IgG4-related lung disease in a worker occupationally exposed to asbestos

Our plain-English summary of IgG4-related lung disease in a worker occupationally exposed to asbestos, by M. Toyoshima, K. Chida, M. Kono, et al (Internal Medicine, 2010).

The study

• Authors: M. Toyoshima, K. Chida, M. Kono, Y. Kaida, Y. Nakamura, T. Suda, H. Sugimura
• Journal: Internal Medicine
• Published: 2010;49(12):1175-8
• Type of article: Case report
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of IgG4-related lung disease in a worker who had been exposed to asbestos is described. The patient had nocturnal cough and wheeze that responded to inhaled corticosteroid, and the radioallergosorbent test was positive against common allergens, suggesting an association with atopic asthma. IgE elevation is reported in asbestos-exposed workers, and asbestos exposure may cause atopic conditions. Predominance of Th2 cytokines and up-regulation of regulatory T lymphocytes have been reported in IgG4-related disease. IgG4-related disease may occur from hypersensitivity of the regulatory immune system to atopic conditions. Asbestos exposure may be a causal factor of IgG4-related disease.

In plain English

This case report described one 57-year-old man with two years of night-time cough, wheeze and breathlessness on exertion. He had been exposed to asbestos (type not stated) for 10 years during building demolition and had smoked 30 cigarettes a day for 30 years. A chest CT scan showed a pleural plaque, consolidations, nodules and emphysema. His blood IgG4 was 3,520 mg/dL and IgE 4,940 IU/ml, allergy testing was positive for common allergens, and his sputum contained many eosinophils. In a surgically removed lung nodule, IgG4-positive plasma cells made up 55.7% of IgG-positive plasma cells, and he was diagnosed with IgG4-related lung disease and pulmonary emphysema. His cough and wheeze disappeared with inhaled corticosteroid and bronchodilator treatment, and his condition remained stable for more than 2 years. The authors speculated that asbestos exposure may have caused asthma and an allergic state that contributed to the disease. They said this hypothesis had no supporting evidence. They also said the exposure history was circumstantial because asbestos in lung tissue was not measured.

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 (single patient)
• Who was studied: One 57-year-old man with nocturnal cough, wheeze and exertional breathlessness of 2 years' duration, referred to a hospital (authors based in Hamamatsu, Japan); smoker of 30 cigarettes per day for 30 years
• Exposure: Occupational asbestos exposure (fiber type not stated) released during building demolition, for 10 years; also a heavy smoking history
• Main results:
  • Chest CT in this patient showed a pleural plaque and swollen hilar and mediastinal lymph nodes, along with consolidations, nodules, ground-glass opacities and emphysema
  • Blood tests in this patient: IgG 8,396 mg/dL, IgG4 3,520 mg/dL, IgE 4,940 IU/ml
  • Allergy testing (RAST) in this patient was positive for common allergens: dermatophagoides (dust mite) score 4, moth score 4, cockroach score 3, dog scurf score 2; sputum showed numerous eosinophils
  • Bronchial reversibility after an inhaled bronchodilator was 1.6% in this patient
  • In the resected lung nodule, IgG4-positive plasma cells were 55.7% of IgG-positive plasma cells; the patient was diagnosed with IgG4-related lung disease and pulmonary emphysema
  • No pancreatic involvement was seen
  • Nocturnal cough and wheeze disappeared on inhaled fluticasone and salmeterol; systemic corticosteroids were not given; the disease and lymph node swelling remained stable for more than 2 years
• The authors' conclusion: The authors concluded that IgG4-related sclerosing disease may occur as a result of up-regulated regulatory T lymphocyte functions in response to atopic conditions. They speculated that in this patient asbestos exposure may have resulted in bronchial asthma, and they called for further investigation of allergic and environmental conditions.
• Limitations the authors state:
  • Asbestos exposure was not confirmed by measuring asbestos in lung tissue; the exposure history is circumstantial (the pleural plaque was taken as evidence of exposure)
  • The proposed link between asbestos, asthma and IgG4-related disease is speculative, with no supporting evidence
  • It cannot be completely excluded that the patient's atopic condition existed before his asbestos exposure
  • Asthma was suggested by the response to inhaled corticosteroid, but bronchial reversibility was not detected
  • The authors found no studies showing a relationship between asbestos exposure and bronchial asthma

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Cytokine.

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