IgG4-related respiratory disease

Abstract

IgG4-related diseases (IgG4-RDs), such as autoimmune pancreatitis and IgG4-related Mikulicz disease, are often accompanied by intrathoracic lesions, which are called IgG4-related respiratory disease (IgG4-RRD). IgG4-RRD has few subjective symptoms, and is usually detected during workup of patients with extra-thoracic lesions of IgG4-RD. IgG4-RRD is characterized by various conditions, including masses, nodules, thickening, and infiltration at numerous sites in the thorax through lymphatic routes. Although elevated serum IgG4 concentrations and pathologic evidence of lymphoplasmacytic infiltrates with abundant IgG4-positive plasma cells are characteristic findings of IgG4-RD, other intrathoracic diseases, such as multicentric Castleman disease and malignancy, may present with similar findings. Developing diagnostic criteria for IgG4-RRD, including clinicoradiological and pathological characteristics, is necessary for its appropriate diagnosis.

Keywords:

• IgG4-related disease
• IgG4-related respiratory disease
• pulmonary manifestations
• diagnostic criteria
• nonspecific interstitial pneumonia

Acknowledgements

The author thanks Dr. Hiroshi Yamamoto, Dr. Tomohiro Handa, Dr. Yuko Waseda, and Dr. Seijiro Minamoto for their contribution to the study of IgG4-RRD by the research teams from the Ministry of Health, Labor, and Welfare of Japan.

Conflict of interest

None.

Additional information

Funding

This manuscript was supported by grants from the Research Committee to Establish Diagnostic Criteria and Development of Treatment for Systemic IgG4-related Sclerosing Disease, supported by the Research Program of Intractable Disease, the Ministry of Health, Labor, and Welfare of Japan [No. H29-Nanchi-Ippan-058].