Tuberc Respir Dis.  2016 Jul;79(3):184-187. 10.4046/trd.2016.79.3.184.

IgG4-Related Lung Disease without Elevation of Serum IgG4 Level: A Case Report

• Kang MK
• Cho Y
• Han M
• Jung SY
• Moon KM
• Kim J
• Kim JR
• Lee DK
• Park JH
• Chung SH

• KMID: 2326687
• DOI: http://doi.org/10.4046/trd.2016.79.3.184

Abstract

Since IgG4-related pancreatitis was first reported in 2001, IgG4-related disease has been identified in other organs such as salivary gland, gallbladder, thyroid, retroperitoneum and kidney; but lung invasion is rare. A 63-year-old man presented with hemoptysis at the pulmonary clinic and chest computed tomography revealed about 4.1 cm irregular shaped mass with spiculated margin at the left upper lobe. Despite no elevation of serum IgG4 level, he was finally diagnosed as IgG4-related lung disease by transthoracic needle biopsy. After treatment with oral glucocorticoids, hemoptysis disappeared and the size of lung mass was decreased.

Keyword

Immunoglobulins; Lung Diseases; Hemoptysis

MeSH Terms

Biopsy, Needle
Gallbladder
Glucocorticoids
Hemoptysis
Humans
Immunoglobulin G*
Immunoglobulins
Kidney
Lung Diseases*
Lung*
Middle Aged
Pancreatitis
Salivary Glands
Thorax
Thyroid Gland
Glucocorticoids
Immunoglobulin G
Immunoglobulins

Figure

• 

  Figure 1 Enhanced chest computed tomography (CT) findings. (A, B) Chest CT on admission day shows about 4.1-cm irregular shaped mass with spiculated margin at left upper lobe. (C, D) Chest CT after 1 month of treatment reveals mass size decreased to 3.6 cm.

• 

  Figure 2 Histopathological findings of the lung. (A) Heavy infiltration of plasma cells, admixed with lymphocytes and neutrophils and storiform pattern of fibrosis are identified (H&E stain, ×200). (B) In IgG4 immunochemical staining, more than 40 multiple scattered infiltrations of IgG4-positive plasma cells are identified in high-power field (×400).

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