title: A case of lymphomatoid granulomatosis-like lung lesions with abundant infiltrating IgG4-positive plasma cells whose serum IgG4 levels became high following the start of corticosteroid therapy.
abstract: A 59-year-old man with a history of prostate hyperplasia was admitted to our hospital for further examination of a lung mass and renal dysfunction. Lung biopsy specimens revealed that inflammatory cells had infiltrated into the blood vessel walls. We initially suspected lymphomatoid granulomatosis, but Epstein Barr virus-encoded small RNA was negative. However, 50% of the infiltrating plasma cells were positive for IgG4. Furthermore, the kidneys and prostate contained abundant IgG4-positive plasma cells. He was diagnosed with IgG4-related sclerosing disease even though serum IgG4 levels were not elevated (45.7 mg/dL). Prednisolone reduced the lung masses and ameliorated renal function, but the serum IgG4 level increased (377 mg/dL). Seronegative IgG4-related sclerosing disease should be considered when patients present with such symptoms and treatment responses, and the secretion of IgG4 might be blocked by its active synthesis.
authors.affiliation: Department of Internal Medicine, Osaka City General Hospital, Osaka. minet56@yahoo.co.jp
authors.forename: Tomoko
authors.initials: T
authors.lastname: Miyashita
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kubo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Takashi
authors.initials: T
authors.lastname: Morikawa
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ishii
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamagami
mesh_terms: D002634:Chemotaxis, Leukocyte / Q000187:drug effects; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis / Q000097:blood*; D008175:Lung Neoplasms / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D008230:Lymphomatoid Granulomatosis / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010950:Plasma Cells / Q000187:drug effects / Q000473:pathology*; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D007074:Immunoglobulin G; D011239:Prednisolone