Kanzaki Yusuke, Miura Takashi, Hashizume Naoto, Saigusa Tatsuya, Ebisawa Soichiro, Kuwahara Koichiro
Department of Cardiology, Shinonoi General Hospital, Nagano, Japan.
Department of Cardiovascular Medicine, School of Medicine, Shinshu University, Matsumoto, Japan.
SAGE Open Med Case Rep. 2017 Aug 25;5:2050313X17728010. doi: 10.1177/2050313X17728010. eCollection 2017.
Immunoglobulin G4-related disease characteristically involves multiple organs including the heart and coronary arteries. Immunoglobulin G4-related coronary artery disease is thought to be due to periarteritis and histopathologically is characterized by marked thickening of the adventitia and periarterial fat with infiltration of immunoglobulin G4-positive plasma cells. Although comprehensive diagnostic criteria require a biopsy for a definite or probable diagnosis of immunoglobulin G4-related disease, obtaining a coronary artery biopsy is difficult and risky. However, imaging findings including coronary angiography and intravascular ultrasound might be useful tools to establish a diagnosis of immunoglobulin G4-related coronary artery disease. We report a case of a 63-year-old man with a history of immunoglobulin G4-related disease who presented with exertional chest pain. We found unique angiographic and intravascular ultrasound features of immunoglobulin G4-related coronary artery disease that distinguished it from those of arteriosclerotic coronary artery disease and suggest that coronary angiography and intravascular ultrasound might be useful tools in the diagnosis of immunoglobulin G4-related coronary artery disease.
免疫球蛋白G4相关疾病的特征是累及包括心脏和冠状动脉在内的多个器官。免疫球蛋白G4相关冠状动脉疾病被认为是由于动脉周围炎引起的，其组织病理学特征是外膜和动脉周围脂肪明显增厚，并伴有免疫球蛋白G4阳性浆细胞浸润。尽管全面的诊断标准要求进行活检以明确或可能诊断免疫球蛋白G4相关疾病，但获取冠状动脉活检困难且有风险。然而，包括冠状动脉造影和血管内超声在内的影像学检查结果可能是诊断免疫球蛋白G4相关冠状动脉疾病的有用工具。我们报告一例63岁有免疫球蛋白G4相关疾病病史的男性，其出现劳力性胸痛。我们发现了免疫球蛋白G4相关冠状动脉疾病独特的血管造影和血管内超声特征，这些特征将其与动脉粥样硬化性冠状动脉疾病区分开来，并提示冠状动脉造影和血管内超声可能是诊断免疫球蛋白G4相关冠状动脉疾病的有用工具。
