Thoracoscopic Findings in IgG4-related Pleuritis

Yasokawa, Naoya; Shirai, Ryo; Tanaka, Hitomi; Koyama, Koji; Oga, Toru; Oka, M.

doi:10.2169/internalmedicine.3031-19

Cited by 10 publications

(4 citation statements)

References 15 publications

(23 reference statements)

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“…Thoracoscopic findings at endoscopic view are usually not specific, including pleural hyperemia, pleural thickening, hyalinized white plaques, expression of collagen fibers deposit and small nodular lesions [ 23 ]. The main histopathological features are dense lymphoplasmacytic infiltrate, obliterative phlebitis, storiform fibrosis, more than 10 IgG4-positive plasma cells per high-power field and an IgG4/IgG-positive plasma cell ratio of more than 40%; a moderate number of eosinophils granulocytes can also be observed.…”

Section: Discussionmentioning

confidence: 99%

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

et al. 2021

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Diagnostic work-up of IgG4-related disease (IgG4-RD) pleural involvement is a complex task, as there is a broad spectrum of differential diagnoses to consider. We report the case of a patient presenting with relapsing pleural effusion, discussing the main challenges for achievement of a definite diagnosis. A 63-year-old man was admitted for pleural effusion prevalent on the ride side, initially labeled as idiopathic non-specific pleuritis, based on tissue evaluation after a medical thoracoscopy. He was started on steroids with initial improvement, but a later CT scan showed a relapse of pleural effusion associated with diffuse pleural thickening; a subsequent surgical pleural biopsy revealed features suggestive for IgG4-RD, with a marked increase of IgG4 positive plasma cells. High IgG4 serum levels were also found. The present case underlines the importance of increasing awareness of this potential condition among physicians in order to properly guide the diagnostic work-up, as it is likely that IgG4-RD accounts for a proportion of patients with pleural effusions, labeled as idiopathic. In particular, in patients with unexplained pleural effusion, IgG4-RD should be included among differential diagnoses when lymphoplasmacytic infiltration is observed, and a multidisciplinary interaction between clinicians and pathologists appears crucial for an accurate diagnosis and an appropriate management.

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Section: Discussionmentioning

confidence: 99%

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

et al. 2021

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“…Metachronous pathology is a characteristic phenomenon that may occur in multiple organs in patients with IgG4‐RD. Bilateral IgG4‐associated pleuritis has been reported in 8 cases, 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 and metachronous IgG4‐related pleuritis has not been reported.…”

Section: Discussionmentioning

confidence: 99%

Metachronous bilateral immunoglobulin G4‐related pleuritis: A case report and literature review

Tanabe

Homma

Matsui

et al. 2023

Respirology Case Reports

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Immunoglobulin G4‐related disease (IgG4‐RD) is a newly recognized disease, and therefore its clinical features are not yet fully understood. Here, we describe a surgical case of metachronous bilateral IgG4‐related pleuritis and postoperative chylothorax. This case could provide key insights into the pathology of IgG4‐RD from a surgical perspective. We present a 70‐year‐old woman who had a right pleural mass. Video‐assisted thoracoscopic pleural mass resection was performed, and the patient was diagnosed with right‐sided IgG4‐related pleuritis. Two years later, she was also diagnosed with left‐sided IgG4‐related pleuritis. We suspected the presence of IgG4‐positive plasma cell infiltration. Additionally, she experienced a complicated postoperative chylothorax on the left side. It is important to consider the altered course of lymphatic vessels when extensively removing the pleura near the right thoracic duct. The occurrence of metachronous bilateral IgG4‐associated pleuritis has not been previously reported, making this case particularly significant for understanding the pathology of IgG4‐RD from a surgical standpoint.

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“…Findings in our study support that the possibility of IgG4-RRD should be considered in cases of pleural thickening, pleural nodules, and milky white plaques on medical thoracoscopy. 2 Unknown Unknown Multiple nodules, thickness and redness, a reduction in liver volume Prednisone/effective [4] 3 No No Blister-like nodules PSL/effective [5] 4 Unknown Unknown Milky white pleural plaques PSL+pericardiectomy/effective [6] 5 No Yes Thickness PSL/effective [7] 6 No No Thickness and redness TD+ Pleurodesis+pre dnisone/effective [8] 7 Unknown Unknown Normal PSL/effective [9] 8 No No A diffffuse inflflammation and fifibrin deposits Methylprednisolone/effective [10] 9 No Yes Thickness Prednisone/effective [11] 10 No No Mobile mass lesions, diffuse pleural thickening PSL/effective [12] 11 No Yes Adhesions, thickening, hyperemia and edema Methylprednisolone/effective PSL = prednisolone, refs = reference, and TD = thoracic drainage.…”

Section: Discussionmentioning

confidence: 99%

“…Ten patients with IgG4-RD involving the pleura [3][4][5][6][7][8][9][10][11][12] were reported to have been diagnosed using medical thoracoscopy following literature review in China National Knowledge Infrastructure, the PubMed database, and Google Scholar. The patient we reported is the 11th case.…”

Section: Literature Reviewmentioning

confidence: 99%

A case report of IgG4-related respiratory disease with pleural effusion and a literature review

et al. 2022

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Rationale: IgG4-related respiratory disease (IgG4-RRD) is a chronic autoimmune disease that affects the respiratory system and organs outside the respiratory system. This study explored the diagnosis and treatment of a case of IgG4-RRD with unilateral pleural effusion diagnosed using medical thoracoscopy, and provides an associated literature review. This report summarizes the clinical characteristics of IgG4-RRD involving the pleura to improve the diagnosis of this disease.Patient concerns: A 39-year-old man presented with a 2-week history of cough and chest tightness. Both physical examination and imaging supported the presence of left pleural effusion.Diagnosis: Medical electronic thoracoscopy was performed to obtain a pleural biopsy, which showed lymphoplasmacytic infiltration, 40 IgG4+ plasma cells per High Power Field (HPF) on microscopy, IgG4/IgG ratio >50%, phlebitis obliterans, and storiform fibrosis. The final diagnosis was IgG4-RRD. Interventions and outcomes:The patient was treated with methylprednisolone, after which his symptoms improved, and he was discharged. Oral hormone therapy was continued outside the hospital. After 4 months, the patient returned to the hospital and his condition had improved significantly.Lessons: Pleural involvement in IgG4-RRD is rare, and its diagnosis depends on pleural biopsy. Thoracoscopy usually reveals pleural thickening, pleural nodules, and milky white plaques.

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Thoracoscopic Findings in IgG4-related Pleuritis

Cited by 10 publications

References 15 publications

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

Pleural Involvement in IgG4-Related Disease: Case Report and Review of the Literature

Metachronous bilateral immunoglobulin G4‐related pleuritis: A case report and literature review

A case report of IgG4-related respiratory disease with pleural effusion and a literature review

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