Department of Nephrology, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Nephrol. 2019 Jan 16;20(1):23. doi: 10.1186/s12882-019-1205-5.
Understanding the uncommon association of IgG4-related disease with other disorders is essential for the accurate diagnosis and effective treatment of patients. To the best of our knowledge, there have been only few reports of patients with IgG4-related kidney disease coexisting with metastasis of malignancy. Here, we report a rare case of simultaneous occurring IgG4-related tubulointerstitial nephritis and colon adenocarcinoma with hepatic metastasis.
A 71-year-old Chinese man presented with dysuria and was initially diagnosed as benign prostatic hyperplasia for one year. He was admitted to the hospital for surgery. After admission, the renal function tests revealed a rapid increase of serum creatinine from 291.0 μmol/L to 415 μmol/L. The hemoglobin level was 89 g/L. Fecal occult blood testing was positive. Urinalysis revealed mild proteinuria. The serum IgG4 level was 13.9 g/L. The abdominal imaging examination revealed multiple solid nodules in the liver. The gastrointestinal endoscopy combined with the biopsy revealed colon adenocarcinoma. Kidney biopsy showed massive IgG4-positive plasma cells and storiform fibrosis infiltration in the tubulointerstitial area, thus establishing the diagnosis of IgG4-related tubulointerstitial nephritis. Corticosteroid therapy was initiated, and subsequently, the renal function dramatically improved without the diminution of the liver nodules. The liver biopsy was performed and a diagnosis of metastatic colon adenocarcinoma was confirmed.
We here reported a rare case of simultaneous occurring of IgG4-related tubulointerstitial nephritis, colon adenocarcinoma with hepatic metastasis. The case highlights the importance of screening for malignancy in patients with IgG4-related disease, and the nature of the mass in other organs of patients with coexisting IgG4-related disease and malignancy should be carefully checked.
了解 IgG4 相关疾病与其他疾病的罕见关联对于准确诊断和有效治疗患者至关重要。据我们所知，仅有少数 IgG4 相关肾病伴恶性肿瘤转移的病例报告。在此，我们报告一例罕见的同时发生 IgG4 相关肾小管间质性肾炎和结肠腺癌伴肝转移的病例。
一名 71 岁的中国男性因排尿困难就诊，最初被诊断为良性前列腺增生 1 年。他因手术入院。入院后，肾功能检查显示血清肌酐从 291.0μmol/L 迅速升高至 415μmol/L。血红蛋白水平为 89g/L。粪便潜血试验阳性。尿分析显示轻度蛋白尿。血清 IgG4 水平为 13.9g/L。腹部影像学检查显示肝脏内多个实性结节。胃肠内镜检查结合活检显示结肠腺癌。肾活检显示大量 IgG4 阳性浆细胞和间质纤维化浸润，从而确立了 IgG4 相关肾小管间质性肾炎的诊断。开始使用皮质类固醇治疗，随后肾功能显著改善，而肝脏结节无缩小。进行了肝活检，确诊为转移性结肠腺癌。
我们在此报告一例罕见的同时发生 IgG4 相关肾小管间质性肾炎、结肠腺癌伴肝转移的病例。该病例强调了在 IgG4 相关疾病患者中筛查恶性肿瘤的重要性，对于同时存在 IgG4 相关疾病和恶性肿瘤的患者，其他器官内肿块的性质应仔细检查。
