A case report of IgG4-related respiratory disease with pleural effusion and a literature review |
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| Authors: | Qing Guo Yue Ren Quanyi Wang Hongyun Pei Shenghua Jiang |
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| Affiliation: | aCollege of Clinical Medicine, Jining Medical University, Jining, Shandong, China;bPathology Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China;cDepartment of Respiratory Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong, China. |
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| 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. |
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| Keywords: | diagnosis immunoglobulin G4 pleural effusion thoracoscope |
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