A Case of IgG4-related Pleuritis Diagnosed with Pleural Biopsy via Thoracoscopy Under Local Anesthesia

DOI
  • Sekiguchi Ryo
    Department of Respiratory Medicine, Toho University School of Medicine
  • Nakamura Yasuhiko
    Department of Respiratory Medicine, Toho University School of Medicine
  • Motohashi Takumi
    Department of Respiratory Medicine, Toho University School of Medicine
  • Urabe Naohisa
    Department of Respiratory Medicine, Toho University School of Medicine
  • Ishiki Takuma
    Department of Respiratory Medicine, Toho University School of Medicine
  • Isobe Kazutoshi
    Department of Respiratory Medicine, Toho University School of Medicine
  • Sakamoto Susumu
    Department of Respiratory Medicine, Toho University School of Medicine
  • Takai Yujiro
    Department of Respiratory Medicine, Toho University School of Medicine
  • Homma Sakae
    Department of Advanced and Integrated Interstitial Lung Disease Research, Toho University School of Medicine
  • Kishi Kazuma
    Department of Respiratory Medicine, Toho University School of Medicine

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  • 局所麻酔下胸腔鏡検査による胸膜生検で診断したIgG4関連胸膜炎の1例

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Abstract

<p>Background. Immunoglobulin (Ig) G4-related disease is characterized by the infiltration of IgG4-positive plasma cells into various organs. A pathological diagnosis based on bronchoscopic or surgical biopsy is required for the definitive diagnosis of IgG4-related respiratory disease. Case Presentation. An 82-year-old man with a 15-year history of hypergammaglobulinemia was examined for bilateral pleural effusion that had been unresponsive to diuretics for approximately half a year. IgG and IgG4 levels in the blood and IgG levels in the pleural effusion were elevated, and thoracoscopy was performed under local anesthesia. A pleural biopsy of the dark brown lesion was performed. The biopsy specimen revealed the infiltration of IgG4-positive plasma cells into the tissue, leading to a diagnosis of IgG4-related pleuritis. The patient was thus treated with prednisolone, and the pleural effusion improved. Conclusion. A pleural biopsy via thoracoscopy under local anesthesia is useful for diagnosing of IgG4-related pleuritis and should be considered if the disease is suspected.</p>

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