IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report
Abstract Background Immune checkpoint inhibitors (ICIs) are the standard treatment for non-small cell lung cancer. The unique adverse events that can arise after treatment with ICIs are known as immune-related adverse events (irAE). As the number of cases under treatment with ICIs increases, new typ...
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doaj-dccebc50193d4b608d713193b5e10a162020-11-25T03:02:43ZengBMCBMC Pulmonary Medicine1471-24662020-04-012011510.1186/s12890-020-1150-xIgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case reportTakeshi Terashima0Eri Iwami1Takashi Shimada2Aoi Kuroda3Tatsu Matsuzaki4Takahiro Nakajima5Aya Sasaki6Keisuke Eguchi7Department of Respiratory Medicine, Tokyo Dental College Ichikawa General HospitalDepartment of Respiratory Medicine, Tokyo Dental College Ichikawa General HospitalDepartment of Respiratory Medicine, Tokyo Dental College Ichikawa General HospitalDepartment of Respiratory Medicine, Tokyo Dental College Ichikawa General HospitalDepartment of Respiratory Medicine, Tokyo Dental College Ichikawa General HospitalDepartment of Respiratory Medicine, Tokyo Dental College Ichikawa General HospitalDepartment of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General HospitalDepartment of Surgery, Tokyo Dental College Ichikawa General HospitalAbstract Background Immune checkpoint inhibitors (ICIs) are the standard treatment for non-small cell lung cancer. The unique adverse events that can arise after treatment with ICIs are known as immune-related adverse events (irAE). As the number of cases under treatment with ICIs increases, new types of characteristics of irAE have emerged. This case report suggests that IgG4-related pleural disease could occur as an irAE. Case presentation A 64-year-old man was diagnosed with pulmonary adenocarcinoma stage IIIB. Following concurrent chemoradiotherapy, durvalumab was administered every two weeks. The patient complained of dyspnea on effort 4 months after the initiation of durvalumab therapy. Chest CT scans showed mild bilateral pleural effusion 4 months after the initiation of durvalumab therapy, and the amount of pleural effusion increased further at 7 months. Durvalumab was thought to be a potential cause of pleural effusion and was withdrawn after 13 courses of administration over 7 months. The level of serum IgG4 was 2750 mg/dL. The levels of IgG4 of the pleural fluids were 2790 mg/dL on the right side and 2890 mg/dL on the left side at 7 months. Microscopic examination of the pleural biopsy revealed lymphoplasmacytic infiltration with storiform fibrosis. Immunohistochemical examinations showed that the number of IgG4-positive cells was > 20/high power field and the percentage of IgG4-positive to IgG-positive plasma cells was > 50%. Oral prednisolone at a dose of 30 mg/day was initiated, and remarkable clinical improvements were achieved. After 4 months of prednisolone therapy, the level of serum IgG4 decreased to 370 mg/dL and chest CT revealed the disappearance of bilateral pleural effusion. Conclusion This was a case of IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment. To our knowledge, this is the first case report of IgG4-related pleural disease as an irAE. It is important to consider the possibility of IgG4-related pleural disease in cases of pleural effusion during the treatment with ICIs.http://link.springer.com/article/10.1186/s12890-020-1150-xDurvalumabIgG4-related pleural diseaseImmune checkpoint inhibitorsImmune-related adverse eventsLung cancer |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Takeshi Terashima Eri Iwami Takashi Shimada Aoi Kuroda Tatsu Matsuzaki Takahiro Nakajima Aya Sasaki Keisuke Eguchi |
spellingShingle |
Takeshi Terashima Eri Iwami Takashi Shimada Aoi Kuroda Tatsu Matsuzaki Takahiro Nakajima Aya Sasaki Keisuke Eguchi IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report BMC Pulmonary Medicine Durvalumab IgG4-related pleural disease Immune checkpoint inhibitors Immune-related adverse events Lung cancer |
author_facet |
Takeshi Terashima Eri Iwami Takashi Shimada Aoi Kuroda Tatsu Matsuzaki Takahiro Nakajima Aya Sasaki Keisuke Eguchi |
author_sort |
Takeshi Terashima |
title |
IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report |
title_short |
IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report |
title_full |
IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report |
title_fullStr |
IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report |
title_full_unstemmed |
IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report |
title_sort |
igg4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment: a case report |
publisher |
BMC |
series |
BMC Pulmonary Medicine |
issn |
1471-2466 |
publishDate |
2020-04-01 |
description |
Abstract Background Immune checkpoint inhibitors (ICIs) are the standard treatment for non-small cell lung cancer. The unique adverse events that can arise after treatment with ICIs are known as immune-related adverse events (irAE). As the number of cases under treatment with ICIs increases, new types of characteristics of irAE have emerged. This case report suggests that IgG4-related pleural disease could occur as an irAE. Case presentation A 64-year-old man was diagnosed with pulmonary adenocarcinoma stage IIIB. Following concurrent chemoradiotherapy, durvalumab was administered every two weeks. The patient complained of dyspnea on effort 4 months after the initiation of durvalumab therapy. Chest CT scans showed mild bilateral pleural effusion 4 months after the initiation of durvalumab therapy, and the amount of pleural effusion increased further at 7 months. Durvalumab was thought to be a potential cause of pleural effusion and was withdrawn after 13 courses of administration over 7 months. The level of serum IgG4 was 2750 mg/dL. The levels of IgG4 of the pleural fluids were 2790 mg/dL on the right side and 2890 mg/dL on the left side at 7 months. Microscopic examination of the pleural biopsy revealed lymphoplasmacytic infiltration with storiform fibrosis. Immunohistochemical examinations showed that the number of IgG4-positive cells was > 20/high power field and the percentage of IgG4-positive to IgG-positive plasma cells was > 50%. Oral prednisolone at a dose of 30 mg/day was initiated, and remarkable clinical improvements were achieved. After 4 months of prednisolone therapy, the level of serum IgG4 decreased to 370 mg/dL and chest CT revealed the disappearance of bilateral pleural effusion. Conclusion This was a case of IgG4-related pleural disease in a patient with pulmonary adenocarcinoma under durvalumab treatment. To our knowledge, this is the first case report of IgG4-related pleural disease as an irAE. It is important to consider the possibility of IgG4-related pleural disease in cases of pleural effusion during the treatment with ICIs. |
topic |
Durvalumab IgG4-related pleural disease Immune checkpoint inhibitors Immune-related adverse events Lung cancer |
url |
http://link.springer.com/article/10.1186/s12890-020-1150-x |
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