title: [Three cases of IgG4-related disease associated with urinary tract obstruction].
abstract: IgG4-related disease (IgG4RD) is a novel clinical entity characterized by tissue infiltration of IgG4-positive plasma cells. We report here 3 cases of IgG4RD associated with urinary tract obstruction. Patient 1 was a 59-year-old male who complained of difficulty on urination. A CT scan showed bilateral ureteral wall thickness, hydronephrosis, and an enlarged prostate. His serum IgG4 was 817 mg/dl. We made a diagnosis of IgG4RD and performed bilateral ureteral stenting and steroid therapy. A significant reduction in the size of the lesion was detected, and IgG4 was decreased to 272 mg/dl. He was doing well after removal of the ureteral stent. Patient 2 was a 51-year-old female who complained of bilateral swelling of the submaxillary gland. A CT scan showed left ureteral wall thickness and hydronephrosis. Her serum IgG4 was 1,020 mg/dl. We made a diagnosis of IgG4RD and performed left ureteral stenting and steroid therapy. A significant reduction in the size of the lesion was detected, and IgG4 was decreased to 337 mg/dl. She was doing well after removal of the ureteral stent. Patient 3 was a 64-year-old male who underwent evaluation for autoimmune pancreatitis. He complained of back pain and bilateral hydronephrosis was detected. His serum IgG4 level was 649 mg/dl. Bilateral ureteral stenting was performed based on a diagnosis of IgG4RD. He did not receive steroid therapy because of poorly-controlled diabetes mellitus. After insertion of the ureteral stent, hydronephrosis and back pain were relieved. We could only find a few case reports in the literature on IgG4RD associated with urinary tract obstruction. It is important for clinicians to bear in mind that IgG4RD sometimes causes urinary tract obstruction.
authors: Department of Urology, Keio University, School of Medicine.
authors: Satoshi
authors: S
authors: Yazawa
authors: Rei
authors: R
authors: Ohara
authors: Takahiro
authors: T
authors: Maeda
authors: Kent
authors: K
authors: Kanao
authors: Seiya
authors: S
authors: Hattori
authors: Yosuke
authors: Y
authors: Nakajima
authors: Mototsugu
authors: M
authors: Oya
mesh_terms: D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D008232:Lymphoproliferative Disorders / Q000150:complications; D008297:Male; D008875:Middle Aged; D014570:Urologic Diseases / Q000209:etiology*
chemical_list: D007074:Immunoglobulin G