title: Immunoglobulin G4-related constrictive pericarditis identified by cytological examination of pericardial effusion: a case report.
abstract: BACKGROUND
  Immunoglobulin G4-related disease is increasingly recognized as a systemic autoimmune disorder characterized by immunoglobulin G4-positive lymphocyte infiltration. Organ biopsy and histopathology are the most important diagnostic methods; however, the significance of a cytological examination in immunoglobulin G4-related disease cases is still unclear.
  
  
  METHODS
  A 73-year-old Asian man who was a former tobacco smoker presented with progressive exertional dyspnea, systemic edema, and pericardial effusion. A cytological examination of his pericardial effusion detected three or four plasma cells per high-power field by Giemsa staining. Moreover, immunoglobulin G4-positive plasma cells were detected by immunostaining. Cardiac catheterization after pericardiocentesis revealed that both ventricular pressure traces showed an early diastolic dip and plateau. Positron-emission tomography with18F-fluorodeoxyglucose imaging revealed inflammatory foci in his pericardium. A surgical pericardiectomy was performed and the resultant specimen showed significant immunoglobulin G4-positive plasma cell infiltration and marked fibrous thickening of his pericardium; therefore, a diagnosis of constrictive pericarditis due to immunoglobulin G4-related disease was made. Oral administration of 0.6-mg/kg/day prednisolone resolved his heart failure and he was discharged on foot 1 week later.
  
  
  CONCLUSIONS
  Our experience with this case indicates that cytological examination of pericardial effusion was useful in the diagnosis of immunoglobulin G4-related disease.
authors.affiliation: Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan. horihori1015@gmail.com.|Division of Cardiovascular Medicine, Sendai Kousei Hospital, 4-15 Hirose-cho, Aoba-ku, Sendai, Miyagi, 980-0873, Japan. horihori1015@gmail.com.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Horie
authors.affiliation: Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Tada
authors.affiliation: Department of Radiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
authors.forename: Keiichirou
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Respiratory Surgery, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
authors.forename: Keitarou
authors.initials: K
authors.lastname: Inazawa
authors.affiliation: Department of Pathology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
authors.forename: Mareyuki
authors.initials: M
authors.lastname: Endo
authors.affiliation: Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Inoue
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018450:Disease Progression; D004417:Dyspnea; D006801:Humans; D007074:Immunoglobulin G; D008297:Male; D010490:Pericardial Effusion / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D010492:Pericardiectomy; D020519:Pericardiocentesis / Q000379:methods*; D010494:Pericarditis, Constrictive / Q000175:diagnosis* / Q000276:immunology / Q000601:surgery; D049268:Positron-Emission Tomography; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D007074:Immunoglobulin G; D011239:Prednisolone
keywords: Case report; Constrictive pericarditis; Cytological examination; IgG4-related disease; Positron-emission tomography