A 52-year-old woman presented to our hospital due to elevated liver enzyme levels and hypereosinophilia. Liver biopsy specimens revealed chronic hepatitis with abundant eosinophils and immunoglobulin G4(IgG4)-positive plasma cell infiltration. Systemic lymphadenopathy, including that involving the hepatic hilar lymph nodes, was observed on computed tomography, and the cervical lymph node biopsy specimens exhibited lymphoid follicular hyperplasia and IgG4-positive plasma cell infiltration. It is sometimes difficult to distinguish hypereosinophilic syndrome (HES) from IgG4-related disease, as some of the clinical findings overlap. The numerous areas of eosinophilic infiltration observed in the liver indicated a diagnosis of HES in our case.
To cite this article: Norihiro Nagamura & Toshihiro Imada (2021): Anti-interferongamma autoantibody related disseminated nontuberculous mycobacteriosis with pathological features of immunoglobulin G4-related disease, Immunological Medicine,
Ureteritis associated with immunological disorder is rarely reported, and most cases in this category are small vessel vasculitis and immunoglobulin G4 (IgG4)-related disease. Rheumatoid arthritis (RA) associated ureteritis is uncommon and underlying etiology is unclear. We present a patient of ureteritis who had medical history of RA and successfully treated with steroid and immunosuppressant.
A 49-year-old woman who had been treated for rheumatoid arthritis (RA) and atopic dermatitis (AD) suffered from gross hematuria for five successive days. Contrast enhanced-computed tomography (CE-CT) showed right dominant upper urinary tract dilatation with enhanced thickened wall. The hematuria continued accompanied with intermittent right back and lower abdominal pain, and following CT image taken after three months presented the progression to bilateral hydronephrosis. Ureteral stents were placed and antibiotic therapy was introduced for obstructive pyelonephritis. Ureterocystoscopy and following biopsy from the upper ureteral tract showed chronic inflammatory change in the histopathology, and we finally considered the stenosing ureteritis to be caused by immune-mediated mechanism related to RA. After starting steroid therapy with methotrexate, therapeutic response was obtained to remove the stents. In the cases of ureteritis or ureteral stenosis of unknown etiology with medical history of immunological disorders, we should consider the underlying immune-activated state and try to test CE-CT and histological examination before performing surgical procedure. After excluding the common causes of ureteritis or ureteral stenosis, these tests would support the appropriate diagnosis.
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