Saito Zenya, Yoshida Masahiro, Kojima Ayako, Tamura Kentaro, Kuwano Kazuyoshi
Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan.
Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Respir Med Case Rep. 2020 Feb 6;29:101019. doi: 10.1016/j.rmcr.2020.101019. eCollection 2020.
Here we describe the case of a 78-year-old man with respiratory failure and right pleural effusion. Computed tomography showed right pleural effusion with pleural calcification, tumor-like shadows induced by passive atelectasis, and enlarged mediastinal lymph nodes. Positron emission tomography showed right pleural thickening, rounded atelectasis, and enlarged mediastinal lymph nodes, without fluid accumulation in other organs. The pleural effusion showed lymphocyte-dominated exudates with elevated adenosine deaminase (ADA) levels. Tuberculous pleuritis was suspected, but thoracoscopic pleural biopsy revealed lymphoplasmacytic infiltration and fibrosis, with 10 immunoglobulin G4 (IgG4)-positive plasma cells/high-power field, and IgG4/IgG ratio of 40%. IgG4 concentrations in serum and right pleural effusion were 929 and 1120 mg/dL, respectively. The patient was diagnosed with IgG4-related pleuritis without other systemic manifestations, and reduction in right pleural effusion was confirmed by corticosteroid therapy. IgG4-related disease is typically a systemic disease causing lymphoplasmacytic inflammation in multiple organs. We describe a rare form of IgG4-related pleuritis showing pleural effusion with no other systemic manifestation.
在此，我们描述了一例患有呼吸衰竭和右侧胸腔积液的78岁男性病例。计算机断层扫描显示右侧胸腔积液伴胸膜钙化、被动性肺不张所致的肿瘤样阴影以及纵隔淋巴结肿大。正电子发射断层扫描显示右侧胸膜增厚、圆形肺不张和纵隔淋巴结肿大，其他器官无积液。胸腔积液显示以淋巴细胞为主的渗出液，腺苷脱氨酶（ADA）水平升高。怀疑为结核性胸膜炎，但胸腔镜胸膜活检显示淋巴细胞浆细胞浸润和纤维化，每高倍视野有10个免疫球蛋白G4（IgG4）阳性浆细胞，IgG4/IgG比值为40%。血清和右侧胸腔积液中的IgG4浓度分别为929和1120mg/dL。该患者被诊断为无其他全身表现的IgG4相关性胸膜炎，皮质类固醇治疗证实右侧胸腔积液减少。IgG4相关性疾病通常是一种导致多个器官淋巴细胞浆细胞炎症的全身性疾病。我们描述了一种罕见的IgG4相关性胸膜炎形式，表现为胸腔积液且无其他全身表现。
