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Case Reports
. 2023 Jun 19;15(6):e40620.
doi: 10.7759/cureus.40620. eCollection 2023 Jun.

Coexistence of IgG4-Related Disease and Reactive Granuloma to Paraffin Plombage

Atsushi Isoda  1   2 , Yukiko Sairenji  2 , Masahiro Mihara  2 , Hirono Iriuchishima  2 , Akio Saito  2
Affiliations
Case Reports

Coexistence of IgG4-Related Disease and Reactive Granuloma to Paraffin Plombage

Atsushi Isoda et al. Cureus. .

Abstract

We present a patient with IgG4-related disease (IgG4-RD) that developed after receiving extra-periosteal paraffin-embedded therapy for the treatment of pulmonary tuberculosis. The patient showed clinicopathological features consistent with IgG4-RD, including the enlargement of affected organs (salivary glands, lymph nodes, and retroperitoneal soft tissue mass), elevation of serum IgG4 levels, and infiltration of IgG4-positive plasma cells. The presence of reactive granulomas with foreign body giant cells (FBGCs) surrounding the paraffin-filled site suggested a type 2 helper T (Th2)-dominant immune response induced by the implanted biomaterial. Furthermore, paraffin, known to act as an adjuvant, may have played a role in activating the immune response and inducing IgG4-RD-like symptoms. This case highlights the potential relationship between foreign substances and the development of autoimmune diseases such as IgG4-RD.

Keywords: adjuvant; foreign body reaction; igg4-related disease; paraffin plombage; reactive granuloma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. FDG PET-CT at admission.
18F-FDG PET-CT revealed the abnormal accumulation of FDG in a soft tissue mass around the plombage (A), salivary glands and cervical lymph nodes (B), axillary lymph nodes (C), and a retroperitoneal soft tissue mass around the abdominal aorta (D). Abbreviation: 18F-FDG PET-CT, 18F-fluorodeoxyglucose positron emission tomography-computed tomography.
Figure 2
Figure 2. Biopsy specimens from the mass surrounding the site of paraffin plombage.
Necrotic tissue and foreign body granuloma with the accumulation of lymphocytes, macrophages, and multinucleated giant cells (A-C: original magnification, ×200). There was no evidence of cancer or tuberculosis, and there were very few IgG4-positive plasma cells.
Figure 3
Figure 3. Biopsy specimens of the left axillary lymph node.
Interfollicular expansion with normal to small germinal centers (A: original magnification, ×40). A mixed infiltrate of small lymphocytes, immunoblasts, immature plasma cells, mature plasma cells, and scattered eosinophils was observed in the interfollicular zone (B: original magnification, ×100). Immunohistochemistry showed a high IgG4 /IgG ratio (C, D: original magnification, ×100).
See this image and copyright information in PMC

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