Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.
Laboratory of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.
Front Immunol. 2021 Apr 21;12:652985. doi: 10.3389/fimmu.2021.652985. eCollection 2021.
IgG4-related disease (IgG4-RD) is a recently recognized systemic fibro-inflammatory disease of unknown cause involving many organs including pancreas, salivary glands, and lymph nodes. Chronic tuberculosis (TB) infection has been reported in IgG4-RD, but the prevalence of TB infection has not been evaluated in IgG4-RD.
Characterization of a patient with IgG4-RD by physical examination, laboratory tests, magnetic resonance imaging (MRI) and histological examination. TB infection was evaluated by medical history, radiological examinations, sputum examinations, tubercular skin test (TST) and interferon gamma (IFN-γ) release assay test (IGRA). Medical records of IgG4-RD patients were reviewed in our institute from February 2015 to September 2020 to explore the prevalence of TB infection in IgG4-RD.
We described a 40-year-old Chinese man presented with headache and diplopia. Physical examination revealed bitemporal hemianopsia and limited abduction of both eyes. MRI revealed uniformly enhancing mass overlying clivus with dural tail sign. Laboratory data revealed elevation of IgG4 (1.9g/L), and TB-IGRA demonstrated significantly elevated IFN-γ (414.21 pg/ml). The clivus lesion was subtotally removed and IgG4 was strongly positive on immunohistochemical staining. The diagnosis of IgG4-RD was established, and the patient received treatment of corticosteroids, methotrexate, and cyclophosphamide with isoniazid prophylaxis. Consequently, the mass shrank remarkably within 3 months. A similar concurrence of TB disease or latent TB infection (LTBI) and IgG4-RD was present in 17/47 (36.2%) patients in our institute.
High frequency of TB/LTBI presented in patients with IgG4-RD. Patients with IgG4-RD and LTBI should be closely monitored for resurgence of TB. Whether TB represents a risk for IgG4-RD should be further investigated in prospective cohort.
IgG4 相关疾病（IgG4-RD）是一种新近被认识的、病因不明的系统性纤维炎症性疾病，可累及胰腺、唾液腺和淋巴结等多个器官。IgG4-RD 中已报道有慢性结核（TB）感染，但 IgG4-RD 中 TB 感染的患病率尚未得到评估。
通过体格检查、实验室检查、磁共振成像（MRI）和组织学检查对 IgG4-RD 患者进行特征描述。通过病史、影像学检查、痰检、结核菌素皮肤试验（TST）和干扰素γ（IFN-γ）释放试验（IGRA）评估 TB 感染。对我院 2015 年 2 月至 2020 年 9 月期间的 IgG4-RD 患者的病历进行回顾性研究，以探讨 IgG4-RD 中 TB 感染的患病率。
我们描述了一位 40 岁的中国男性，他表现为头痛和复视。体格检查发现双眼颞侧偏盲和双眼外展受限。MRI 显示颅底上方有均匀强化的肿块，伴有硬膜尾征。实验室数据显示 IgG4 升高（1.9g/L），TB-IGRA 显示 IFN-γ 显著升高（414.21pg/ml）。患者接受了颅底病变大部切除术，免疫组化染色显示 IgG4 强阳性。诊断为 IgG4-RD，患者接受了糖皮质激素、甲氨蝶呤和环磷酰胺治疗，并进行了异烟肼预防。结果，肿块在 3 个月内显著缩小。在我院，17/47（36.2%）的 IgG4-RD 患者存在 TB 疾病或潜伏性 TB 感染（LTBI）的类似合并症。
IgG4-RD 患者中 TB/LTBI 的发生率较高。患有 IgG4-RD 和 LTBI 的患者应密切监测 TB 的复发情况。TB 是否是 IgG4-RD 的危险因素需要在前瞻性队列研究中进一步探讨。
