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Case Reports
. 2025 May 15;20(8):3820-3825.
doi: 10.1016/j.radcr.2025.04.028. eCollection 2025 Aug.

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

Ning Xia  1 , Wei Wang  2 , Wei Zhang  1 , Yan Li  1 , Xiu-Hong Nie  1
Affiliations
Case Reports

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

Ning Xia et al. Radiol Case Rep. .

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.

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Figures

Fig 1
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
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
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
Fig. 4
Re-examination of Chest CT After Glucocorticoid Treatment showed the pleural effusion in the left side was almost disappeared.
See this image and copyright information in PMC

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