Ishida Atsuko, Furuya Naoki, Nishisaka Takashi, Mineshita Masamichi, Miyazawa Teruomi
*Department of Internal Medicine, Division of Respiratory and Infectious Diseases, St Marianna University School of Medicine, Kawasaki †Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
J Bronchology Interv Pulmonol. 2014 Jul;21(3):237-41. doi: 10.1097/LBR.0000000000000082.
A 74-year-old woman with massive bilateral pleural effusion, which was exudative in nature, and with mononuclear cell predominance underwent a pleuroscopy. Parietal pleura were thickened and partly reddish in color. Biopsy specimens taken from the parietal pleura revealed lymphoplasmacytic inflammation with fibrosis. As her performance status rapidly worsened with thoracentesis, we performed bilateral pleurodesis using talc. Pathologic evaluation of the pleural biopsy specimen with immunohistochemical staining revealed 91 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of 91%. Thus, the diagnosis of pleuritis from IgG4-related disease was established. Our case suggests that IgG4-related disease is one of the causes of pleural effusion, and it should be included in the differential diagnosis of unexplained pleuritis.
一名74岁女性，双侧大量胸腔积液，性质为渗出液，以单核细胞为主，接受了胸腔镜检查。壁层胸膜增厚，部分呈红色。取自壁层胸膜的活检标本显示淋巴细胞浆细胞性炎症伴纤维化。由于胸腔穿刺术后她的身体状况迅速恶化，我们使用滑石粉进行了双侧胸膜固定术。对胸膜活检标本进行免疫组织化学染色的病理评估显示，每高倍视野有91个IgG4阳性浆细胞，IgG4/IgG比值为91%。因此，确诊为IgG4相关疾病所致胸膜炎。我们的病例表明，IgG4相关疾病是胸腔积液的病因之一，在不明原因胸膜炎的鉴别诊断中应予以考虑。
