IgG4-related tubulointerstitial nephritis presenting with psychiatric manifestations and skin lesions

Ramachandran, Raja; Rajakumar, V; Rawat, Amit; Nada, Ritambhra; Kumar, Vivek; Rathi, Manish; Kohli, Harbir Singh; Sakhuja, Vinay; Jha, Vivekanand

doi:10.1007/s11255-013-0447-6

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…The reported case and ours are characterized by infiltration of plasma cells, some of which bore IgG4, and deposition of IgG4 in the vascular endothelial cells. Notably, these and our own cases developed psoriasis‐like eruption after long‐standing sclerosing cholangitis and/or sclerosing kidney . As the frequency of psoriasis is generally high, it remains to be elucidated whether IgG4‐RD and psoriasis are pathologically related or simply coincidental.…”

Section: Classification Of Igg4‐related Diseasementioning

confidence: 74%

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IgG4‐related skin disease

et al. 2014

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IgG4-related disease (IgG4-RD) is a recently established clinical entity characterized by high levels of circulating IgG4, and tissue infiltration of IgG4(+) plasma cells. IgG4-RD exhibits a distinctive fibroinflammatory change involving multiple organs, such as the pancreas and salivary and lacrimal glands. The skin lesions of IgG4-RD have been poorly characterized and may stem not only from direct infiltration of plasma cells but also from IgG4-mediated inflammation. Based on the documented cases together with ours, we categorized the skin lesions into seven subtypes: (1) cutaneous plasmacytosis (multiple papulonodules or indurations on the trunk and proximal part of the limbs), (2) pseudolymphoma and angiolymphoid hyperplasia with eosinophilia (plaques and papulonodules mainly on the periauricular, cheek and mandible regions), (3) Mikulicz disease (palpebral swelling, sicca syndrome and exophthalmos), (4) psoriasis-like eruption (strikingly mimicking psoriasis vulgaris), (5) unspecified maculopapular or erythematous eruptions, (6) hypergammaglobulinaemic purpura (bilateral asymmetrical palpable purpuric lesions on the lower extremities) and urticarial vasculitis (prolonged urticarial lesions occasionally with purpura) and (7) ischaemic digit (Raynaud phenomenon and digital gangrene). It is considered that subtypes 1-3 are induced by direct infiltration of IgG4(+) plasma cells, while the other types (4-7) are caused by secondary mechanisms. IgG4-related skin disease is defined as IgG4(+) plasma-cell-infiltrating skin lesions that form plaques, nodules or tumours (types 1-3), but may manifest secondary lesions caused by IgG4(+) plasma cells and/or IgG4 (types 4-7).

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Section: Classification Of Igg4‐related Diseasementioning

confidence: 74%

“…A couple of cases have shown that patients with IgG4‐RD develop multiple hyperkeratotic erythematous plaques indistinguishable from chronic plaque psoriasis . There were typical histological findings, but plasma cells infiltrated perivascularly .…”

Section: Classification Of Igg4‐related Diseasementioning

confidence: 99%

IgG4‐related skin disease

et al. 2014

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“…This creates significant potential pitfalls. For example, failure to utilize stringent diagnostic criteria resulted in a recent attempt at classification of cutaneous IgG4‐RD that incorporated many spurious entities, including a lithium‐induced exacerbation of incidental psoriasis (not biopsied), cases that were never evaluated for the presence of IgG4‐bearing plasma cells, and mimetic cases wherein the diagnosis of IgG4‐RD was ruled out . We now address these diagnostic pitfalls by classification of IgG4‐RD mimics based on degree of clinicopathologic similarity (Fig.…”

Section: Methodsmentioning

confidence: 99%

IgG4‐related skin disease may have distinct systemic manifestations: a systematic review

et al. 2016

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IgG4-related disease (IgG4-RD) is an increasingly prevalent protean multisystem disorder characterized by single or multi-organ infiltration of IgG4-bearing plasma cells. Skin involvement has been recognized and is relevant to proper diagnosis. A systematic literature review of 50 cases involving the skin reveals that patients with IgG4-related skin disease show predominant involvement of the head and neck and have a distinct pattern of systemic involvement, also favoring the head and neck - lymphatics, orbit, salivary, and lacrimal glands - but generally lacking pancreaticobiliary involvement (16% of cases), which by contrast is a predominant manifestation in systemic IgG4-RD (60% with pancreaticobiliary involvement). We summarize clinical and pathologic descriptive data from this systematic review. We review differential diagnosis and propose a diagnostic scheme for stratifying probability of disease based upon comprehensive integration of clinical, histopathologic, and laboratory data. Plasmacyte infiltration and storiform fibrosis are prominent in IgG4-related skin disease, but obliterative venulitis is less common than in the prototypical IgG4-related disease manifestation of autoimmune pancreatitis. IgG4 tissue and serum values, with a mean (±95% CI) in the reviewed cases of 132.8 ± 32.6 IgG4-positive plasma cells per high-power field and 580 ± 183.8 mg/dl, respectively, are incorporated into the suggested criteria. The distinct set of manifestations identified by this systematic review and the proposed diagnostic considerations, while requiring further validation in prospective studies, highlight the need to consider that IgG4-related skin disease defines a unique systemic disease complex along the spectrum of IgG4-RD.

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“…1 Psoriasis-like eruptions have been reported in only two cases, which were complicated with sclerosing cholangitis or tubulointerstitial nephritis. 5,6 To our knowledge, patients described above in case 1 and case 2 are the first two reported cases of GPP complicated by IgG4-RD.…”

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confidence: 87%

“…IgG4‐positive plasma cells or IgG4 can indirectly lead to psoriasis‐like eruptions, hypergammaglobulinaemic purpura, unspecified maculopapular or erythematous eruptions, urticarial vasculitis, and ischaemic digit as secondary skin manifestations . Psoriasis‐like eruptions have been reported in only two cases, which were complicated with sclerosing cholangitis or tubulointerstitial nephritis . To our knowledge, patients described above in case 1 and case 2 are the first two reported cases of GPP complicated by IgG4‐RD.…”

mentioning

confidence: 89%