Tanabe Keitaro, Homma Takahiro, Matsui Shoko, Tsuchiya Tomoshi, Saji Hisashi
Division of Thoracic Surgery University of Toyama Toyama Japan.
Division of Thoracic Surgery Kurobe City Hospital Kurobe Japan.
Respirol Case Rep. 2023 Aug 16;11(9):e01204. doi: 10.1002/rcr2.1204. eCollection 2023 Sep.
Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized disease, and therefore its clinical features are not yet fully understood. Here, we describe a surgical case of metachronous bilateral IgG4-related pleuritis and postoperative chylothorax. This case could provide key insights into the pathology of IgG4-RD from a surgical perspective. We present a 70-year-old woman who had a right pleural mass. Video-assisted thoracoscopic pleural mass resection was performed, and the patient was diagnosed with right-sided IgG4-related pleuritis. Two years later, she was also diagnosed with left-sided IgG4-related pleuritis. We suspected the presence of IgG4-positive plasma cell infiltration. Additionally, she experienced a complicated postoperative chylothorax on the left side. It is important to consider the altered course of lymphatic vessels when extensively removing the pleura near the right thoracic duct. The occurrence of metachronous bilateral IgG4-associated pleuritis has not been previously reported, making this case particularly significant for understanding the pathology of IgG4-RD from a surgical standpoint.
免疫球蛋白G4相关性疾病（IgG4-RD）是一种新发现的疾病，因此其临床特征尚未完全明确。在此，我们描述一例异时性双侧IgG4相关性胸膜炎及术后乳糜胸的外科病例。该病例能够从外科角度为IgG4-RD的病理学提供关键见解。我们报告一名70岁女性，她有右侧胸膜肿块。进行了电视辅助胸腔镜下胸膜肿块切除术，患者被诊断为右侧IgG4相关性胸膜炎。两年后，她又被诊断为左侧IgG4相关性胸膜炎。我们怀疑存在IgG4阳性浆细胞浸润。此外，她术后左侧发生了乳糜胸并发症。在广泛切除右胸导管附近的胸膜时，考虑淋巴管走行的改变很重要。异时性双侧IgG4相关性胸膜炎的发生此前未见报道，因此该病例对于从外科角度理解IgG4-RD的病理学具有特殊意义。
