IgG4-related lung disease with pulmonary lesions and recurrent pleural effusion: A case of report

Abstract

We report a rare case of IgG4-related lung disease (RLD) with pulmonary lesions and recurrent pleural effusion to improve the diagnosis and treatment of this disease. A 60-year-old man was admitted to hospital for cough and dyspnea. CT scan showed a right lower lobe intrapulmonary mass with unilateral right-sided pleural effusion. Histology revealed no malignant findings. After 1 year, the patient re-admitted to our hospital with high serum level of IgG4 and IgE concentrations. CT scan demonstrated partial resolution of intrapulmonary mass and right-sided pleural effusion, while concurrently revealing interval development of substantial left-sided pleural effusion. The patient was diagnosed with IgG4-RLD by biopsy finally. This is a first case report of IgG4-RLD with intrapulmonary lesions accompanied by asynchronous, rapidly accumulating bilateral pleural effusions. Clinicians should consider the possibility of IgG4-RLD with intrapulmonary lesions accompanied by asynchronous, rapidly growing bilateral pleural effusion, particularly after rigorously excluding common diseases.

Keywords: IgG4-related lung disease; Pulmonary lesions; Recurrent pleural effusion.

Fig. 1

Chest CT scan showed: (1) a heterogeneously dense intrapulmonary mass (6.9×5.8×5.1cm) in the right lower lobe and right-sided pleural effusion (long white arrows) (d); (2) a minimal amount of soft tissue in the paravertebral region (short white arrow) (d).

Fig. 2

One year later, re-examination of Chest CT showed: (1) partial resolution of the original intrapulmonary mass and right-sided pleural effusion (long white arrow) (f); (2) new-onset left-sided pleural effusion (long white arrow) (f); (3) a minimal amount of soft tissue in the paravertebral region (short white arrow) (e).

Fig. 3

Histopathological findings of IgG4-related lung disease. (a. H&E Staining, Original Magnification ×20; b. H&E Staining, Original Magnification ×40; HE staining showed an infammatory cell infltrate consisting of plasma cells and lymphocytes (white arrow); c. IHC staining showed IgG-positive cells per HPF (white arrow); d. IHC staining for IgG4-positive cells per HPF (white arrow)). Abbreviations: H&E, Hematoxylin and Eosin; HPF, High-Power Field; IHC, Immunohistochemistry.

Fig. 4

Re-examination of Chest CT After Glucocorticoid Treatment showed the pleural effusion in the left side was almost disappeared.