Vol.22 No.1

Original Article

Respiratory involvement in IgG4-related Mikulicz’s disease

Authors

Shoko Matsui1 , Hirofumi Taki1 , Koichiro Shinoda1 , Kensuke Suzuki1 , Ryuji Hayashi1 , Kazuyuki Tobe1 , Yoshiharu Tokimitsu2 , Masayuki Ishida3 , Hiroaki Fushiki3 , Hikaru Seto4 , Junya Fukuoka5 , Shin Ishizawa6

  • Department of Internal Medicine (1), University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
  • Department of Internal Medicine (3), University of Toyama, Toyama, Japan
  • Department of Otorhinolaryngology, University of Toyama, Toyama, Japan
  • Department of Radiology, Faculty of Medicine, University of Toyama, Toyama, Japan
  • Department of Surgical Pathology, Toyama University Hospital, Toyama, Japan
  • Department of Pathological Diagnosis, Toyama Prefectural Central Hospital, Toyama, Japan
Received:

15 June 2011

Accepted:

12 July 2011

Published online:

3 August 2011

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Abstract

‘Immunoglobulin G4 (IgG4)-related disease’ is a new clinical concept of multi-organ diseases, with Mikulicz’s disease (MD) being a clinical phenotype of IgG4-related disease. To clarify the clinical characteristics of respiratory involvement associated with IgG4-related MD, we retrospectively assessed 25 patients with MD, 11 (44%) of whom had allergic symptoms, and 7 (28%) of whom complained of respiratory problems. Thirteen patients (52%) presented with pulmonary and/or mediastinal lesions (P-MD) on chest computed tomography (CT), and 11 (44%) had lesions limited to the lacrimal and/or salivary glands (L-MD). Mean serum total protein, IgG, and IgG4 concentrations were significantly higher and CH50 was significantly lower in the P-MD than in the L-MD group. Immune complex was present only in the P-MD group. Chest CT images showed bronchial wall thickening, consolidation, nodule(s), interlobular thickening, ground glass opacity, pleural thickening/effusion, and mediastinal lymphadenopathy. Five of seven patients who underwent histological examination of the lungs had abundant IgG4-positive plasma cell infiltrates (IgG4/IgGpositive plasma cells >40%), but the other two did not. These findings suggest that respiratory lesions are not rare in patients with IgG4-related MD, and that they present with various manifestations. IgG4-related MD should be differentiated from similar diseases, such as sarcoidosis, bronchial asthma, Sjögren’s syndrome, and malignant lymphoma.

Key words

IgG4-related disease - Mikulicz’s disease - Respiratory involvement - Autoimmune pancreatitis