Scientific Letter
Cavitary lung nodules associated with IgG4-deposition disease
Nódulos pulmonares cavitados con relación a la enfermedad por depósito de IgG4
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(B): variable eosinophil counts; (C): at least 3 complete blood counts with ≥300 eosinophils/μL.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Golpe, David Dacal, Pilar Sanjuán-López, Irene Martín-Robles, Luis A. 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"apellidos" => "Pérez-de-Llano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289619303679" "doi" => "10.1016/j.arbres.2019.09.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303679?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919304240?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000002/v2_202002112050/S1579212919304240/v2_202002112050/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212920300136" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.09.007" "estado" => "S300" "fechaPublicacion" => "2020-02-01" "aid" => "2267" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2020;56:126-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Cystic Metastasis of a Giant Cell Tumor Causing Recurrent Spontaneous Pneumothorax" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "126" "paginaFinal" => "127" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis quística de un tumor de células gigantes causante de neumotórax espontáneo recurrente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1050 "Ancho" => 1500 "Tamanyo" => 256922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Axial chest CT with pulmonary window settings shows bilateral small pulmonary nodules, two of which are cavitated (arrows). (B, C) CT performed 4 months later demonstrates a left spontaneous pneumothorax (asterisk) and growth of the nodules, which now present with relatively thick walls and ground-glass halos (arrows). (D) CT performed 1 year after A shows a new left pneumothorax (asterisk) and evolution of the cavitated nodules into thin-walled cystic lesions (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nathalie Cruz da Silva Bürger, Gláucia Zanetti, Edson Marchiori" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Nathalie" "apellidos" => "Cruz da Silva Bürger" ] 1 => array:2 [ "nombre" => "Gláucia" "apellidos" => "Zanetti" ] 2 => array:2 [ "nombre" => "Edson" "apellidos" => "Marchiori" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0300289619303618" "doi" => "10.1016/j.arbres.2019.09.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303618?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920300136?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000002/v2_202002112050/S1579212920300136/v2_202002112050/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Cavitary lung nodules associated with IgG4-deposition disease" "tieneTextoCompleto" => true "saludo" => "To the Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "127" "paginaFinal" => "128" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Silvia Aguado Ibáñez, Luis Arturo Arvelo Castro, Clara Salas Antón, Myriam Aguilar Pérez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Silvia" "apellidos" => "Aguado Ibáñez" "email" => array:1 [ 0 => "s.aguado.ibanez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luis Arturo" "apellidos" => "Arvelo Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Clara" "apellidos" => "Salas Antón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Myriam" "apellidos" => "Aguilar Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Neumología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos pulmonares cavitados con relación a la enfermedad por depósito de IgG4" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 455 "Ancho" => 1750 "Tamanyo" => 221084 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imaging tests and histopathological study.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">IgG4-related disease is a multisystem disorder characterized by the formation of fibroinflammatory lesions, causing the affected tissues to malfunction.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The 2 main features of this disease are tissue infiltration by IgG4 and raised IgG4 levels in serum, but these phenomena are not present in all patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">IgG4-related disease represents a diagnostic challenge as it mimics many other processes, including cancers, infections, and autoimmune diseases. For this reason, in most cases, the affected tissues must be biopsied in order to arrive at a diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of an asymptomatic 79-year-old woman, former smoker, who was referred to our department for the study of lung nodules, detected incidentally on a chest X-ray obtained for a preoperative work-up. Fiberoptic bronchoscopy showed no significant changes. Chest computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) was performed, which revealed 2 lesions of thick irregular morphology with large central cavitation and coarse peripheral calcifications lacking interior content in both apical segments, measuring 45 and 40<span class="elsevierStyleHsp" style=""></span>mm in diameter in the right upper lobe (RUL) and left upper lobe (LUL), respectively.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical laboratory testing showed only positive antinuclear antibodies (ANA), titer 1/160 with a granular pattern, and normal IgG4 levels (53<span class="elsevierStyleHsp" style=""></span>mg/dl).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Left thoracotomy was performed with a wedge resection of LUL segment 6 and vertex which included a nodular lesion measuring 6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.7<span class="elsevierStyleHsp" style=""></span>mm. An inflammatory infiltrate with abundant plasma cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) was observed that was diagnostic for nodular pulmonary disease due to IgG4-deposition disease (the immunohistochemical study expressed abundant IgG with a IgG4/IgG ratio >40%).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Taking into account that the patient remained asymptomatic at all times, and that her IgG4 subclass levels were normal, we decided to continue with clinical and radiological follow-up. After 3 years of follow-up, the patient remains asymptomatic and her radiological lesions are stable.</p><p id="par0040" class="elsevierStylePara elsevierViewall">IgG4-related disease is a recently described condition that more often affects men (ratio of 1 to 0.7) between 60 to 65 years old, predominantly individuals of Asian race.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is characterized by raised serum IgG4 and IgG4 infiltration in the affected tissue.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In 1995, Yoshida et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> described a form of chronic pancreatitis and postulated that an autoimmune mechanism was the cause of the pancreatic lesion. However, it was not until 2003 that Kamisawa et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> first established the term “IgG4-related autoimmune disease” (formerly also known as “hyper-IgG4 disease” and “sclerosing disease”), while demonstrating that patients who had autoimmune pancreatitis due to this mechanism could also have extensive lesions in other tissues.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Associated symptoms depend on the organ involved and include abdominal pain (40%), respiratory symptoms (13%), pruritus (13%), and diarrhea (6%). Constitutional symptoms such as weight loss, fatigue and low-grade fever may occur. In addition, some subjects can be asymptomatic at the time of diagnosis and show abnormalities only in laboratory tests or imaging studies.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients with intrathoracic involvement are often asymptomatic, and are typically diagnosed after an incidental finding on an imaging study. Approximately 38% of patients have respiratory symptoms, usually cough and dyspnea on exertion. The most frequent intrathoracic manifestation is the presence of hilar and mediastinal lymphadenopathies (40%–100%). The 2 most common forms of pulmonary parenchymal involvement are rounded opacities (nodules or masses) and interstitial lung disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Serologically, peripheral eosinophilia is found in 34% of patients. Most patients with intrathoracic involvement have raised IgG4 levels in peripheral blood (>140<span class="elsevierStyleHsp" style=""></span>mg/dl), but this biomarker is considered to be relatively insensitive and nonspecific for the diagnosis of this disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The usefulness of other immunological markers such as rheumatoid factor or C-reactive protein is limited.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Information from bronchoalveolar lavage (BAL) in IgG4-related lung disease (predominance of lymphocytes with a normal CD4<span class="elsevierStyleSup">+</span>/CD8<span class="elsevierStyleSup">+</span> ratio) is scant and its role is yet to be defined.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Histopathological findings are needed for the diagnosis of the disease. The specimen of choice is surgical lung biopsy, but transbronchial biopsy can also be helpful. Eosinophilic infiltration in observed the interlobular and peribronchial septa and the presence of granulomas is rare.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In the lung, collagenized fibrosis and active fibroblast proliferation are more predominant than in autoimmune pancreatitis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis of IgG4-related disease is, then, based on a combination of histopathological, clinical, serological and radiological characteristics.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Steroid treatment is the modality most often recommended in the literature, and the response of intrathoracic and extrapulmonary lesions is similar. The optimal dose is not known, but most experts recommend oral prednisone at an initial dose of 30 to 40<span class="elsevierStyleHsp" style=""></span>mg/day,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> while 1<span class="elsevierStyleHsp" style=""></span>mg/kg/day can be used if progress is slow. These doses must be maintained for 2 to 4 weeks and may be reduced in the case of a good response, but patients must always be closely monitored for possible relapse. The optimal duration of maintenance therapy has not been determined and some patients with pulmonary involvement may not achieve complete resolution of their disease.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Evidence on the use of immunosuppressive therapy other than corticosteroids is scant.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Treatment with rituximab in combination with steroids has shown promising results in retrospective studies, and in an open-label pilot study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> this combination even demonstrated a favorable disease response.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The prognosis of this disease depends on several parameters, including factors specific to both the patient and the disease. It must also be borne in mind that disease relapse after the withdrawal of steroids is relatively common.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-07-08" "fechaAceptado" => "2019-08-29" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Aguado Ibáñez S, et al. Nódulos pulmonares cavitados con relación a la enfermedad por depósito de IgG4. Arch Bronconeumol. 2020;56:127–128.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 455 "Ancho" => 1750 "Tamanyo" => 221084 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imaging tests and histopathological study.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IgG4-related disease: a cross-sectional study of 114 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 63 | 25 | 88 |
| 2024 September | 51 | 18 | 69 |
| 2024 August | 65 | 33 | 98 |
| 2024 July | 49 | 18 | 67 |
| 2024 June | 61 | 23 | 84 |
| 2024 May | 67 | 35 | 102 |
| 2024 April | 43 | 27 | 70 |
| 2024 March | 56 | 24 | 80 |
| 2024 February | 42 | 18 | 60 |
| 2023 March | 18 | 6 | 24 |
| 2023 February | 70 | 26 | 96 |
| 2023 January | 37 | 23 | 60 |
| 2022 December | 75 | 23 | 98 |
| 2022 November | 71 | 39 | 110 |
| 2022 October | 72 | 38 | 110 |
| 2022 September | 44 | 32 | 76 |
| 2022 August | 37 | 41 | 78 |
| 2022 July | 36 | 46 | 82 |
| 2022 June | 36 | 40 | 76 |
| 2022 May | 36 | 33 | 69 |
| 2022 April | 41 | 43 | 84 |
| 2022 March | 43 | 39 | 82 |
| 2022 February | 36 | 41 | 77 |
| 2021 February | 4 | 0 | 4 |
| 2020 April | 1 | 0 | 1 |
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