Diagnosis and Treatment > Investigation > Immunoglobulin G2

You are looking at 1 - 2 of 2 items

Huanyu Ding Department of Endocrinology and Metabolism, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China

Search for other papers by Huanyu Ding in
Google Scholar
PubMed
Close
,
Yang Li Department of Pathology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China

Search for other papers by Yang Li in
Google Scholar
PubMed
Close
,
Caishun Ruan Department of Endocrinology and Metabolism, Longyan People Hospital, Longyan, 364000, People's Republic of China

Search for other papers by Caishun Ruan in
Google Scholar
PubMed
Close
,
Yuan Gao Department of General Practice, Community Health Center of Qianjin Street, Tianhe District, Guangzhou, 510660, People's Republic of China

Search for other papers by Yuan Gao in
Google Scholar
PubMed
Close
,
Hehua Wang Department of Hematology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China

Search for other papers by Hehua Wang in
Google Scholar
PubMed
Close
,
Xiangsong Zhang Department Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China

Search for other papers by Xiangsong Zhang in
Google Scholar
PubMed
Close
, and
Zhihong Liao Department of Endocrinology and Metabolism, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China

Search for other papers by Zhihong Liao in
Google Scholar
PubMed
Close

Summary

Erdheim-Chester disease (ECD), one type of systemic non-Langerhans cell histiocytosis, has been rarely seen and is characterized by the accumulation of foamy CD68+CD1a- histiocytes. We reported a case of ECD and reviewed the clinical features of 13 cases of ECD reported so far in China. A 53-year-old male was diagnosed with central diabetes insipidus in March 2014, followed by fever, splenomegaly and anemia in July 2014. His initial pituitary magnetic resonance imaging (MRI) revealed the absence of high signal at T1-weighted image in posterior pituitary without any lesion. A further positron emission tomography/computer tomography (PET/CT) images showed elevated metabolic activity of 18F-2-fluro-D-deoxy-glucose (FDG) and low 13N-NH3 uptake in the posterior pituitary, and multi-organ involvement. Biopsy at right femur lesion revealed that granulomatous infiltration of foamy histiocytes and Touton giant cells surrounded by fibrosis tissues. Immunohistochemistry stain was positive for CD68, negative for CD207/Langerin and S-100. The diagnosis of ECD was confirmed and the treatment with pegylated interferon was effective. ECD was a possible immune-related disorder concluding from the IgG4 immunohistochemistry results. We summarized the pathological manifestations for ECD and its differential diagnosis from Langerhans cell histiocytosis (LCH) and Rosai-Dorfman disease (RDD). ECD should be considered by both pathologists and clinicians in the differential diagnosis when central diabetes insipidus is accompanied with multi-organ involvement, especially skeletal system involvement, or recurrent fever.

Learning points

  • ECD should be considered when central diabetes insipidus is accompanied with multisystem involvement, especially symmetric/asymmetric bone lesions, or recurrent fever.

  • PET/CT scanning was helpful for locating pituitary lesion, discovering multiple system involvement and indicating the biopsy sites.

  • Conducting proper immunohistochemistry stains was important for diagnosing ECD. ECD might be correlated with immune disorder.

Open access
Mahmud Abo Salook Endocrine Institute

Search for other papers by Mahmud Abo Salook in
Google Scholar
PubMed
Close
,
Carlos Benbassat Endocrine Institute
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Search for other papers by Carlos Benbassat in
Google Scholar
PubMed
Close
,
Yulia Strenov Pathology Laboratory, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel

Search for other papers by Yulia Strenov in
Google Scholar
PubMed
Close
, and
Amit Tirosh Endocrine Institute
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Search for other papers by Amit Tirosh in
Google Scholar
PubMed
Close

Summary

A 55-year-old male, with a positive medical history for hypothyroidism, treated with stable doses for years was admitted with subacute thyroiditis and a feeling of pain and pressure in the neck. Laboratory tests showed decrease in TSH levels, elevated erythrocyte sedimentation rate, and very high antithyroid antibodies. Owing to enlarging goiter and exacerbation in the patient's complaints, he was operated with excision of a fibrotic and enlarged thyroid lobe. Elevated IgG4 plasma levels and high IgG4/IgG plasma cell ratio on immunohistochemistry led to the diagnosis of IgG4-mediated thyroiditis. We concluded that IgG4-thyroiditis and IgG4-related disease should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.

Learning points

  • IgG4-related disease is a systemic disease that includes several syndromes; IgG4-related thyroiditis is one among them.

  • IgG4-thyroiditis should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.

  • Patients with suspected IgG4-thyroiditis should have blood tested for IgG4/IgG ratio and appropriate immunohistochemical staining if possible.

Open access