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CORRESPONDENCEPredominance of Th2 and regulatory cytokines in the serum of a patient with IgG4-related lymphadenopathy Dear Editor, Immunoglobulin G4 (IgG4)-related lymphadenopathy is a novel clinical entity characterized by numerous IgG4 + plasma cells in lymph nodes and elevated serum IgG4 levels. 1-4 However, patients with hyper-interleukin 6 (IL-6) syndromes such as multicentric Castleman's disease, rheumatoid arthritis, or other immune-mediated inflammatory conditions, frequently show lymph node involvement and often fulfill the diagnostic criteria for IgG4-related lymphadenopathy. 1,2,5 Therefore, diagnosis should not rest on pathological findings alone but be supplemented with additional laboratory analyses. We describe a patient with IgG4-related lymphadenopathy with marked increase in serum levels of Th2 and regulatory cytokines.A 76-year-old man presented with a complaint of generalized fatigue and appetite loss. He was also aware of body weight loss which developed over a few months. The patient had no history of allergy, bronchial asthma, atopic disorder, rhinitis or eczema. Physical examination showed a body temperature of 36.5°C, blood pressure of 130/73 mmHg, and pulse of 93 beats/min. No crackle or wheeze was detected on auscultation. He had multiple palpable lymph nodes in the neck, supraclavicular, axillary and inguinal regions. Laboratory studies showed a C-reactive protein level of 3.77 mg/dL (normal < 0.30), hemoglobin of 11.3 g/ dL, white cell count of 9250/lL (neutrophils 5828/lL, eosinophils 2220/lL [24%]), and platelet count of 14.0 9 10 4 /lL. Serum lactate dehydrogenase level was not elevated at 175 U/L (normal 120-240). Serum total IgG was elevated at 5087 mg/dL (normal 1000-1800), and IgG4 increased at 1140 mg/dL 22.4% of total IgG). No M-protein was detected by immunoelectrophoresis. Serum IgE was markedly elevated at 20 523 IU/mL (normal < 170). Serological tests showed negativity for antinuclear antibodies and rheumatoid factor. Serum concentrations of complements (C3 and C4) were normal. An antigen and antibody combination test for human immunodeficiency virus infection was negative.