title: A case of IgG4-related lung disease complicated by asymptomatic chronic Epstein-Barr virus infection.
abstract: BACKGROUND
  IgG4-related disease is characterized by IgG4-positive plasmacyte infiltration into various organs, but its etiology is not unknown.
  
  
  OBJECTIVE
  To elucidate the etiology of IgG4-related disease.
  
  
  METHODS
  We experienced an interesting case of IgG4-related lung disease complicated by chronic EB virus infection.
  
  
  RESULTS
  A 70-year-old male visited our hospital due to failure of pneumonia treatment. Chest computed tomography (CT) showed consolidation in the right middle field and slight mediastinal lymphadenopathy in the subcarinal region. Lung consolidation improved with antibiotics; subcarinal lymphadenopathy progressed after 4 months. Malignant lymphoma was suspected given elevated sIL2-R levels (1862 U/mL). Patchy ground glass opacities appeared in the bilateral lung field just before surgical biopsy. He was diagnosed with IgG4-related lung disease after inspection of a pathological specimen obtained from the right upper lung and right hilar lymph node. EB virus-infected cells were also detected in the lymph node. Blood examination revealed EB virus viremia, but the patient did not present with symptoms or organ involvement. This led to a diagnosis of asymptomatic chronic EB virus infection.
  
  
  CONCLUSIONS
  Recent studies have suggested an association between EB virus infection and IgG4-related diseases in the pathological exploration of surgically resected lymph nodes. Our case is the first case of IgG4-related lung disease in which EB virus infection was both pathologically and clinically proved. The present case is of particular interest in view of this newly reported association, and may serve as a fundamental report for future studies connecting EB virus infection with IgG4-related diseases.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Kotetsu
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikegame
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Takebe-Akazawa
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan.
authors.forename: Takaomi
authors.initials: T
authors.lastname: Koga
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Okabayashi
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, 811-3195, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Takata
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008168:Lung / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology* / Q000821:virology; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007074:Immunoglobulin G; D011239:Prednisolone
keywords: EB virus; Epstein-Barr virus; IgG4-related disease; IgG4-related lung disease