Characteristics of pleural effusion in IgG4-related pleuritis

Saito, Zenya; Yoshida, Masahiro; Kojima, Aya; Tamura, Kentaro; Kuwano, Kazuyoshi

doi:10.1016/j.rmcr.2020.101019

Cited by 7 publications

(12 citation statements)

References 16 publications

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“…ADA is a hallmark of lymphocytes activation and is widely used in the auxiliary diagnosis of tuberculous pleuritic. As a result, after ruling out mycobacterial infection using proper tools, elevated ADA levels in pleural fluid may be useful for identifying IgG4-RD pleuritis [21]. With reference to serology, it is important to underline that high IgG4 levels (>135 mg/dL), significantly contribute to the achievement of a definite diagnosis in a suggestive context, but their absence does not allow us to exclude this condition.…”

Section: Discussionmentioning

confidence: 99%

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Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

et al. 2021

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Diagnostic work-up of IgG4-related disease (IgG4-RD) pleural involvement is a complex task, as there is a broad spectrum of differential diagnoses to consider. We report the case of a patient presenting with relapsing pleural effusion, discussing the main challenges for achievement of a definite diagnosis. A 63-year-old man was admitted for pleural effusion prevalent on the ride side, initially labeled as idiopathic non-specific pleuritis, based on tissue evaluation after a medical thoracoscopy. He was started on steroids with initial improvement, but a later CT scan showed a relapse of pleural effusion associated with diffuse pleural thickening; a subsequent surgical pleural biopsy revealed features suggestive for IgG4-RD, with a marked increase of IgG4 positive plasma cells. High IgG4 serum levels were also found. The present case underlines the importance of increasing awareness of this potential condition among physicians in order to properly guide the diagnostic work-up, as it is likely that IgG4-RD accounts for a proportion of patients with pleural effusions, labeled as idiopathic. In particular, in patients with unexplained pleural effusion, IgG4-RD should be included among differential diagnoses when lymphoplasmacytic infiltration is observed, and a multidisciplinary interaction between clinicians and pathologists appears crucial for an accurate diagnosis and an appropriate management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

et al. 2021

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“…This case posed a diagnostic challenge because tuberculous pleurisy needed to be excluded. Many cases of pleural effusion due to IgG4-RD with high levels of ADA have been reported [ 3 ]. However, ADA has been commonly used as a marker for tuberculous pleural effusion [ [6] , [7] , [8] ].…”

Section: Discussionmentioning

confidence: 99%

“…IgG4-related pleural effusion is a rare phenotype of IgG4-RD [ 2 ]. It is commonly characterized by high levels of lymphocytes and adenosine deaminase (ADA) [ 3 ]. However, pleural effusion and elevated ADA levels are also suggestive of tuberculous pleurisy.…”

Section: Introductionmentioning

confidence: 99%

A case of immunoglobulin G4-Related disease with pleural effusion, requiring exclusion of tuberculous pleurisy

Doita

Tamura

Baba

et al. 2022

Respiratory Medicine Case Reports

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“…Clinically, a lymph node or pleural biopsy can be performed to achieve a diagnosis according to the pathological results. Tamura K, 2020, [3] 2 43/F Tong X, 2017, [4] 3 Saito Z, 2020, [7] 6 74/F To summarize, IgG4-RRD involving the pleura is rare Affected patients mainly have clinical symptoms of cough and dyspnea, and may have pleural effusion, pleural thickening, and mediastinal lymph node enlargement on imaging. Furthermore, these patients may also be characterized by exudative pleural effusion, and normal or increased ADA levels.…”

Section: Discussionmentioning

confidence: 99%

A case report of IgG4-related respiratory disease with pleural effusion and a literature review

et al. 2022

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Rationale: IgG4-related respiratory disease (IgG4-RRD) is a chronic autoimmune disease that affects the respiratory system and organs outside the respiratory system. This study explored the diagnosis and treatment of a case of IgG4-RRD with unilateral pleural effusion diagnosed using medical thoracoscopy, and provides an associated literature review. This report summarizes the clinical characteristics of IgG4-RRD involving the pleura to improve the diagnosis of this disease.Patient concerns: A 39-year-old man presented with a 2-week history of cough and chest tightness. Both physical examination and imaging supported the presence of left pleural effusion.Diagnosis: Medical electronic thoracoscopy was performed to obtain a pleural biopsy, which showed lymphoplasmacytic infiltration, 40 IgG4+ plasma cells per High Power Field (HPF) on microscopy, IgG4/IgG ratio >50%, phlebitis obliterans, and storiform fibrosis. The final diagnosis was IgG4-RRD. Interventions and outcomes:The patient was treated with methylprednisolone, after which his symptoms improved, and he was discharged. Oral hormone therapy was continued outside the hospital. After 4 months, the patient returned to the hospital and his condition had improved significantly.Lessons: Pleural involvement in IgG4-RRD is rare, and its diagnosis depends on pleural biopsy. Thoracoscopy usually reveals pleural thickening, pleural nodules, and milky white plaques.

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Characteristics of pleural effusion in IgG4-related pleuritis

Cited by 7 publications

References 16 publications

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

A case of immunoglobulin G4-Related disease with pleural effusion, requiring exclusion of tuberculous pleurisy

A case report of IgG4-related respiratory disease with pleural effusion and a literature review

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