title: IgG4-related pleural disease diagnosed by a re-evaluation of chronic bilateral pleuritis in a patient who experienced occasional acute left bacterial pleuritis.
abstract: A 78-year-old man with cryptogenic chronic bilateral lymphoplasmacytic pleuritis, diagnosed based on left parietal pleural biopsy specimens obtained by pleuroscopy, developed acute left bacterial pleuritis. The left pleural effusion was neutrophil dominant, however, the right pleural effusion showed lymphoplasmacytic infiltration. Laboratory examinations revealed that his serum IgG4 concentration was increased, with a higher level of IgG4 in the right pleural effusion. Re-evaluation of the previous biopsy specimens using an immunostaining method revealed numerous IgG4-positive plasma cell infiltrations with IgG4-positive/IgG-positive plasma cells at 85.4%. Accordingly, the new diagnosis of this patient was considered to be chronic bilateral IgG4-related pleuritis.
authors.affiliation: The First Department of Internal Medicine, Shinshu University School of Medicine, Japan. yama5252@shinshu-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Toshiro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Masanori
authors.initials: M
authors.lastname: Yasuo
authors.forename: Orie
authors.initials: O
authors.lastname: Kobayashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsushima
authors.forename: Michiko
authors.initials: M
authors.lastname: Ito
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Urushihata
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hanaoka
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Koizumi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Uehara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawakami
authors.forename: Hideaki
authors.initials: H
authors.lastname: Hamano
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawa
authors.forename: Keishi
authors.initials: K
authors.lastname: Kubo
mesh_terms: D000208:Acute Disease; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D002908:Chronic Disease; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood* / Q000378:metabolism; D008297:Male; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology; D010996:Pleural Effusion / Q000276:immunology / Q000473:pathology; D010998:Pleurisy / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology
chemical_list: D007074:Immunoglobulin G