IgG4-related Bronchial Gland Inflammation Proved by Transbronchial Cryobiopsy

IgG4‑related disease with endobronchial nodules: A case report and literature review

The present case report describes the case of a rare presentation of IgG4-related lung disease (IgG4-RLD) with endobronchial nodules and systemic involvement. An 84-year-old male presented with unexplained weight loss and enlarged submandibular lymph nodes. Diagnostic examinations revealed elevated serum IgG4 levels, along with findings of endobronchial nodules during bronchoscopy. Biopsies of endobronchial nodules revealed benign bronchial mucosa with fibrosis and inflammatory infiltration; however, he was not diagnosed with IgG4-RLD. A histological examination of the left salivary gland and submandibular lymph nodes confirmed the diagnosis of IgG4-related disease, revealing storiform fibrosis and abundant IgG4-positive plasma cells. The patient was treated with prednisolone, resulting in a reduction in submandibular swelling and decreased serum IgG4 levels. This case emphasizes the importance of considering IgG4-RLD as a potential diagnosis in patients presenting with endobronchial nodules and systemic disease. Accurate sampling methods, such as surgical lung biopsy or transbronchial cryobiopsies, are crucial for definitive diagnosis. Increased awareness among physicians can lead to timely recognition and appropriate management of this rare condition.

IgG4-related disease causing dacryoadenitis, bronchial stenosis and lobar collapse

Immunoglobulin G4-related disease (IgG4-RD) is a rare systemic fibroinflammatory disease that can affect almost any organ in the body. The most common sites of IgG4-RD include the salivary glands, orbits and lacrimal glands, pancreas, biliary tree, retroperitoneum and thyroid. Immunoglobulin G4-related lung disease (IgG4-RLD) can occur in isolation or as a component of multisystem disease. Its manifestations are heterogeneous and include lung cavitation, interstitial changes, pleural effusions and lung lesions.We describe a patient with Ig4-RLD manifesting as bronchial stenosis and left upper lobe collapse.

Update on respiratory lesions in patients with IgG4-related autoimmune pancreatitis

We previously reported respiratory involvement in 25 patients with autoimmune pancreatitis, a pancreatic manifestation of IgG4-related disease that responds well to glucocorticoid treatment. However, whether all respiratory lesions in patients with autoimmune pancreatitis have genuine respiratory involvement is unclear. This study aimed to update respiratory lesions' clinical and radiological characteristics in patients with autoimmune pancreatitis. We retrospectively reviewed the clinical and radiological data of 74 consecutive patients diagnosed with autoimmune pancreatitis at Shinshu University Hospital and treated with glucocorticoid. Clinical features and chest high-resolution computed tomography findings before and after therapy were reviewed. Fifty-one patients (68.9%) had respiratory lesions. In 65 of the 74 patients, chest high-resolution computed tomography results were evaluated before and after treatment. Patients with IgG4-related disease and respiratory lesions showed significantly higher serum IgG4 levels and hypocomplementemia than those without respiratory lesions; they also had more affected organs. While most abnormal thoracic findings improved, 4 cases of 7 with reticular opacities and all 11 cases with emphysema did not improve. Therefore, these lesions with poor response to glucocorticoid treatment should not be considered due to respiratory involvement of autoimmune pancreatitis based on the current classification criteria for IgG4-related disease. Patients with autoimmune pancreatitis and respiratory lesions exhibited higher disease activity than those without. Most chest high-resolution computed tomography lesions were responsive to glucocorticoid treatment, whereas reticular opacities and emphysema were poorly responsive.

The Usefulness of a Transbronchial Lung Cryobiopsy for Diffuse Bronchiolitis

We herein report four cases of diffuse bronchiolitis proven by a transbronchial lung cryobiopsy (TBLC). Based on various aspects, including the pathological findings, we definitively diagnosed two patients with diffuse panbronchiolitis (DPB) and the other two with primary ciliary dyskinesia (PCD). One of the DPB patients had more severe peribronchiolar fibrosis than the other, and the disease course was refractory to macrolide therapy. One of the PCD patients was additionally diagnosed with combined constrictive bronchiolitis. This report highlights the importance of a TBLC in the differentiation of bronchiolitis, suggesting its utility for helping pulmonologists formulate a treatment strategy.