Abstract
TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: We present a rare inflammatory cause of radiological consolidation found in a 67-year-old lady with unresolved pneumonia. CASE PRESENTATION: A 67-year-old lady was referred to the chest clinic with a persisting right middle lobe opacity on subsequent chest radiography 6 week's after the initial presentation with pneumonia. She had completed a course of co-amoxiclav with clarithromycin. A contrast-enhanced CT Chest demonstrated consolidation in the medial aspect of right middle lobe. Spirometry was consistent with mild restrictive defect. Blood tests showed raised IgG and IgA levels. Serum electrophoresis revealed polyclonal increase in γ-globulins. Her bronchoalveolar lavage was unremarkable. This prompted to investigate her with CT-guided biopsy which showed fibro-inflammatory cells. Alas IgG4-related lung disease was confirmed. She showed clinico-radiological improvement with a course of steroid. Figure: CXR and CT chest showing RML consolidation DISCUSSION: IgG4-related lung disease can be associated with a rare pneumonic presentation. It is an idiopathic multi system disorder characterised by presence of IgG4-positive lymphoplasmacytic infiltrates and storiform fibrosis along with raised serum IgG4. It's presentation is organ specific and its pulmonary presentation ranges from consolidation to interstitial disease, and lymph node enlargement. Among the five radiologic subtypes, alveolar consolidative and solid nodular type remain most common. It is typically steroid responsive. CONCLUSIONS: Although very rare but this case depicts importance of considering inflammatory pneumonia such as IgG4 related lung disease as a differential in unresolved pneumonia. Reference 1: Kamisawa T. IgG4-related disease. Lancet 2015; 385: 1460. Refernece 2: Kang, J. Long-term clinical course and outcomes of immunoglobulin G4-related lung disease. https://doi.org/10.1186/s12931-020-01542-6 DISCLOSURE: Nothing to declare.
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