title: IgG4-related pleural disease presenting as a massive bilateral effusion.
abstract: A 74-year-old woman with massive bilateral pleural effusion, which was exudative in nature, and with mononuclear cell predominance underwent a pleuroscopy. Parietal pleura were thickened and partly reddish in color. Biopsy specimens taken from the parietal pleura revealed lymphoplasmacytic inflammation with fibrosis. As her performance status rapidly worsened with thoracentesis, we performed bilateral pleurodesis using talc. Pathologic evaluation of the pleural biopsy specimen with immunohistochemical staining revealed 91 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of 91%. Thus, the diagnosis of pleuritis from IgG4-related disease was established. Our case suggests that IgG4-related disease is one of the causes of pleural effusion, and it should be included in the differential diagnosis of unexplained pleuritis.
authors.affiliation: *Department of Internal Medicine, Division of Respiratory and Infectious Diseases, St Marianna University School of Medicine, Kawasaki †Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ishida
authors.forename: Naoki
authors.initials: N
authors.lastname: Furuya
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishisaka
authors.forename: Masamichi
authors.initials: M
authors.lastname: Mineshita
authors.forename: Teruomi
authors.initials: T
authors.lastname: Miyazawa
mesh_terms: D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D001706:Biopsy; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D007150:Immunohistochemistry; D010994:Pleura / Q000473:pathology; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010998:Pleurisy / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D018700:Pleurodesis; D013906:Thoracoscopy
chemical_list: D007074:Immunoglobulin G