Miyoshi Azusa, Katsura Hideki, Akaba Tomohiro, Kondo Mitsuko, Tagaya Etsuko
Department of Respiratory Medicine Tokyo Women's Medical University Tokyo Japan.
Respirol Case Rep. 2024 Jul 30;12(8):e01442. doi: 10.1002/rcr2.1442. eCollection 2024 Aug.
Here we report a rare case of immunoglobulin G4 (IgG4)-related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66-year-old man was admitted to our hospital with right-dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right-dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video-assisted thoracoscopic surgery showed fibrosis-associated lymphoplasmacytic infiltration, 45-60 IgG4-positive plasma cells per high-power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4-related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy.
在此，我们报告一例罕见的通过胸腔镜胸膜活检诊断的免疫球蛋白G4（IgG4）相关胸膜疾病。一名66岁男性因以右侧为主的双侧胸腔积液和逐渐加重的呼吸困难入院。胸部X线片显示以右侧为主的胸腔积液，而胸部计算机断层扫描显示双侧胸腔积液且无实质病变。尽管双侧胸腔积液为渗出液且淋巴细胞数量增加，但最初难以明确诊断。血清和胸腔积液中观察到高IgG4水平。通过电视辅助胸腔镜手术采集的右侧胸膜活检标本的病理评估显示纤维化相关的淋巴浆细胞浸润，每高倍视野有45 - 60个IgG4阳性浆细胞，IgG4/免疫球蛋白G比值为40%。因此，该患者被诊断为IgG4相关胸膜疾病。皮质类固醇治疗后双侧胸腔积液有所改善。
