Nagayasu Atsushi, Kubo Satoshi, Nakano Kazuhisa, Nakayamada Shingo, Iwata Shigeru, Miyagawa Ippei, Fukuyo Shunsuke, Saito Kazuyoshi, Tanaka Yoshiya
The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan.
Internal Medicine, Tobata General Hospital, Japan.
Intern Med. 2018 Aug 1;57(15):2251-2257. doi: 10.2169/internalmedicine.0387-17. Epub 2018 Mar 9.
An 81-year-old man was admitted with bilateral pleural effusion. A clinical examination showed lymphocytic pleura effusion and elevated serum IgG4 levels, so that IgG4-related disease was suggested, whereas tuberculous pleurisy was suspected because of high adenosine deaminase (ADA) levels in the pleural effusion. A surgical pleural biopsy revealed that there were large numbers of IgG4-positive cells and IgG4/IgG positive cell ratio exceeded 40% in several sites. Accordingly, we diagnosed IgG4-related pleuritis and treated with the patient with glucocorticoid therapy. The ADA levels in pleural effusion can increase in IgG4-related pleuritis, and it is therefore important to perform a pleural biopsy.
一名81岁男性因双侧胸腔积液入院。临床检查显示为淋巴细胞性胸腔积液且血清IgG4水平升高，因此提示为IgG4相关疾病，而胸腔积液中腺苷脱氨酶（ADA）水平升高又怀疑为结核性胸膜炎。手术胸膜活检显示在几个部位有大量IgG4阳性细胞且IgG4/IgG阳性细胞比例超过40%。据此，我们诊断为IgG4相关胸膜炎，并对患者进行了糖皮质激素治疗。在IgG4相关胸膜炎中胸腔积液的ADA水平可能会升高，因此进行胸膜活检很重要。
