title: Nontuberculous mycobacterial infection with concurrent IgG4-related lymphadenopathy.
abstract: Disseminated nontuberculous mycobacteria (NTM) infection with concurrent IgG4-related lymphadenopathy has not been reported. We described a patient with neutralizing autoantibodies to interferon-gamma (IFN-γ) and elevated levels of serum IgG4 presenting with generalized lymphadenopathy and reactive dermatosis. Histologically, lymph nodes (LNs) showed effaced nodal architecture with polymorphic infiltrates, mimicking angioimmunoblastic T-cell lymphoma. Both the absolute number and the ratio of IgG4+ plasma cells to IgG+ plasma cells were increased. Mycobacterium abscessus was isolated from cultures of LNs, and demonstrated by polymerase chain reaction-restriction fragment length polymorphism. The skin biopsy showed neutrophilic dermatosis, consistent with Sweet syndrome. The patient met the criteria of both adult-onset immunodeficiency syndrome and IgG4-related lymphadenopathy. This case provides evidence of disseminated NTM infection with concurrent type III IgG4-related lymphadenopathy in the patient with anti-IFN-γ autoantibodies.
authors.affiliation: Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Shao-Wen
authors.initials: SW
authors.lastname: Weng
authors.affiliation: Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ming-Chung
authors.initials: MC
authors.lastname: Wang
authors.affiliation: Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wan-Ting
authors.initials: WT
authors.lastname: Huang
mesh_terms: D044466:Asian People; D001323:Autoantibodies / Q000097:blood; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000382:microbiology; D008206:Lymphatic Diseases / Q000097:blood / Q000382:microbiology*; D016399:Lymphoma, T-Cell / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000097:blood / Q000382:microbiology*; D009170:Nontuberculous Mycobacteria / Q000254:growth & development / Q000302:isolation & purification*; D010950:Plasma Cells / Q000378:metabolism; D012871:Skin Diseases / Q000097:blood / Q000382:microbiology; D013624:Taiwan
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G
keywords: IgG4-related lymphadenopathy; Mycobacterium abscessus; adult-onset immunodeficiency; anti-interferon-gamma autoantibody; nontuberculous mycobacteria