2型糖尿病合并IgG4相关性肺疾病一例
|
摘要
IgG4相关性疾病且单纯肺受累、低血清IgG4滴度少见,尤其在T2DM患者中极易被误诊漏诊。本例患者经肺部病理检查及排除其他器官受累后,确诊为T2DM合并单纯肺受累的IgG4相关性疾病,予泼尼松治疗后好转出院。若临床上遇到肺部CT表现相似而抗感染治疗效果不满意时,需排除该疾病。
IgG4-related diseases characterized by simple lung damage and low serum IgG4 are rare,especially in patients with type 2 diabetes(T2 DM),which are easily misdiagnosed and missed. After lung pathological examination and exclusion of other organs involved,this T2 DM patient was diagnosed as IgG4-associated disease with simple lung damage. The patient's condition improved after prednisone treatment. In clinical practice,if the lung CT has suspicious signs but the antibiotic treatment is not effective,this disease should be cautiously excluded.
IgG4-related diseases characterized by simple lung damage and low serum IgG4 are rare,especially in patients with type 2 diabetes(T2 DM),which are easily misdiagnosed and missed. After lung pathological examination and exclusion of other organs involved,this T2 DM patient was diagnosed as IgG4-associated disease with simple lung damage. The patient's condition improved after prednisone treatment. In clinical practice,if the lung CT has suspicious signs but the antibiotic treatment is not effective,this disease should be cautiously excluded.
引文
[1]韩国敬,胡红,毛丹,等. IgG4相关性肺疾病八例临床特征分析.中华结核和呼吸杂志,2017,49:193198.
[2] Stone JH,Zen Y. IgG4related disese. Engl J Med,2012,366:539551.
[3] Hamano H,Kawa S,Horiuchi A,et al.High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med,2001,34:732738.
[4] Kamisawa T,Funata N,Hayashi Y,et al. A new clinicopathological entity of IgG4related autoimmune disease. J Gstroenterol,2003,38:982984.
[5] Zen Y,Nakanuma Y. IgG4 related disease:a crosssectional study of 114 cases. Am J Surg Pathol,2010,34:18121819.
[6]张盼盼,赵继志,王木,等. IgG4相关性疾病346例临床特征分析.中华内科杂志,2017,56:644649.
[7] Otani K,Inoue D,Itoh T,et al. Transbronchial lung biopsy for the diagnosis of IgG4related lung disease. Histopathology,2018,73:4958.
[8] Matsui S,Hebisawa A,Sakai F,et al. Immunoglobulin G4related lung disease:clinicoradiological and pathological features.Respirology,2013,18:480487.
[9]刘涌,孙永昌,冯瑞娥,等. IgG4相关性肺疾病一例并文献复习.中华结核和呼吸杂志,2012,35:752757.
[10]Umehara H,Okazaki K,Masaki Y,et al. Comprehensivediagnostic criteria for IgG4related disease(IgG4RD),2011,Mod Rheumatol,2012,22:2130.
[11]Wallace ZS,Deshpande V,Mattoo H,et al. IgG4related disease:Clinical and laboratory features in 125 patients. Arthritis Rheumatol,2015,67:24662475.
[12]Yamamoto M,Awakawa T,Takahashi H. Is rituximab effective for IgG4related disease in the long term? Experience of cases treated with rituximab for 4 years. Ann Rheum Dis,2015,74:e46.
[13]Sun X,Liu H,FengR,et al. Biopsyproven IgG4related lung disease. BMC Pulm Med,2016,16:20.
[2] Stone JH,Zen Y. IgG4related disese. Engl J Med,2012,366:539551.
[3] Hamano H,Kawa S,Horiuchi A,et al.High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med,2001,34:732738.
[4] Kamisawa T,Funata N,Hayashi Y,et al. A new clinicopathological entity of IgG4related autoimmune disease. J Gstroenterol,2003,38:982984.
[5] Zen Y,Nakanuma Y. IgG4 related disease:a crosssectional study of 114 cases. Am J Surg Pathol,2010,34:18121819.
[6]张盼盼,赵继志,王木,等. IgG4相关性疾病346例临床特征分析.中华内科杂志,2017,56:644649.
[7] Otani K,Inoue D,Itoh T,et al. Transbronchial lung biopsy for the diagnosis of IgG4related lung disease. Histopathology,2018,73:4958.
[8] Matsui S,Hebisawa A,Sakai F,et al. Immunoglobulin G4related lung disease:clinicoradiological and pathological features.Respirology,2013,18:480487.
[9]刘涌,孙永昌,冯瑞娥,等. IgG4相关性肺疾病一例并文献复习.中华结核和呼吸杂志,2012,35:752757.
[10]Umehara H,Okazaki K,Masaki Y,et al. Comprehensivediagnostic criteria for IgG4related disease(IgG4RD),2011,Mod Rheumatol,2012,22:2130.
[11]Wallace ZS,Deshpande V,Mattoo H,et al. IgG4related disease:Clinical and laboratory features in 125 patients. Arthritis Rheumatol,2015,67:24662475.
[12]Yamamoto M,Awakawa T,Takahashi H. Is rituximab effective for IgG4related disease in the long term? Experience of cases treated with rituximab for 4 years. Ann Rheum Dis,2015,74:e46.
[13]Sun X,Liu H,FengR,et al. Biopsyproven IgG4related lung disease. BMC Pulm Med,2016,16:20.