Characteristics of pleural effusion in IgG4-related pleuritis
Here we describe the case of a 78-year-old man with respiratory failure and right pleural effusion. Computed tomography showed right pleural effusion with pleural calcification, tumor-like shadows induced by passive atelectasis, and enlarged mediastinal lymph nodes. Positron emission tomography show...
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doaj-bba2dc65f3ab4641be13e93be66baf3e2020-11-25T03:23:01ZengElsevierRespiratory Medicine Case Reports2213-00712020-01-0129Characteristics of pleural effusion in IgG4-related pleuritisZenya Saito0Masahiro Yoshida1Ayako Kojima2Kentaro Tamura3Kazuyoshi Kuwano4Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan; Corresponding author. Department of Respiratory Medicine, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan.Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, JapanDivision of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, JapanDivision of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, JapanDivision of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanHere we describe the case of a 78-year-old man with respiratory failure and right pleural effusion. Computed tomography showed right pleural effusion with pleural calcification, tumor-like shadows induced by passive atelectasis, and enlarged mediastinal lymph nodes. Positron emission tomography showed right pleural thickening, rounded atelectasis, and enlarged mediastinal lymph nodes, without fluid accumulation in other organs. The pleural effusion showed lymphocyte-dominated exudates with elevated adenosine deaminase (ADA) levels. Tuberculous pleuritis was suspected, but thoracoscopic pleural biopsy revealed lymphoplasmacytic infiltration and fibrosis, with 10 immunoglobulin G4 (IgG4)-positive plasma cells/high-power field, and IgG4/IgG ratio of 40%. IgG4 concentrations in serum and right pleural effusion were 929 and 1120 mg/dL, respectively. The patient was diagnosed with IgG4-related pleuritis without other systemic manifestations, and reduction in right pleural effusion was confirmed by corticosteroid therapy. IgG4-related disease is typically a systemic disease causing lymphoplasmacytic inflammation in multiple organs. We describe a rare form of IgG4-related pleuritis showing pleural effusion with no other systemic manifestation. Keywords: IgG4-related disease, Pleural effusion, Pleuritishttp://www.sciencedirect.com/science/article/pii/S2213007119303004 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zenya Saito Masahiro Yoshida Ayako Kojima Kentaro Tamura Kazuyoshi Kuwano |
spellingShingle |
Zenya Saito Masahiro Yoshida Ayako Kojima Kentaro Tamura Kazuyoshi Kuwano Characteristics of pleural effusion in IgG4-related pleuritis Respiratory Medicine Case Reports |
author_facet |
Zenya Saito Masahiro Yoshida Ayako Kojima Kentaro Tamura Kazuyoshi Kuwano |
author_sort |
Zenya Saito |
title |
Characteristics of pleural effusion in IgG4-related pleuritis |
title_short |
Characteristics of pleural effusion in IgG4-related pleuritis |
title_full |
Characteristics of pleural effusion in IgG4-related pleuritis |
title_fullStr |
Characteristics of pleural effusion in IgG4-related pleuritis |
title_full_unstemmed |
Characteristics of pleural effusion in IgG4-related pleuritis |
title_sort |
characteristics of pleural effusion in igg4-related pleuritis |
publisher |
Elsevier |
series |
Respiratory Medicine Case Reports |
issn |
2213-0071 |
publishDate |
2020-01-01 |
description |
Here we describe the case of a 78-year-old man with respiratory failure and right pleural effusion. Computed tomography showed right pleural effusion with pleural calcification, tumor-like shadows induced by passive atelectasis, and enlarged mediastinal lymph nodes. Positron emission tomography showed right pleural thickening, rounded atelectasis, and enlarged mediastinal lymph nodes, without fluid accumulation in other organs. The pleural effusion showed lymphocyte-dominated exudates with elevated adenosine deaminase (ADA) levels. Tuberculous pleuritis was suspected, but thoracoscopic pleural biopsy revealed lymphoplasmacytic infiltration and fibrosis, with 10 immunoglobulin G4 (IgG4)-positive plasma cells/high-power field, and IgG4/IgG ratio of 40%. IgG4 concentrations in serum and right pleural effusion were 929 and 1120 mg/dL, respectively. The patient was diagnosed with IgG4-related pleuritis without other systemic manifestations, and reduction in right pleural effusion was confirmed by corticosteroid therapy. IgG4-related disease is typically a systemic disease causing lymphoplasmacytic inflammation in multiple organs. We describe a rare form of IgG4-related pleuritis showing pleural effusion with no other systemic manifestation. Keywords: IgG4-related disease, Pleural effusion, Pleuritis |
url |
http://www.sciencedirect.com/science/article/pii/S2213007119303004 |
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