IgG4-related disease in asbestos-related pleural disease

Our plain-English summary of IgG4-related disease in asbestos-related pleural disease, by Y. Onishi, Y. Nakahara, K. Hirano, et al (Respirology Case Reports, 2016).

The study

• Authors: Y. Onishi, Y. Nakahara, K. Hirano, S. Sasaki, T. Kawamura, Y. Mochiduki
• Journal: Respirology Case Reports
• Published: 2016;4(1):22-4
• Type of article: Case report
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 67-year-old man with a history of asbestos exposure and rounded atelectasis complained of cough and swelling in the left submandibular region. Computed tomography showed an increase in size of the right lower lung lobe lesion, which was recognized as the pre-existing rounded atelectasis, as well as swelling of the pancreas and submandibular glands. Biopsy from a submandibular gland and the pulmonary lesion led to a diagnosis of immunoglobulin G4-related disease (IgG4-RD). IgG4-RD is a recently recognized disease that was first reported as an autoimmune disease; however, some reports have indicated another pathogenesis of an allergic nature that is characterized by type 2 helper T cell (Th2) inflammation. Additionally, it is recognized that long-term exposure to asbestos can cause immune dysregulation. Here we present a case of IgG4-RD associated with asbestos-related pleural disease. Asbestos-induced immune dysregulation may be one etiology of IgG4-RD.

In plain English

This case report, from a hospital in Himeji, Japan, describes one 67-year-old man who had done interior finishing work and used asbestos from age 20 to 62. He had also smoked one pack a day for 20 years. The article does not state the type of asbestos. For 8 years he had been checked regularly for pleural thickening and a lesion in the right lower lung that had been diagnosed as asbestos-related rounded atelectasis. He came to the hospital with a cough and swelling under his left jaw. Scans showed that the lung lesion had grown and that his pancreas, submandibular glands and mediastinal (central chest) lymph nodes were swollen. His blood IgG4 level was 1430 mg/dL, against a normal level below 105. Biopsies of a submandibular gland and of the lung lesion showed many IgG4-positive plasma cells, and he was diagnosed with IgG4-related disease. Treatment with the steroid prednisolone improved the swelling and the lung lesion, but the rounded atelectasis remained. The authors concluded that his asbestos exposure seemed to be related to the onset of the disease, and that the case reports a potential relationship. The report describes a single patient.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 67-year-old man seen at the National Hospital Organization Himeji Medical Center, Japan; he had been followed for asbestos-related rounded atelectasis since a first CT in 2006
• Exposure: Occupational asbestos use in interior finishing work from age 20 to 62 (fiber type not stated); also smoked one pack of tobacco per day for 20 years
• Main results:
  • A right lower lobe lesion diagnosed as asbestos-related rounded atelectasis had been stable for 8 years before it enlarged on chest X-ray and CT
  • In this patient, the pancreas, submandibular glands and mediastinal lymph nodes were swollen
  • The patient's serum IgG was 3159 mg/dL (normal 870 to 1700), IgG4 was 1430 mg/dL (normal below 105) and IgE was 407 IU/mL (normal below 232), all elevated
  • Biopsies of the left submandibular gland and of the right lower lobe lesion both showed infiltration of IgG4-positive plasma cells, with an IgG4-positive to IgG-positive plasma cell ratio of more than 50%
  • Prednisolone at 40 mg/day (0.6 mg/kg/day) reduced the patient's serum IgG and IgG4 and improved the swelling and the lung lesion, but the rounded atelectasis persisted
• The authors' conclusion: The authors concluded that asbestos exposure seemed to have been related to the onset of IgG4-related disease in this patient, and that the case reports a potential relationship between asbestos exposure and the disease

Topics

Medical terms in this study, explained in our Lexicon: Asbestos-Related Pleural Disease, Asbestos Exposure, Rounded Atelectasis, Biopsy, Inflammation, Etiology.

Related studies

• Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice — M.R. Becklake (1976)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — American Thoracic Society (2004)
• The worldwide pandemic of asbestos-related diseases — L. Stayner, L.S. Welch, et al. (2013)
• Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis — R.T. Lin, K. Takahashi, et al. (2007)
• Mass and number of fibres in the pathogenesis of asbestos-related lung disease in rats — J.M. Davis, S.T. Beckett, et al. (1978)
• High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation — D.R. Aberle, G. Gamsu, et al. (1988)

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