Fukushima Atsuki, Tabuchi Hitoshi
Ophthalmology, Tsukazaki Hospital, Himeji, JPN.
Ophthalmology, Hiroshima University, Hiroshima, JPN.
Cureus. 2022 Sep 29;14(9):e29725. doi: 10.7759/cureus.29725. eCollection 2022 Sep.
Immunoglobulin G4 (IgG4)-positive plasma cells play a pivotal role in the pathogenesis of IgG4-related diseases, in which fibrosis is observed in various organs. Lesions often develop in the lacrimal gland and orbit; however, uveitis and scleritis are also noticed. We present the case of a 55-year-old woman who was diagnosed with eosinophilic pneumonia in November 2021 at the Department of Collagen Disease of another hospital. She was treated with 25 mg of oral prednisolone. On January 11, 2022, when the dose of prednisolone was reduced to 7.5 mg, she began complaining of conjunctival hyperemia in the left eye, and a few days later, eye pain was also reported. On January 17, she visited an ophthalmology clinic and was prescribed betamethasone and tacrolimus eye drops, and was subsequently admitted to our hospital. The blood test results showed a high IgG4 level. We consulted the collagen disease physician to evaluate her previous data. The serum IgG4 level collected on December 6, 2021, was 608 mg/dL, and a re-examination of the bronchial biopsy tissues on December 2, 2021, confirmed 48% of IgG4-positive cells. Thus, pulmonary lesions appeared to be IgG4-related pathologies. Increasing the oral prednisolone dose to 30 mg improved the scleritis. As seen in this case, the possibility of an IgG4-related disease should be considered when scleritis is observed in a patient diagnosed with eosinophilic pneumonia.
免疫球蛋白G4（IgG4）阳性浆细胞在IgG4相关疾病的发病机制中起关键作用，这类疾病在多个器官中可观察到纤维化。病变常发生于泪腺和眼眶；不过，葡萄膜炎和巩膜炎也较为常见。我们报告一例55岁女性病例，她于2021年11月在另一家医院的胶原病科被诊断为嗜酸性肺炎。她接受了25毫克口服泼尼松龙治疗。2022年1月11日，当泼尼松龙剂量减至7.5毫克时，她开始抱怨左眼结膜充血，几天后还出现了眼痛。1月17日，她前往眼科门诊就诊，医生开了倍他米松和他克莫司眼药水，随后她入住我院。血液检查结果显示IgG4水平升高。我们咨询了胶原病医生以评估她之前的数据。2021年12月6日采集的血清IgG4水平为608毫克/分升，2021年12月2日对支气管活检组织的复查证实IgG4阳性细胞占48%。因此，肺部病变似乎是IgG4相关病理改变。将口服泼尼松龙剂量增至30毫克后，巩膜炎有所改善。如此病例所示，当在诊断为嗜酸性肺炎的患者中观察到巩膜炎时，应考虑IgG4相关疾病的可能性。
