Thomas Ancy Elsa, Thangakunam Balamugesh, Kodiatte Thomas, Christopher Devasahayam Jesudas
Department of Pulmonary Medicine Christian Medical College Hospital Vellore India.
Respirol Case Rep. 2025 Feb 15;13(2):e70111. doi: 10.1002/rcr2.70111. eCollection 2025 Feb.
A 56-year-old man presented with right-sided pleuritic chest pain and intermittent cough for 4 months, with a background history of well-controlled asthma and allergic rhinitis. Chest radiographs revealed right-sided pleural effusion, the fluid chemistry showed an exudate effusion with negative cytology and abundant eosinophils. Thoracoscopic pleural biopsy showed moderate lymphoplasmacytic chronic inflammation. Immunohistochemistry showed IgG4 staining up to 90 plasma cells/hpf (> 10% diagnostic), and the IgG4: IgG ratio was 40% (> 40% diagnostic), confirming the diagnosis of IgG4-related disease (IgG4-RD). Elevated serum IgG4 level (300 mg/dL; normal range: 3-201 mg/dL), further supported the diagnosis. While eosinophilic pleural effusion (EPE) accounts for 5%-16% of all exudative pleural effusions, IgG4-related pleural disease is an extremely rare cause of EPE.
一名56岁男性，右侧胸膜炎性胸痛伴间歇性咳嗽4个月，有哮喘和过敏性鼻炎病史，病情控制良好。胸部X线片显示右侧胸腔积液，胸水化学检查显示为渗出液，细胞学检查阴性，嗜酸性粒细胞丰富。胸腔镜胸膜活检显示中度淋巴浆细胞慢性炎症。免疫组化显示IgG4染色达90个浆细胞/高倍视野（>10%为诊断标准），IgG4:IgG比值为40%（>40%为诊断标准），确诊为IgG4相关性疾病（IgG4-RD）。血清IgG4水平升高（300mg/dL；正常范围：3-201mg/dL），进一步支持诊断。虽然嗜酸性胸腔积液（EPE）占所有渗出性胸腔积液的5%-16%，但IgG4相关性胸膜疾病是EPE极为罕见的病因。
