A case report of IgG4-related respiratory disease with pleural effusion and a literature review. Issue 30 (29th July 2022)

• Record Type: Journal Article
• Authors: Guo, Qing; Ren, Yue; Wang, Quanyi; Pei, Hongyun; Jiang, Shenghua
• Is Part Of: Medicine. Volume 101:Issue 30(2022)
• Page Start: e29338
• Publication Date: 2022-07-29
• Subjects: diagnosis -- immunoglobulin G4 -- pleural effusion -- thoracoscope; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000029338
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : 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.