Pulmonary pseudo-tumour, aortitis and IgG4 disease.

Abstract

Learning point for clinicians A definitive diagnosis of IgG4-related disease is difficult in patients with intrathoracic or aortic lesions alone. Correlation with specific histopathological findings is essential, regardless of the serum IgG4 concentration, and the number of IgG4-positive plasma cells or the IgG4/IgG ratio in tissue. A 52-year-old man was admitted with a 1-year history of 20 kg weight loss and fatigue. He had no fever, night sweats, dyspnoea or cough. He had a 40 pack-year history of smoking and drank 50 g of alcohol per day. His past medical history was significant for hyperuricemia with gout episodes, mixed dyslipidaemia, obstructive sleep apnoea–hypopnoea syndrome and epileptic seizures. Physical examination was unremarkable. A chest X-ray showed an ill-defined mass-like lesion in the left upper lobe. His leucocyte count was 17.7 × 109/l, C-reactive protein 5.5 mg/dl and ESR 65 mm/1st h. Serum …