1. Immunoglobulin G4-related constrictive pericarditis identified by cytological examination of pericardial effusion: a case report.
- Author
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Kazunori Horie, Norio Tada, Keiichirou Yamaguchi, Keitarou Inazawa, Mareyuki Endo, Naoto Inoue, Horie, Kazunori, Tada, Norio, Yamaguchi, Keiichirou, Inazawa, Keitarou, Endo, Mareyuki, and Inoue, Naoto
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IMMUNOGLOBULIN G , *POSITRON emission tomography , *CYTOLOGY , *FLUORODEOXYGLUCOSE F18 , *ADRENOCORTICAL hormones , *HORMONE therapy , *ANTI-inflammatory agents , *PREDNISOLONE , *DYSPNEA , *CARDIAC surgery , *IMMUNOGLOBULINS , *PERICARDITIS , *PERICARDIUM paracentesis , *TREATMENT effectiveness , *DISEASE progression , *DISEASE complications , *PERICARDIAL effusion , *DIAGNOSIS , *THERAPEUTICS - 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.Case Presentation: 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 with 18F-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.Conclusion: Our experience with this case indicates that cytological examination of pericardial effusion was useful in the diagnosis of immunoglobulin G4-related disease. [ABSTRACT FROM AUTHOR]- Published
- 2016
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