Isolated Involvement of Prostate Gland by Immunoglobulin G4–Related Disease Diagnosed With the Help of FDG PET/CT

Kousik, Vankadari; Mittal, Bhagwant Rai; Kumar, Rajender; Singh, Harmandeep; Bhattacharya, Anish; Kochhar, Rakesh

doi:10.1097/rlu.0000000000002689

Cited by 2 publications

(3 citation statements)

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“…We report the youngest age of presentation with voiding symptoms attributable to IgG4-RD. Only one previous case by Vankadari et al has reported a case of IgG4-related prostatitis in a 20-year-old male, however his presenting symptoms were recurring fever and abdominal pain, with no voiding symptoms [14]. Our case is also the first to report priapism in a patient with IgG4-RD.…”

Section: Discussionsupporting

confidence: 50%

“…There have been no previous reports outlining duration of steroid or rituximab treatment required to achieve symptomatic improvement. 18 F-Fluorodeoxyglucose ( 18 F-FDG)-positron emission tomography (PET) has also been used to support diagnosis of IgG4-related prostatitis as IgG4 lesions are FDG-avid [14,20].…”

Section: Discussionmentioning

confidence: 99%

“…Although IgG4-RD may affect nearly every organ system, genitourinary involvement is less commonly reported and typically manifests as retroperitoneal fibrosis [6]. Involvement of the prostate is less common, but IgG4-related prostatitis has been reported in limited case reports [7][8][9][10][11][12][13][14][15]. In the majority of described cases, those with prostatic involvement are elderly males over the age of 55 whose symptoms were initially attributed to benign prostatic hyperplasia (BPH) [8,10].…”

Section: Introductionmentioning

confidence: 99%

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IgG4-related prostatitis manifesting as urinary obstruction in a 28-year-old male

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Background Immunoglobulin G4-related disease (IgG4-RD) is a systemic lymphoproliferative disorder characterized by elevated serum IgG4 levels and tumefactive lesions that can involve nearly every organ system. Involvement of the prostate is rare but has been reported in limited cases. Case presentation A 28-year-old man of Asian descent with a history of sinusitis and priapism presented to hospital with rigors and voiding symptoms. He was diagnosed with IgG4-RD one month prior to presentation, following pathological analysis of a submandibular mass that demonstrated chronic sclerosing sialadenitis. On presentation, white blood cell count, C-reactive protein, and prostate serum antigen levels were all within normal limits. Examination was notable for a large, firm prostate, and a foley catheter was inserted. Contrast CT of the abdomen was unremarkable. Further workup revealed elevated serum IgG4 levels (9.22 g/L) and he was subsequently started on prednisone 35 mg daily. Imaging to screen for systemic IgG4-RD involvement demonstrated paravertebral soft tissue involvement and he was given rituximab 1000 mg IV × 2 doses. MRI revealed diffuse prostatitis. Five days after starting prednisone and one day after his first dose of rituximab, he successfully passed trial of void and was discharged home. Conclusions IgG4-related prostatitis is a rare and underrecognized manifestation of IgG4-RD. Our case highlights the need to consider IgG4-related prostatitis as an etiology of urinary obstruction in young individuals. Resolution of symptoms following treatment with steroids may be diagnostic of IgG4-related prostatitis, and may potentially avoid the need for invasive diagnostic procedures such as prostate biopsy.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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IgG4-related prostatitis manifesting as urinary obstruction in a 28-year-old male

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Therapy of immunoglonuline IgG4 related disease (IgG4-RD)

Adam¹,

Dastych²,

Čermák³

et al. 2022

Vnitř Lék

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Oddělení chirurgie nemocnice Frýdek Místek a Chirurgické oddělení Vsetínské nemocnice S imunoglobulinem IgG4 asociované onemocnění (IgG4-related disease -IgG4-RD) je heterogenní skupina chorob s multiorgánovým poškozením, která byla rozpoznána v posledních 12 letech. Cílem tohoto textu je podat přehled zkušeností s léčbou této choroby. Glukokortikoidy zůstávají stále léčbou první volby, ale dlouhodobé podávání glukokortikoidů v monoterapii je spojeno s četnými nežádoucími účinky a komplikacemi. V případě kombinace glukokortikoidů s některým z léků ze skupiny imunosupresiv je možné podávat nižší dávky glukokortikoidů po kratší čas a počet léčebných odpovědí je vyšší než při použití pouhých glukokortikoidů. Rituximab je možno použít jako monoterapii anebo v kombinaci s glukokortikoidy a imunosupresivními léky. Který z imunosupresivních léků považovat za nejvhodnější, není známo. Pouze jedna studie srovnávala léčbu kombinací glukokortikoidů a mykofenolát mofetilu s léčbou glukokortikoidy a cyklofosfamidem. Počet léčebných odpovědí byl v obou ramenech stejný, ale délka remise byla delší ve skupině pacientů léčených glukokortikoidy a cyklofosfamidem. Rituximab dosahuje vysoký počet léčebných odpovědí (90 %) i v monoterapii, ale je možné jeho účinek dále potencovat glukokortikoidy a imunosupresivy. Rituximab je nyní preferován a doporučován pro udržovací léčbu v dávce 1000 mg 1× za 6 měsíců. U pacientů s multiorgánovým postižením se nám osvědčila kombinace rituximabu, cyklofosfamidu a dexametazonu následovaná aplikací rituximabu s jednorázovou dávku dexametazonu v 6měsíčních intervalech. V klinickém zkoušení jsou dva nové a nadějné léky: abatacept a dupilimab. Základem pro úspěšnou léčbu je podobně jako u jiných chorob časná diagnostika se zahájením léčby před vznikem ireversibilních fibrotických změn v postižených orgánech.

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Isolated Involvement of Prostate Gland by Immunoglobulin G4–Related Disease Diagnosed With the Help of FDG PET/CT

Cited by 2 publications

References 9 publications

IgG4-related prostatitis manifesting as urinary obstruction in a 28-year-old male

IgG4-related prostatitis manifesting as urinary obstruction in a 28-year-old male

Therapy of immunoglonuline IgG4 related disease (IgG4-RD)

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