Kato Yuto, Fukunaga Kentaro, Ooka Aya, Tokuoka Shunichi, Kataoka Yoko, Fujita Takuya, Sugihara Hiroyuki, Yamaguchi Masafumi
Department of Respiratory Medicine Koka Public Hospital Koka Japan.
Department of Thoracic Surgery Koka Public Hospital Koka Japan.
Respirol Case Rep. 2024 Jun 17;12(6):e01404. doi: 10.1002/rcr2.1404. eCollection 2024 Jun.
Immunoglobulin G4 (IgG4)-related disease is a chronic inflammatory condition often characterized by exudative pleural effusions. However, transudative pleural effusions, like in the presented case of an 80-year-old man with multiple comorbidities, are less common but possible. Despite initial treatment with diuretics, the effusion persisted, prompting further investigation. Medical thoracoscopy revealed lymphatic follicle hyperplasia and an abundance of IgG4-positive plasmacytoid cells, confirming IgG4-related pleuritis. This case underscores the importance of considering inflammatory etiologies, such as IgG4-related disease, when faced with unresponsive transudative pleural effusions. Thoracoscopy serves as a valuable diagnostic tool in such scenarios, allowing for precise diagnosis and appropriate management.
免疫球蛋白G4（IgG4）相关疾病是一种慢性炎症性疾病，常表现为渗出性胸腔积液。然而，如本病例中一名患有多种合并症的80岁男性出现的漏出性胸腔积液则较为少见，但仍有可能发生。尽管最初使用利尿剂进行治疗，但胸腔积液仍持续存在，促使进一步检查。内科胸腔镜检查显示淋巴滤泡增生以及大量IgG4阳性浆细胞样细胞，确诊为IgG4相关性胸膜炎。该病例强调了在面对无反应性漏出性胸腔积液时考虑炎症病因（如IgG4相关疾病）的重要性。胸腔镜检查在这种情况下是一种有价值的诊断工具，可实现精确诊断和恰当管理。
