed the elevated serum IgG4 concentration. The patient was then diagnosed with IgG4-RD and successfully treated with prednisolone. There was a significant clinical, serological and radiological improvement after one month of treatment and no signs of relapse within twenty months. However, it took almost 18 years and the efforts of eight different medical specialists to establish the correct diagnosis.
CONCLUSION A comprehensive approach to the patient is essential to improving the recognition of rare immune system conditions, such as IgG4-RD.
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Affiliation(s)
- Sandra Strainiene
- Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Lukas Sarlauskas
- Clinic of Internal Diseases, Family Medicine and Oncology, Centre of Internal Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ilona Savlan
- Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Valentina Liakina
- Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
- Department of Chemistry and Bioengineering, Faculty of Fundamental Science, Vilnius Gediminas Technical University, Vilnius 10223, Lithuania
| | - Ieva Stundiene
- Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Jonas Valantinas
- Clinic of Gastroenterology, Nephrourology and Surgery, Centre of Hepatology, Gastroenterology and Dietetics, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
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Abstract
OBJECTIVES Fibrosing pancreatitis (FP) shares clinical features with autoimmune pancreatitis (AIP), although both entities have not been definitely linked. This study aimed to assess the presence of AIP criteria in an historic FP patient cohort and investigate the clinical features, management, and long-term outcomes of pediatric FP (P-FP). METHODS Clinical data of 14 P-FP patients from Toronto and 42 P-FP cases from a literature review were collected and compared to pediatric AIP (P-AIP). Toronto P-FP patients were recontacted to assess their current health status using a brief questionnaire. RESULTS Jaundice and abdominal pain were the symptoms at presentation in 44 of 56 (79%) and 50 of 56 (89%) P-FP patients, respectively. Common findings on cross sectional imaging were an enlarged pancreas head with narrowing of the distal common bile duct (51/54, 94%). Histopathology mainly showed gland fibrosis (39/39, 100%). Three of twelve (25%) P-FP patients had elevated IgG4 in serum. None of the patients were treated with corticosteroids, but some underwent surgical or endoscopic intervention. Toronto patients were followed for a median of 13.6 years (interquartile range: 2.9-22.8). Complications during follow-up included exocrine pancreatic insufficiency (3/14, 21%) and pancreatic gland atrophy (5/13, 38%); but none of the patients had disease relapse or developed diabetes type 3c. Five (5/14, 36%) patients developed other immune-mediated diseases over time. CONCLUSIONS Clinical features of patients with P-FP resembled those recently described in a subgroup of P-AIP presenting with jaundice. Long-term outcome of these patients is generally good, with or without invasive interventions. As some patients may develop exocrine pancreatic insufficiency and/or other immune-mediated diseases, ongoing clinical monitoring is recommended.
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Tian X, Deng Z, Wang S, Wang Y. Basic Research and Clinical Reports Associated with Low Serum IgG4 Concentrations. Int Arch Allergy Immunol 2019; 181:149-158. [PMID: 31805576 DOI: 10.1159/000503967] [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] [Received: 08/27/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022] Open
Abstract
Elevated IgG4 concentrations in serum have received a great deal of attention recently, whereas the significance of decreased IgG4 levels was frequently neglected in spite of its close relation with infectious and noninfectious inflammations. In this review, based on the structural and functional characteristics of IgG4, we bring together case reports and research related to low levels of IgG4 and try to scratch the importance of decreased IgG4 concentrations in serum. As with elevated IgG4 levels, low serum IgG4-related diseases can be involved in multiple systems such as infection in the respiratory system, stroke in the circulatory system, and glomerulonephritis in the urinary system. Both genetic and immune dysregulation can contribute to decreased IgG4 levels. In the light of animal experiments, we believe that the mystery of low IgG4 can be revealed as long as enough attention is acquired.
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Affiliation(s)
- Xinyu Tian
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Zhenling Deng
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Song Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yue Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China,
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Koda R, Tsuchida M, Iino N, Murata M, Inui K, Nakagawa Y, Nishiyama T, Ikeda Y, Hasegawa G, Oguma F, Narita I. IgG4-related Periarteritis Successfully Diagnosed by an Alternative Prostate Biopsy. Intern Med 2019; 58:2401-2406. [PMID: 30996194 PMCID: PMC6746632 DOI: 10.2169/internalmedicine.2723-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 56-year-old man was referred to our facility after developing edema in his right leg. Enhanced computed tomography (CT) revealed a periarterial soft tissue mass surrounding the right iliac artery compressing the iliac vein. His elevated serum IgG4 level indicated IgG4-related disease (IgG4-RD). Both a percutaneous and surgical biopsy of this periarterial lesion proved challenging and were not pursued. A prostate biopsy, however, finally provided a histological diagnosis of IgG4-RD. Oral steroid therapy successfully resolved his leg edema and periarterial lesion. This case illustrates the usefulness of an alternative prostate biopsy for the histological diagnosis of IgG4-RD when approaching the primary affected lesion is difficult.
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Affiliation(s)
- Ryo Koda
- Department of Nephrology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Masafumi Tsuchida
- Department of Nephrology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Noriaki Iino
- Department of Nephrology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Masaki Murata
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Kohei Inui
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Yuki Nakagawa
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Tsutomu Nishiyama
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Yohei Ikeda
- Department of Radiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Go Hasegawa
- Department of Pathology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Fumiaki Oguma
- Department of Cardiovascular Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Japan
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Pomponio G, Olivari D, Mattioli M, Angeletti A, Rossetti G, Goteri G, Gabrielli A. Sustained clinical response after single course of rituximab as first-line monotherapy in adult-onset asthma and periocular xanthogranulomas syndrome associated with IgG4-related disease: A case report. Medicine (Baltimore) 2018; 97:e11143. [PMID: 29952960 PMCID: PMC6039602 DOI: 10.1097/md.0000000000011143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE IgG4-related disease (IgG4-RD) is an emerging immune-mediated disease characterized by multi-organ involvement and variable clinical behavior. PATIENT CONCERNS We describe the case of a 50-year-old woman affected by a rare variant of IgG4-RD, characterized by eyelid xanthelasmas, adult-onset asthma and salivary and lacrimal glands enlargement. Multiple lymphadenopathies and a pulmonary mass were present at initial evaluation. INTEVENTIONS After a single course of rituximab (2g in 2 refracted doses), an almost complete clinical remission was achieved without chronic steroid administration. OUTCOMES Magnetic resonance imaging (MRI), high-resolution computed tomography (HRCT) of the thorax, and positron emission tomography (18FDG-PET-CT) confirmed good response to treatment. Circulating plasmablasts dropped to undetectable levels as well. Xanthelasmas only remained unchanged. Remission persisted at 1-year follow-up. LESSONS Steroid therapy is still considered standard first-line therapy in IgG4-RD. However, high doses are generally required and relapses are common during the tapering phase. Rituximab is a well described steroid-sparing strategy, so far reserved to refractory cases only. In our experience, rituximab has been used as first-line monotherapy, showing great and sustained efficacy and optimal tolerability. The peculiar variant of IgG4-RD affecting our patient, the relatively low baseline plasmablast concentration, and the early placement of rituximab therapy may have facilitated the good response.
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Affiliation(s)
| | | | | | | | | | - Gaia Goteri
- Section of Pathological Anatomy, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
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Ciccone F, Ciccone A, Di Ruscio M, Vernia F, Cipolloni G, Coletti G, Calvisi G, Frieri G, Latella G. IgG4-Related Disease Mimicking Crohn's Disease: A Case Report and Review of Literature. Dig Dis Sci 2018; 63:1072-1086. [PMID: 29417330 DOI: 10.1007/s10620-018-4950-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/26/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Fabiana Ciccone
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy
| | - Antonio Ciccone
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy
| | - Mirko Di Ruscio
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy
| | - Filippo Vernia
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy
| | - Gianluca Cipolloni
- Pathology Unit, San Salvatore Hospital, Via Lorenzo Natali, 1, Coppito, 67100, L'Aquila, Italy
| | - Gino Coletti
- Pathology Unit, San Salvatore Hospital, Via Lorenzo Natali, 1, Coppito, 67100, L'Aquila, Italy
| | - Giuseppe Calvisi
- Pathology Unit, San Salvatore Hospital, Via Lorenzo Natali, 1, Coppito, 67100, L'Aquila, Italy
| | - Giuseppe Frieri
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazza S. Tommasi, 1, Coppito, 67100, L'Aquila, Italy.
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