Cargando…
IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT
In general, we have to assume tuberculous pleurisy when a patient presents with pleural effusion and elevated adenosine deaminase (ADA). However, other diseases need to be considered, including immunoglobulin (Ig)G4-related disease (IgG4-RD). This case involved a 65-year-old asymptomatic man with ri...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193316/ https://www.ncbi.nlm.nih.gov/pubmed/32373457 http://dx.doi.org/10.1016/j.rmcr.2020.101066 |
_version_ | 1783528171767857152 |
---|---|
author | Tamura, Kentaro Suzuki, Manabu Ishii, Satoru Takasaki, Jin Naka, Go Iikura, Motoyasu Izumi, Shinyu Takeda, Yuichiro Hojo, Masayuki Sugiyama, Haruhito |
author_facet | Tamura, Kentaro Suzuki, Manabu Ishii, Satoru Takasaki, Jin Naka, Go Iikura, Motoyasu Izumi, Shinyu Takeda, Yuichiro Hojo, Masayuki Sugiyama, Haruhito |
author_sort | Tamura, Kentaro |
collection | PubMed |
description | In general, we have to assume tuberculous pleurisy when a patient presents with pleural effusion and elevated adenosine deaminase (ADA). However, other diseases need to be considered, including immunoglobulin (Ig)G4-related disease (IgG4-RD). This case involved a 65-year-old asymptomatic man with right pleural effusion showing elevated ADA. He had no articular findings or rashes. Results were negative for all autoantibodies. Pleura, mediastinal lymph nodes, and areas around the aorta and vertebra showed high uptake of (18)F-fluorodeoxyglucose (FDG) on positron-emission tomography-computed tomography (PET-CT). These findings were specific for IgG4-RD. Based on the results of FDG-PET-CT, we performed thoracoscopy under local anesthesia and bronchoscopy. Pleural biopsy and culture, and other examinations including sputum and blood yielded negative findings for tuberculous pleurisy. A pleural biopsy specimen showed IgG4-positive plasma cells and fibrosis without obliterative phlebitis or storiform fibrosis, and serum IgG4 was also high. The ratio of IgG4-to IgG-positive plasma cells was under 40%, and >10 IgG4-positive cells were seen in high-power fields. This case was classed as ‘possible IgG4-RD’ on the comprehensive diagnostic criteria for IgG4-RD, but did not meet the diagnostic criteria for IgG4-related respiratory disease. Prednisolone proved effective against the pleural effusion. We therefore clinically diagnosed IgG4-RD with pleural effusion based on the 2019 classification criteria for IgG4-RD in the United States. Although few cases of IgG4-RD with pleural effusion have been reported, this disease needs to be considered among the differential diagnoses for high-ADA pleural effusion. FDG-PET-CT and thoracoscopy under local anesthesia may be helpful for diagnosis. |
format | Online Article Text |
id | pubmed-7193316 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-71933162020-05-05 IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT Tamura, Kentaro Suzuki, Manabu Ishii, Satoru Takasaki, Jin Naka, Go Iikura, Motoyasu Izumi, Shinyu Takeda, Yuichiro Hojo, Masayuki Sugiyama, Haruhito Respir Med Case Rep Case Report In general, we have to assume tuberculous pleurisy when a patient presents with pleural effusion and elevated adenosine deaminase (ADA). However, other diseases need to be considered, including immunoglobulin (Ig)G4-related disease (IgG4-RD). This case involved a 65-year-old asymptomatic man with right pleural effusion showing elevated ADA. He had no articular findings or rashes. Results were negative for all autoantibodies. Pleura, mediastinal lymph nodes, and areas around the aorta and vertebra showed high uptake of (18)F-fluorodeoxyglucose (FDG) on positron-emission tomography-computed tomography (PET-CT). These findings were specific for IgG4-RD. Based on the results of FDG-PET-CT, we performed thoracoscopy under local anesthesia and bronchoscopy. Pleural biopsy and culture, and other examinations including sputum and blood yielded negative findings for tuberculous pleurisy. A pleural biopsy specimen showed IgG4-positive plasma cells and fibrosis without obliterative phlebitis or storiform fibrosis, and serum IgG4 was also high. The ratio of IgG4-to IgG-positive plasma cells was under 40%, and >10 IgG4-positive cells were seen in high-power fields. This case was classed as ‘possible IgG4-RD’ on the comprehensive diagnostic criteria for IgG4-RD, but did not meet the diagnostic criteria for IgG4-related respiratory disease. Prednisolone proved effective against the pleural effusion. We therefore clinically diagnosed IgG4-RD with pleural effusion based on the 2019 classification criteria for IgG4-RD in the United States. Although few cases of IgG4-RD with pleural effusion have been reported, this disease needs to be considered among the differential diagnoses for high-ADA pleural effusion. FDG-PET-CT and thoracoscopy under local anesthesia may be helpful for diagnosis. Elsevier 2020-04-25 /pmc/articles/PMC7193316/ /pubmed/32373457 http://dx.doi.org/10.1016/j.rmcr.2020.101066 Text en © 2020 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Case Report Tamura, Kentaro Suzuki, Manabu Ishii, Satoru Takasaki, Jin Naka, Go Iikura, Motoyasu Izumi, Shinyu Takeda, Yuichiro Hojo, Masayuki Sugiyama, Haruhito IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT |
title | IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT |
title_full | IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT |
title_fullStr | IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT |
title_full_unstemmed | IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT |
title_short | IgG4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and FDG-PET-CT |
title_sort | igg4-related disease with elevated adenosine deaminase in pleural effusion diagnosed clinically using thoracoscopy under local anesthesia and fdg-pet-ct |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193316/ https://www.ncbi.nlm.nih.gov/pubmed/32373457 http://dx.doi.org/10.1016/j.rmcr.2020.101066 |
work_keys_str_mv | AT tamurakentaro igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT suzukimanabu igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT ishiisatoru igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT takasakijin igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT nakago igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT iikuramotoyasu igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT izumishinyu igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT takedayuichiro igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT hojomasayuki igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct AT sugiyamaharuhito igg4relateddiseasewithelevatedadenosinedeaminaseinpleuraleffusiondiagnosedclinicallyusingthoracoscopyunderlocalanesthesiaandfdgpetct |