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Intern Med. 2018 Aug 1;57(15):2251-2257. doi: 10.2169/internalmedicine.0387-17. Epub 2018 Mar 9.

IgG4-related Pleuritis with Elevated Adenosine Deaminase in Pleural Effusion.

Author information

1
The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan.
2
Internal Medicine, Tobata General Hospital, Japan.

Abstract

An 81-year-old man was admitted with bilateral pleural effusion. A clinical examination showed lymphocytic pleura effusion and elevated serum IgG4 levels, so that IgG4-related disease was suggested, whereas tuberculous pleurisy was suspected because of high adenosine deaminase (ADA) levels in the pleural effusion. A surgical pleural biopsy revealed that there were large numbers of IgG4-positive cells and IgG4/IgG positive cell ratio exceeded 40% in several sites. Accordingly, we diagnosed IgG4-related pleuritis and treated with the patient with glucocorticoid therapy. The ADA levels in pleural effusion can increase in IgG4-related pleuritis, and it is therefore important to perform a pleural biopsy.

KEYWORDS:

IgG4-related disease with pleuritis; adenosine deaminase; pleural biopsy; pleural effusion; tuberculous pleurisy

PMID:
29526951
PMCID:
PMC6120838
DOI:
10.2169/internalmedicine.0387-17
[Indexed for MEDLINE]
Free PMC Article

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