Spuriously Low Serum IgG4 Concentrations Caused by the Prozone Phenomenon in Patients With IgG4-Related Disease
|
|
- Isabella Byrd
- 5 years ago
- Views:
Transcription
1 ARTHRITIS & RHEUMATOLOGY Vol. 66, No. 1, January 2014, pp DOI /art , American College of Rheumatology BRIEF REPORT Spuriously Low Serum IgG4 Concentrations Caused by the Prozone Phenomenon in Patients With IgG4-Related Disease Arezou Khosroshahi, 1 Lynn A. Cheryk, 2 Mollie N. Carruthers, 3 Judith A. Edwards, 2 Donald B. Bloch, 3 and John H. Stone 3 Objective. To determine the frequency of the prozone effect in patients with IgG4-related disease (IgG4-RD). Methods. After identifying the prozone effect in an index patient with IgG4-RD, we examined additional samples to determine the frequency of this phenomenon. Thirty-eight serum samples obtained from patients with IgG4-RD whose results had been reported previously were retested. The serum IgG4 concentrations determined by this repeat analysis were compared with the originally reported values. Results. In 10 (26%) of 38 patients, the originally reported IgG4 values were falsely low; the prozone effect was identified in each of these 10 samples. Correction of the prozone effect by sample dilution led to revision of the mean serum IgG4 concentration in the 10 samples, from 26 mg/dl to 2,008 mg/dl (normal range mg/dl). All 10 patients whose samples were affected by the prozone effect had active IgG4-RD. Failure to detect the elevated serum IgG4 concentrations had a direct impact on the decision not to institute treatment in these patients. Conclusion. The prozone effect may lead to major underestimations of IgG4 concentrations in patients with IgG4-RD and offers a potential explanation for the poor correlation observed between disease activity and serum IgG4 levels in some patients. This phenomenon should be considered if the serum IgG4 measurement 1 Arezou Khosroshahi, MD: Emory University School of Medicine, Atlanta, Georgia, and Massachusetts General Hospital and Harvard Medical School, Boston; 2 Lynn A. Cheryk, PhD, Judith A. Edwards, BS: Mayo Medical Laboratories, Andover, Massachusetts; 3 Mollie N. Carruthers, MD, Donald B. Bloch, MD, John H. Stone, MD, MPH: Massachusetts General Hospital and Harvard Medical School, Boston. Address correspondence to John H. Stone, MD, MPH, Massachusetts General Hospital, Rheumatology Unit, Yawkey 2, 55 Fruit Street, Boston, MA jhstone@partners.org. Submitted for publication March 10, 2013; accepted in revised form September 5, appears discordant with the clinicopathologic diagnosis and the clinical assessment of disease activity. IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition of unknown etiology (1). The condition is defined by its unique pathologic features, which are similar across all affected organs (2). Patients with IgG4-RD also share certain clinical characteristics, e.g., the tendency to form tumefactive lesions, frequent elevations in the serum IgG4 concentration, and an excellent initial (but often unsustained) response to glucocorticoid treatment (1). Since the initial recognition of this condition, the elevated serum IgG4 concentrations and increased numbers of IgG4-positive plasma cells in tissue have been regarded as diagnostic hallmarks (3,4). Many clinicians give emphasis to the serum IgG4 concentration when evaluating patients with possible IgG4-RD. Some are inclined to reject the diagnosis of IgG4-RD if the serum IgG4 concentration is normal. Any phenomenon that contributes to an increase in the rate of false-negative results of serum IgG4 assays may lead to underdiagnosis or failure to recognize that disease once deemed to be quiescent might be active again. Delays in the initiation of therapy can be associated with substantial diseaserelated morbidity (5). We previously evaluated a patient with biopsyproven IgG4-RD within 4 days of an assessment by his primary care physician. The serum IgG4 value at the time of the patient s appointment with us was reported to be 30.8 mg/dl (normal range mg/dl). This report was not consistent with his known status of active disease within the lacrimal and parotid glands, both of which had been biopsied recently because of progressive enlargement. Moreover, the serum sample that had been tested at another laboratory only 4 days prior to his appointment with our group showed an elevated serum IgG4 concentration of 632 mg/dl. This finding led us to seek an explanation for the discrepant results. 213
2 214 KHOSROSHAHI ET AL PATIENTS AND METHODS Reexamination of the original serum sample. Discussions regarding the disparate laboratory findings raised the possibility that the low value had been the result of the prozone effect. Serial dilution of the stored original sample to 1:8,000 demonstrated that the serum IgG4 concentration on the day that we evaluated the patient was actually 655 mg/dl, not 30.8 mg/dl, as originally reported. Correction of the low value following dilution confirmed the prozone effect as the cause of the patient s spuriously low serum IgG4 value. We then investigated other stored samples from our IgG4-RD Registry to determine the extent of this problem. Study cohort. Between July 2009 and April 2012, we obtained serum samples from patients with IgG4-RD. All patients were enrolled in the Massachusetts General Hospital IgG4-RD Registry and had a biopsy-confirmed diagnosis of IgG4-RD. Thirty-eight serum samples from patients in the IgG4-RD Registry whose original serum IgG4 concentration had been previously reported were retested. Assessment of disease activity. The disease activity of patients with IgG4-RD at the time when serum samples were obtained was assessed retrospectively, using the IgG4-RD Responder Index (6). Because an accurate assessment of the serum IgG4 concentration is important when performing a valid Responder Index assessment, the Index was calculated using both the initial and the amended reports of the serum IgG4 level, and the results were compared. Serum IgG assays. Total IgG was measured by immunonephelometry, using a Siemens BN II instrument and Siemens reagent. Concentrations of the IgG subclasses (IgG1, IgG2, IgG3, and IgG4) were measured by immunonephelometry, using a Siemens BN II instrument and reagent sets obtained from either Siemens or The Binding Site. The assays were performed at the Mayo Medical Laboratories, Andover, Massachusetts. Serial dilutions of serum were performed, and the IgG4 content was measured until the results obtained from 2 sequential dilutions either agreed within 20% or the reaction had reached its end point. During retesting of the serum specimens, the laboratory assessed the IgG subclasses using 2 sets of reagents, the IgG subclass reagent set from Siemens and the reagent set from The Binding Site. The rationale for doing so was the fact that the procedure of the laboratory for IgG subclass testing had changed over the course of our sample collection. Samples assayed from July 2009 to October 2010 had been evaluated using the Siemens IgG subclass reagents. After October 2010, reagents from The Binding Site were used. The technicians who performed the retesting were blinded to the patients clinical history and previously reported assay values. RESULTS Demographic features of the patients. Sera from 38 patients were retested for total IgG and its subclasses. The baseline characteristics of the patients are shown in Supplementary Table 1 (available on the Arthritis & Rheumatology Web site at doi/ /art.38193/abstract). The average age of the patients with IgG4-RD was 59 years (range years); 23 of the patients were male, and 15 were female. Clinical manifestations of IgG4-RD. Among the 38 patients, the manifestations of IgG4-RD covered the full range of organ system involvement. In 22 patients (57%), multiple organs were affected by IgG4-RD. In 16 (42%) of the 38 patients, only 1 organ was affected by IgG4-RD. Thirty-two patients (84%) had active disease at the time of their serum evaluation. When the uncorrected serum IgG4 value was used, the mean IgG4-RD Responder Index score among these 32 patients was 5.6 (range 2 12), compared with a score of 6.7 (range 3 12) when the corrected serum IgG4 value was used. In the remaining patients, disease was in clinical remission at the time their serum was sampled, and all of them had an IgG4-RD Responder Index score of zero. Eighteen (47%) of the 38 patients had been treated for IgG4-RD with glucocorticoids and/or immunosuppressive medications before measurements of their serum IgG4 concentration. However, 24 (63%) of the 38 patients were receiving no treatment at the time their serum samples were obtained. The remaining 14 patients (37%) were receiving treatment with glucocorticoids, methotrexate, azathioprine, or mycophenolate mofetil (or glucocorticoids in combination with one of these other agents) at the time of serum sampling. Serum IgG4 concentrations. At the time of initial laboratory testing, only 42% of the patients with IgG4-RD (16 of 38) had elevated serum IgG4 concentrations. We observed a consistent 2-fold difference between the 2 reagents: the IgG4 values determined using Siemens reagents were twice the values reported using The Binding Site reagents. This finding was observed across the spectrum of values in these patients and resulted in reduced sensitivity using The Binding Site reagents. According to the package insert for each reagent set, the reagents appear to be calibrated to the same International Federation of Clinical Chemistry standard material. Therefore, this does not appear to be an explanation for the observed bias between the 2 reagent sets. Any observed difference in the result 2-fold between the 2 reagents was considered clinically significant. When The Binding Site reagents were used, falsely low IgG4 values were reported in 10 (26%) of 38 patients (Table 1). Upon retesting, the prozone phenomenon was demonstrated in 100% of these patients. Probing for the prozone effect by performing repeated dilutions until the reported concentration could be reproduced by more than one dilution step or the reaction reached its end point led to a correction in the
3 THE PROZONE EFFECT IN IgG4-RELATED DISEASE 215 Table 1. Characteristics of the patients with IgG4-related disease in whom the originally reported IgG4 value was significantly different from the retest value Case no. IgG4 value, mg/dl Original report* Retest Fold increase after dilution No. of affected organs Active disease Presence of prozone effect , Yes Yes Yes Yes Yes Yes Yes Yes , Yes Yes , Yes Yes , Yes Yes , Yes Yes , Yes Yes Yes Yes * Using the Binding Site reagent. Using Siemens reagent. mean IgG4 concentration reported, from 26 mg/dl to 2,008 mg/dl (normal range mg/dl). Samples assayed with the Siemens reagent were automatically tested for antigen excess; the appropriate dilutions were performed either automatically by the instrument or manually as the result of a flag associated with the value, thereby avoiding the prozone effect. The Binding Site assay gave no indication that antigen excess might be present. All 10 patients whose samples were affected by the prozone effect had active IgG4-RD (mean IgG4-RD Responder Index 7.7 [range 6 12]). In 6 of those patients, multiple organs were affected by IgG4-RD. A medical records review indicated that the original clinical decision regarding further evaluation (e.g., tissue biopsy) or treatment might have been different if the correct value had been known to the clinician. Other IgG subclass abnormalities. One other irregularity in IgG subclass testing was identified in this study. Serum IgG2 concentrations were spuriously high in 9 patients (24% of all samples) when The Binding Site reagent was used. The patients whose sera were affected by problems with IgG2 concentration measurement tended to be those who also had extremely high serum IgG4 concentrations (i.e., 500 mg/dl). Six of these patients were among those whose initial serum IgG4 concentration measurements were affected by the prozone phenomenon, leading to deceptively low results. DISCUSSION IgG4-RD was identified as an emerging disease entity less than a decade ago, and recognition of this condition has increased quickly in recent years (7 9). Although details of the pathophysiology of this condition have not been elucidated, infiltration of high numbers of IgG4-bearing plasma cells into the tissue of involved organs is an important feature of this disease (2). Moreover, the majority of patients have elevated serum concentrations of IgG4, and these concentrations correlate approximately with disease activity (10). In patients with multiple organ involvement, elevations of the serum IgG4 level are striking, occasionally reaching times the upper limit of normal. Because many clinicians consider elevated serum IgG4 concentrations to be linked tightly with the diagnosis of IgG4-RD, factors that cause spuriously low serum IgG4 concentrations may lead to a failure to diagnose IgG4-RD. In this study, we demonstrated that the prozone effect led to falsely low serum IgG4 concentrations in 26% of patients tested. A point of even greater concern stems from the general relationship between active disease and higher serum IgG4 concentrations. The prozone effect is more likely to occur in patients with active disease precisely the subset of patients for whom an accurate diagnosis is most critical. Diagnostic delays in the setting of IgG4-RD can lead to cirrhosis, pancreatic failure, aneurysms of the thoracic or abdominal aorta, advanced renal dysfunction, and many other complications (5,11). The failure of serum IgG4 assays to accurately identify patients with possible IgG4-RD may also lead to additional morbidity and costs from unnecessary diagnostic tests in pursuit of the wrong diagnosis. Nephelometric assays, which are commonly used today for the measurement of serum IgG, measure the amount of light scattered at a given wavelength by a particulate suspension. The amount of light scatter is dependent on the size and amount of aggregates formed by the binding of antibodies present in the reagent to antigens present in the patient sample (12); in the present case, the antigen consists of the IgG subclass molecule being assayed. The combination of antibodies and antigens leads to formation of lattices large enough to scatter light (12). The antigen antibody aggregation and lattice formation increase to a maximum. If the antigen is present in substantial excess of the antibody available, then lattice formation and the light scatter signal begin to decrease, a phenomenon known as the hook or prozone effect (13). To detect the prozone effect, samples are tested both before and after dilutions are performed. If the result obtained when dilutions are performed is greater than that obtained in the undiluted sample, then the
4 216 KHOSROSHAHI ET AL prozone phenomenon is present. The prozone effect can be circumvented by diluting the test sample to allow the antibody concentration to remain in excess of the antigen concentration. As knowledge of IgG4-RD has broadened and clinicians have more often assessed the serum IgG4 concentrations of their patients, recognition of the potential shortcomings of serum IgG4 assays as biomarkers for diagnosis and disease activity assessments has developed. Wide variability exists in the reported frequency of elevated serum IgG4 levels (14 18), and the reliability of the serum IgG4 concentration as a biomarker for diagnosis and disease activity has been questioned. Although the prozone effect appears to explain a substantial number of false-negative results of serum IgG4 assays, the cumulative literature and our own experience suggest the existence of patients with biopsy-proven IgG4-RD and normal serum IgG4 concentrations. Our analysis identifies the interaction of IgG4 with other IgG subclasses (in this case, IgG2) as another possible reason for erroneous results of IgG4 assays. IgG4 has unique structural and functional properties that lead to Fc Fc interactions between different IgG4 molecules and between the Fc portions of IgG4 and those of other IgG subclasses. These phenomena have been reported by other investigators (19), focusing in particular on the interaction between IgG4 and IgG1 (20,21). To our knowledge, this is the first report of possible interaction between IgG4 and IgG2. Deceptively high IgG2 levels were reported in no less than 24% of all samples tested in this cohort. We have also observed potential IgG4 IgG2 interaction in other patients with IgG4-RD (Stone J, et al: unpublished observations). We have demonstrated that the prozone effect is an important explanation for the disparity that sometimes exists between the presence of clinical features of IgG4-RD and the results of serum IgG4 assays. Clinicians should consider the possibility of the prozone effect when the reported serum IgG4 measurement appears discordant with other evidence for a diagnosis of IgG4-RD or the overall assessment of disease activity in a patient with known disease. Other causes of spurious results of IgG subclass testing may be identified as awareness of IgG4-RD grows and investigations of serum IgG subclass concentrations become more common. AUTHOR CONTRIBUTIONS All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. Dr. Stone had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design. Khosroshahi, Cheryk, Carruthers, Edwards, Bloch, Stone. Acquisition of data. Khosroshahi, Cheryk, Edwards, Bloch, Stone. Analysis and interpretation of data. Khosroshahi, Cheryk, Edwards, Bloch, Stone. REFERENCES 1. Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med 2012;366: Deshpande V, Zen Y, Chan JK, Yi EE, Sato Y, Yoshino T, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol 2012;25: Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med 2001;344: Kamisawa T, Funata N, Hayashi Y, Eishi Y, Koike M, Tsuruta K, et al. A new clinicopathological entity of IgG4-related autoimmune disease. J Gastroenterol 2003;38: Stone JH, Patel VI, Oliveira GR, Stone JR. Case records of the Massachusetts General Hospital. Case A 60-year-old man with abdominal pain and aortic aneurysms. N Engl J Med 2012; 367: Carruthers MN, Stone JH, Deshpande V, Khosroshahi A. Development of an IgG4-RD Responder Index. Int J Rheumatol 2012;2012: Chen G, Cheuk W, Chan JK. IgG4-related sclerosing disease: a critical appraisal of an evolving clinicopathologic entity. Zhonghua Bing Li Xue Za Zhi 2010;39: In Chinese. 8. Stone JH. IgG4-related disease: nomenclature, clinical features, and treatment. Semin Diagn Pathol 2012;29: Umehara H, Okazaki K, Masaki Y, Kawano M, Yamamoto M, Saeki T, et al, the Research Program for Intractable Disease by Ministry of Health, Labor and Welfare (MHLW) Japan G4 team. A novel clinical entity, IgG4-related disease (IgG4RD): general concept and details [review]. Mod Rheumatol 2012;22: Kamisawa T, Okamoto A, Funata N. Clinicopathological features of autoimmune pancreatitis in relation to elevation of serum IgG4. Pancreas 2005;31: Khosroshahi A, Bloch DB, Deshpande V, Stone JH. Rituximab therapy leads to rapid decline of serum IgG4 levels and prompt clinical improvement in IgG4-related systemic disease. Arthritis Rheum 2010;62: Feldkamp CS. Immunochemical techniques. In: Kaplan LA, Pesce AJ, Kazmierczak SC, editors. Clinical chemistry: theory, analysis, correlation. 4th ed. St. Louis: Mosby; p Kricka LJ. Principles of immunochemical techniques. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz textbook of clinical chemistry and molecular diagnostics. St. Louis: Elsevier Saunders; p Raina A, Yadav D, Krasinskas AM, McGrath KM, Khalid A, Sanders M, et al. Evaluation and management of autoimmune pancreatitis: experience at a large US center. Am J Gastroenterol 2009;104: Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol 2007;102: Frulloni L, Lunardi C, Simone R, Dolcino M, Scattolini C, Falconi M, et al. Identification of a novel antibody associated with autoimmune pancreatitis. N Engl J Med 2009;361: Morselli-Labate AM, Pezzilli R. Usefulness of serum IgG4 in the
5 THE PROZONE EFFECT IN IgG4-RELATED DISEASE 217 diagnosis and follow up of autoimmune pancreatitis: a systematic literature review and meta-analysis. J Gastroenterol Hepatol 2009; 24: Yamamoto M, Takahashi H, Ohara M, Suzuki C, Naishiro Y, Yamamoto H, et al. A new conceptualization for Mikulicz s disease as an IgG4-related plasmacytic disease. Mod Rheumatol 2006;16: Rispens T, Ooievaar-De Heer P, Vermeulen E, Schuurman J, van der Neut Kolfschoten M, Aalberse RC. Human IgG4 binds to IgG4 and conformationally altered IgG1 via Fc-Fc interactions. J Immunol 2009;182: Kawa S, Kitahara K, Hamano H, Ozaki Y, Arakura N, Yoshizawa K, et al. A novel immunoglobulin-immunoglobulin interaction in autoimmunity. PLoS One 2008;3:e Van der Neut Kolfschoten M, Schuurman J, Losen M, Bleeker WK, Martinez-Martinez P, Vermeulen E, et al. Anti-inflammatory activity of human IgG4 antibodies by dynamic Fab arm exchange. Science 2007;317:
Review Article The Utility of Serum IgG4 Concentrations as a Biomarker
International Rheumatology Volume 2012, Article ID 198314, 4 pages doi:10.1155/2012/198314 Review Article The Utility of Serum IgG4 Concentrations as a Biomarker Shigeyuki Kawa, 1 Tetsuya Ito, 2 Takayuki
More informationFOR PUBLIC CONSULTATION ONLY. Evidence Review: Rituximab for immunoglobulin G4-related disease (IgG4-RD)
Evidence Review: Rituximab for immunoglobulin G4-related disease (IgG4-RD) NHS England FOR PUBLIC CONSULTATION ONLY Evidence Review: Rituximab for immunoglobulin G4-related disease (IgG4- RD) First published:
More informationOverview of the Immunoglobulin G4-related Disease Spectrum
Review Article The Korean Journal of Pancreas and Biliary Tract 2015;20:124-129 http://dx.doi.org/10.15279/kpba.2015.20.3.124 pissn 1976-3573 eissn 2288-0941 면역글로불린 G4 연관질환의개요 1 한림대학교의과대학한림대학교성심병원내과, 2
More informationRenal manifestations of IgG4-related systemic disease
Renal manifestations of IgG4-related systemic disease Lynn D. Cornell, M.D. Mayo Clinic Rochester, MN While autoimmune pancreatitis (AIP) has been recognized since the first description by Sarles et al
More informationImmunoglobulin G4-Related Disease with Several Inflammatory Foci
CASE REPORT Immunoglobulin G4-Related Disease with Several Inflammatory Foci Akira Sakamaki 1, Kenya Kamimura 1, Kazuhiko Shioji 1, Junko Sakurada 2, Takeshi Nakatsue 3, Yoko Wada 3, Michitaka Imai 1,
More informationValue of Serum IgG4 in the Diagnosis of Autoimmune Pancreatitis and in Distinguishing it from Acute and Chronic Pancreatitis of Other Etiology
94 Jul 2017 Vol 10 No.3 North American Journal of Medicine and Science Original Research Value of Serum IgG4 in the Diagnosis of Autoimmune Pancreatitis and in Distinguishing it from Acute and Chronic
More informationA Case of IgG4-Related Disease Presenting as Massive Pleural Effusion and Thrombophlebitis
CASE REPORT http://dx.doi.org/10.4046/trd.2014.76.4.179 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2014;76:179-183 A Case of IgG4-Related Disease Presenting as Massive Pleural Effusion
More informationIgG4-related disease: features and treatment response in a multi-ethnic cohort in Singapore
IgG4-related disease: features and treatment response in a multi-ethnic cohort in Singapore W. Fong 1,2,3, I. Liew 1, D. Tan 2,3,4, K.H. Lim 5, A. Low 6, Y.Y. Leung 1,2 1 Department of Rheumatology and
More informationLymphoplasmacytic sclerosing pancreatitis without IgG4 tissue infiltration or serum IgG4 elevation: IgG4-related disease without IgG4
238 & 2015 USCAP, Inc All rights reserved 0893-3952/15 $32.00 Lymphoplasmacytic sclerosing pancreatitis without IgG4 tissue infiltration or serum IgG4 elevation: IgG4-related disease without IgG4 Phil
More informationHow 5 Diseases Became One. Moez Tajdin R3 McGill University
How 5 Diseases Became One Moez Tajdin R3 McGill University Conflicts of Interest None! Mr. M. ID: 65 M PMH Benign prostatic hyperplasia Prostate cancer Awaiting biopsy Skin rash Dyslipidemia Hypertension
More informationClinical Study IgG4-Related Disease Is Not Associated with Antibody to the Phospholipase A2 Receptor
International Rheumatology Volume 2012, Article ID 139409, 6 pages doi:10.1155/2012/139409 Clinical Study IgG4-Related Disease Is Not Associated with Antibody to the Phospholipase A2 Receptor Arezou Khosroshahi,
More informationClinical outcomes and pathological characteristics of immunoglobulin G4-related ophthalmic disease versus orbital inflammatory pseudotumor
ORIGINAL ARTICLE Korean J Intern Med 2019;34:220-226 Clinical outcomes and pathological characteristics of immunoglobulin G4-related ophthalmic disease versus orbital inflammatory pseudotumor Hong Ki Min
More informationInt J Clin Exp Pathol 2016;9(3): /ISSN: /IJCEP Sun Young Choi 1, Sanghui Park 2
Int J Clin Exp Pathol 2016;9(3):4033-4037 www.ijcep.com /ISSN:1936-2625/IJCEP0020891 Case Report Is the presence of IgG4+ cells within urothelial carcinomas of the renal pelvis that contain rhabdoid and
More informationComparison of multidetector-row computed tomography findings of IgG4-related sclerosing cholangitis and cholangiocarcinoma
Comparison of multidetector-row computed tomography findings of IgG4-related sclerosing cholangitis and cholangiocarcinoma Poster No.: C-0245 Congress: ECR 2014 Type: Scientific Exhibit Authors: M. Yata,
More informationRenal Pathology Case Conference. Case 2
Renal Pathology Case Conference Case 2 Lynn D. Cornell, M.D. Mayo Clinic, Rochester, MN cornell.lynn@mayo.edu March 2, 2008 Clinical presentation 68 year old woman, initially with normal renal function
More informationThe newly recognized fibroinflammatory condition. An orphan disease: IgG4-related spinal pachymeningitis: report of 2 cases
case report J Neurosurg Spine 25:790 794, 2016 An orphan disease: IgG4-related spinal pachymeningitis: report of 2 cases Bishan D. Radotra, MD, 1 Ashish Aggarwal, DNB, MCh, 2 Ankur Kapoor, MS, MCh, 2 Navneet
More informationMikulicz s Disease with Progressively Transformed Germinal Centers-type Immunoglobulin G4-related Lymphadenopathy Mimicking Sjögren s Syndrome
Journal of Rheumatic Diseases Vol. 22, No. 6, December, 2015 http://dx.doi.org/10.4078/jrd.2015.22.6.395 Case Report Mikulicz s Disease with Progressively Transformed Germinal Centers-type Immunoglobulin
More informationIgG4-Related Disease
IgG4-related disease (IgG4-RD) is a systemic autoimmune fibroinflammatory disease that produces sclerotic, tumefactive masses containing dense lymphoplasmacytic infiltrates rich in immunoglobulin (Ig)
More informationChronic Sclerosing Dacryoadenitis
The Korean Journal of Pathology 2008; 42: 118-22 Chronic Sclerosing Dacryoadenitis - Report of 2 Cases - Ji Eun Kwon Sang Kyum Kim Sang-Ryul Lee 1 Woo-Ick Yang Haeryoung Kim 2 Department of Pathology and
More informationCME/SAM. Increased Immunoglobulin (Ig) G4 Positive Plasma Cell Density and IgG4/IgG Ratio Are Not Specific for IgG4- Related Disease in the Skin
Increased Immunoglobulin (Ig) G4 Positive Plasma Cell Density and IgG4/IgG Ratio Are Not Specific for IgG4- Related Disease in the Skin Julia S. Lehman, MD, 1,2 Thomas C. Smyrk, MD, 1 and Mark R. Pittelkow,
More informationClinical Study Spectrum of Disorders Associated with Elevated Serum IgG4 Levels Encountered in Clinical Practice
International Rheumatology Volume 2012, Article ID 232960, 6 pages doi:10.1155/2012/232960 Clinical Study Spectrum of Disorders Associated with Elevated Serum IgG4 Levels Encountered in Clinical Practice
More informationIgG4-related systemic disease (ISD) is a multisystem
Utility of Serum Immunoglobulin G4 in Distinguishing Immunoglobulin G4-Associated Cholangitis from Cholangiocarcinoma Abdul M. Oseini, 1 * Roongruedee Chaiteerakij, 1 * Abdirashid M. Shire, 1 Amaar Ghazale,
More informationCase report: IgG4-related mass-forming thyroiditis accompanied by regional lymphadenopathy
Sakai and Imamura Diagnostic Pathology (2018) 13:3 DOI 10.1186/s13000-017-0681-9 CASE REPORT Case report: IgG4-related mass-forming thyroiditis accompanied by regional lymphadenopathy Yasuhiro Sakai 1,2*
More informationIgG4-related sclerosing disease
IgG4-related sclerosing disease TERUMI KAMISAWA, KENSUKE TAKUMA, NAOTO EGAWA Department of Internal Medicine Tokyo Metropolitan Komagome Hospital 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan JAPAN
More informationCase Report Thoracic Paravertebral Mass as an Infrequent Manifestation of IgG4-Related Disease
Hindawi Case Reports in Rheumatology Volume 2017, Article ID 4716245, 4 pages https://doi.org/10.1155/2017/4716245 Case Report Thoracic Paravertebral Mass as an Infrequent Manifestation of IgG4-Related
More informationdoi: /s x
doi: 10.1038/s41598-018-28405-x www.nature.com/scientificreports Received: 5 December 2017 Accepted: 21 June 2018 Published: xx xx xxxx OPEN Factors in glucocorticoid regimens associated with treatment
More informationA case of retroperitoneal fibrosis responding to steroid therapy
Challenging Clinical Cases Vol. 43 (6): 1185-1189, November - December, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0520 A case of retroperitoneal fibrosis responding to steroid therapy Ryuta Watanabe 1, Akira
More informationRecovery of renal function after glucocorticoid therapy for IgG4-related kidney disease with renal dysfunction
Clin Exp Nephrol (2016) 20:87 93 DOI 10.1007/s10157-015-1140-0 ORIGINAL ARTICLE Recovery of renal function after glucocorticoid therapy for IgG4-related kidney disease with renal dysfunction Takako Saeki
More informationA case of marginal zone B cell lymphoma mimicking IgG4-related dacryoadenitis and sialoadenitis
Ohta et al. World Journal of Surgical Oncology (2015) 13:67 DOI 10.1186/s12957-015-0459-z WORLD JOURNAL OF SURGICAL ONCOLOGY CASE REPORT Open Access A case of marginal zone B cell lymphoma mimicking IgG4-related
More informationIgG4-Negative Autoimmune Pancreatitis with Sclerosing Cholangitis and Colitis: Possible Association with Primary Sclerosing Cholangitis?
CASE REPORT IgG4-Negative Autoimmune Pancreatitis with Sclerosing Cholangitis and Colitis: Possible Association with Primary Sclerosing Cholangitis? Keita Saeki 1, Shigenari Hozawa 1, Naoteru Miyata 1,
More informationClinical Study Evaluation and Clinical Validity of a New Questionnaire for Mikulicz s Disease
International Rheumatology Volume 2, Article ID 283459, pages doi:1.1155/2/283459 Clinical Study Evaluation and Clinical Validity of a New Questionnaire for Mikulicz s Disease Motohisa Yamamoto, 1 Hiroki
More informationIgG4-Related Disease: Puzzles and Pitfalls
IgG4-Related Disease: Puzzles and Pitfalls Roberto Novoa, MD Section of Dermatopathology Departments of Pathology and Dermatology Stanford University Medical Center Stanford, CA Disclosures I have no relevant
More informationClinical Study Development of an IgG4-RD Responder Index
International Rheumatology Volume 2012, Article ID 259408, 7 pages doi:10.1155/2012/259408 Clinical Study Development of an IgG4-RD Responder Index Mollie N. Carruthers, 1 John H. Stone, 1 Vikram Deshpande,
More informationKey words: diagnosis, immunoglobulin G4, immunoglobulin G4-related diseases, immunohistochemistry, pseudolymphoma. CASE HISTORY
doi: 10.1111/1346-8138.12301 Journal of Dermatology 2013; 40: 998 1003 ORIGINAL ARTICLE Case of immunoglobulin G4-related skin disease: Possible immunoglobulin G4-related skin disease cases in cutaneous
More informationKazuichi Okazaki 1 and Hisanori Umehara Introduction. 2. The Concept of IgG4-Related Disease
Hindawi Publishing Corporation International Journal of Rheumatology Volume 2012, Article ID 357071, 9 pages doi:10.1155/2012/357071 Review Article Are Classification Criteria for IgG4-RD Now Possible?
More informationDepartment of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea 2
Case Report pissn 1738-2637 / eissn 2288-2928 J Korean Soc Radiol 2018;79(5):276-281 https://doi.org/10.3348/jksr.2018.79.5.276 Sequential CT Findings in Two Cases of Immunoglobulin G4-Related Lung Disease:
More informationBiopsy-proven IgG4-related lung disease
Sun et al. BMC Pulmonary Medicine (2016) 16:20 DOI 10.1186/s12890-016-0181-9 RESEARCH ARTICLE Biopsy-proven IgG4-related lung disease Xuefeng Sun 1, Hongrui Liu 2, Ruie Feng 2, Min Peng 1, Xiaomeng Hou
More informationPulmonary function tests findings and their diagnostic value in patients with IgG4-related disease
Original Article Pulmonary function tests findings and their diagnostic value in patients with IgG4-related disease Lu Cao, Yi-Bing Chen, Da-Hui Zhao, Wen-Fang Shi, Song Meng, Li-Xin Xie Department of
More informationInternational Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease
ARTHRITIS & RHEUMATOLOGY Vol. 67, No. 7, July 2015, pp 1688 1699 DOI 10.1002/art.39132 VC 2015, American College of Rheumatology SPECIAL ARTICLE International Consensus Guidance Statement on the Management
More informationCase Report Immunoglobulin G4-related disease coexisting with rectal cancer: a case report
Int J Clin Exp Pathol 2018;11(11):5481-5485 www.ijcep.com /ISSN:1936-2625/IJCEP0082565 Case Report Immunoglobulin G4-related disease coexisting with rectal cancer: a case report Wei-Ji Xie 1*, Gui-Tian
More informationIgG4-Related Disease: Dataset of 235 Consecutive Patients
IgG-Related Disease: Dataset of 235 Consecutive Patients Dai Inoue, MD, PhD, Kotaro Yoshida, MD, PhD, Norihide Yoneda, MD, PhD, Kumi Ozaki, MD, PhD, Takashi Matsubara, MD, PhD, Keiichi Nagai, MD, PhD,
More informationUsefulness of PET/CT Imaging in Systemic IgG4-related Sclerosing Disease. A Report of Three Cases
MULTIMEDIA ARTICLE - Clinical Imaging Usefulness of PET/CT Imaging in Systemic IgG4-related Sclerosing Disease. A Report of Three Cases Vien X Nguyen 1, Giovanni De Petris 2, Ba D Nguyen 3 Departments
More informationA Case of Multiple Giant Coronary Aneurysms and Abdominal Aortic Aneurysm Coexisting with IgG4-related Disease
CASE REPORT A Case of Multiple Giant Coronary Aneurysms and Abdominal Aortic Aneurysm Coexisting with IgG4-related Disease Hirofumi Takei 1, Hayato Nagasawa 1, Ryota Sakai 1, Koji Nishimura 1, Takahiko
More informationA case of mantle cell lymphoma presenting as IgG4-related dacryoadenitis and sialoadenitis, so-called Mikulicz sdisease
Hayashi et al. World Journal of Surgical Oncology (2015) 13:225 DOI 10.1186/s12957-015-0644-0 WORLD JOURNAL OF SURGICAL ONCOLOGY CASE REPORT Open Access A case of mantle cell lymphoma presenting as IgG4-related
More informationCharacterizing IgG4-related disease with 18 F-FDG PET/CT: a prospective cohort study
Eur J Nucl Med Mol Imaging (2014) 41:1624 1634 DOI 10.1007/s00259-014-2729-3 ORIGINAL ARTICLE Characterizing IgG4-related disease with 18 F-FDG PET/CT: a prospective cohort study Jingjing Zhang & Hua Chen
More informationSonographic findings of immunoglobulin G4-related sc. Author(s) Akihiro; Nakamaru, Yuji; Hatanaka, Kanako C.; Shimiz
Title Sonographic findings of immunoglobulin G4-related sc Omotehara, Satomi; Nishida, Mutsumi; Satoh, Megumi; Author(s) Akihiro; Nakamaru, Yuji; Hatanaka, Kanako C.; Shimiz CitationJournal of medical
More informationClinical Commissioning Policy Proposition:
Clinical Commissioning Policy Proposition: Rituximab for immunoglobulin G4-related disease (IgG4-RD) Reference: NHS England A13X07/01 Information Reader Box (IRB) to be inserted on inside front cover for
More informationImmunoglobulin G4 Non-Related Sclerosing Disease with Intracardiac Mass Mimicking Mitral Stenosis: Case Report
SE REPORT ardiovascular isorders J Korean Med Sci 2013; 28: 1830-1834 Immunoglobulin G4 Non-Related Sclerosing isease with Intracardiac Mass Mimicking Mitral Stenosis: ase Report Ji-won Hwang, 1 * Sung-Ji
More informationReview Article Orbital IgG4-Related Disease: Clinical Features and Diagnosis
International Scholarly Research Network Volume 2012, Article ID 412896, 5 pages doi:10.5402/2012/412896 Review Article Orbital IgG4-Related Disease: Clinical Features and Diagnosis Toshinobu Kubota 1
More informationImmunoglobulin G4-related disease (IgG4-
review article Oman Medical Journal [2018], Vol. 33, No. 2: 97-103 ARTICLE INFO Article history: Received: 12 April 2017 Accepted: 14 August 2017 Online: DOI 10.5001/omj.2018.20 Keywords: Immunoglobulin
More informationCase Report Usefulness of minor salivary gland biopsy in the diagnosis of IgG4-related disease: a case report
Int J Clin Exp Pathol 2014;7(5):2673-2677 www.ijcep.com /ISSN:1936-2625/IJCEP0000175 Case Report Usefulness of minor salivary gland biopsy in the diagnosis of IgG4-related disease: a case report Kentaro
More informationTreatment of immunoglobulin G4-related sialadenitis: outcomes of glucocorticoid therapy combined with steroid-sparing agents
Hong et al. Arthritis Research & Therapy (2018) 20:12 DOI 10.1186/s13075-017-1507-6 RESEARCH ARTICLE Open Access Treatment of immunoglobulin G4-related sialadenitis: outcomes of glucocorticoid therapy
More informationA Case of Autoimmune Pancreatitis Associated with Retroperitoneal Fibrosis
CASE REPORT A Case of Autoimmune Pancreatitis Associated with Retroperitoneal Fibrosis Koushiro Ohtsubo 1, Hiroyuki Watanabe 1, Tomoya Tsuchiyama 1, Hisatsugu Mouri 1, Yasushi Yamaguchi 1, Yoshiharu Motoo
More informationPlasma cells produce various immunoglobulins, ActaDV ActaDV
506 CLINICAL REPORT Evaluation of IgG4 + Plasma Cell Infiltration in Patients with Systemic Plasmacytosis and Other Plasma Cell-infiltrating Skin Diseases Shintaro TAKEOKA 1, Masahiro KAMATA 1, Carren
More informationClinicopathological characteristics of immunoglobulin G4-related sialadenitis
Li et al. Arthritis Research & Therapy (2015) 17:186 DOI 10.1186/s13075-015-0698-y RESEARCH ARTICLE Open Access Clinicopathological characteristics of immunoglobulin G4-related sialadenitis Wei Li 1, Yan
More informationCASE 01 LA Path Slide Seminar 13 March, 08. Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center
CASE 01 LA Path Slide Seminar 13 March, 08 Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center Clinical History 60 year old male presented with obstructive jaundice
More informationHideaki Miura, Yasutaka Miyachi. Department of Internal Medicine, Social Insurance Central General Hospital. Tokyo, Japan
CASE REPORT IgG4-Related Retroperitoneal Fibrosis and Sclerosing Cholangitis Independent of Autoimmune Pancreatitis. A Recurrent Case after a 5-Year History of Spontaneous Remission Hideaki Miura, Yasutaka
More informationAutoimmune Pancreatitis and Retroperitoneal Fibrosis
Autoimmune Pancreatitis and Retroperitoneal Fibrosis Thomas C. Smyrk, MD Associate Professor of Pathology Mayo Clinic, Rochester MN 55902 smyrk.thomas@mayo.edu Summary Retroperitoneal fibrosis complicated
More informationConsensus Statement on the Pathology of IgG4-Related Disease
Consensus Statement on the Pathology of IgG4-Related Disease The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Deshpande,
More informationAnalysis of Serum IgG Subclasses in Churg-Strauss Syndrome The Meaning of Elevated Serum Levels of IgG4
ORIGINAL ARTICLE Analysis of Serum IgG Subclasses in Churg-Strauss Syndrome The Meaning of Elevated Serum Levels of IgG4 Motohisa Yamamoto, Hiroki Takahashi, Chisako Suzuki, Tetsuya Tabeya, Mikiko Ohara,
More informationAmong the benign intraepithelial melanocytic proliferations, Inflamed Conjunctival Nevi. Histopathological Criteria. Resident Short Reviews
Resident Short Reviews Inflamed conjunctival nevi (ICN) may suggest malignancy because of their rapid growth and atypical histology. The objective of this study was to characterize the diagnostic features
More informationIncidence of Malignancy in Type 1 Autoimmune Pancreatitis
ORIGINAL ARTICLE Incidence of Malignancy in Type 1 Autoimmune Pancreatitis Junko Tahara 1, Kyoko Shimizu 1, Junichi Akao 1, Yukiko Takayama 1, Katsutoshi Tokushige 1, Masakazu Yamamoto 2 1 Department of
More informationAutoimmune pancreatitis / IgG4-associated cholangitis and primary sclerosing cholangitis Overlapping or separate diseases? q
Journal of Hepatology 51 (2009) 398 402 Review Autoimmune pancreatitis / IgG4-associated cholangitis and primary sclerosing cholangitis Overlapping or separate diseases? q George J.M. Webster 1,2, *, Stephen
More informationA novel clinical entity, IgG4-related disease (IgG4RD): general concept and details
Mod Rheumatol (2012) 22:1 14 DOI 10.1007/s10165-011-0508-6 REVIEW ARTICLE A novel clinical entity, IgG4-related disease (IgG4RD): general concept and details Hisanori Umehara Kazuichi Okazaki Yasufumi
More informationIsolated Mass-Forming IgG4-Related Cholangitis as an Initial Clinical Presentation of Systemic IgG4-Related Disease
Journal of Pathology and Translational Medicine 2016; 50: 300-305 CASE STUDY Isolated Mass-Forming IgG4-Related Cholangitis as an Initial Clinical Presentation of Systemic IgG4-Related Disease Seokhwi
More informationIgG4-Related Sclerosing Cholangitis
REVIEW IgG4-Related Sclerosing Cholangitis Emma L. Culver, B.Sc., M.B.Ch.B., D.Phil., M.R.C.P.,* and Eleanor Barnes, M.B.B.S., D.Phil., M.R.C.P.*,, BACKGROUND IgG4-related sclerosing cholangitis (IgG4-SC)
More informationCLINICAL SCIENCES. Orbital Inflammation With IgG4-Positive Plasma Cells
CLINICAL SCIENCES Orbital Inflammation With IgG4-Positive Plasma Cells Manifestation of IgG4 Systemic Disease José Antonio Plaza, MD; James A. Garrity, MD; Ahmet Dogan, MD, PhD; Anuradha Ananthamurthy,
More informationAutoimmune pancreatitis (AIP) can be defined as a
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:1010 1016 Diagnosis of Autoimmune Pancreatitis: The Mayo Clinic Experience SURESH T. CHARI,* THOMAS C. SMYRK, MICHAEL J. LEVY,* MARK D. TOPAZIAN,* NAOKI
More informationReview Article IgG4-related lymphadenopathy: a potentially under- and over-diagnosed entity
Int J Clin Exp Pathol 2017;10(10):10153-10166 www.ijcep.com /ISSN:1936-2625/IJCEP0026563 Review Article IgG4-related lymphadenopathy: a potentially under- and over-diagnosed entity Zenggang Pan 1, Jiehao
More informationThe most common presentation of autoimmune pancreatitis. A Diagnostic Strategy to Distinguish Autoimmune Pancreatitis From Pancreatic Cancer
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:1097 1103 A Diagnostic Strategy to Distinguish Autoimmune Pancreatitis From Pancreatic Cancer SURESH T. CHARI,* NAOKI TAKAHASHI, MICHAEL J. LEVY,* THOMAS
More informationClinical features of IgG4-related periaortitis/periarteritis based on the analysis of 179 patients with IgG4-related disease: a case control study
Ozawa et al. Arthritis Research & Therapy (2017) 19:223 DOI 10.1186/s13075-017-1432-8 RESEARCH ARTICLE Open Access Clinical features of IgG4-related periaortitis/periarteritis based on the analysis of
More informationA 44-Year-Old Man With Chronic Cough, Weakness, and a Mediastinum Mass
[ Pulmonary, Critical Care, and Sleep Pearls ] A 44-Year-Old Man With Chronic Cough, Weakness, and a Mediastinum Mass Dimitrios Theofilos, MD ; Christina Triantafillidou, MD, PhD ; Athanasios Zetos, MD
More informationDiagnostic And Therapeutic Challenges in IgG4-Related disease in the Sphenoid Sinus
Diagnostic And Therapeutic Challenges in IgG4-Related disease in the Sphenoid Sinus Omar Abu Suliman, MBBS, SB-ORL Senior Registrar, otolaryngology Head & neck surgery King Abdullah Medical City, Makkah,
More informationUlcerative Colitis and Immunoglobulin G4
Gut and Liver, Vol. 8, No. 1, January 2014, pp. 29-4 ORiginal Article Ulcerative Colitis and Immunoglobulin G4 Go Kuwata*, Terumi Kamisawa*, Koichi Koizumi*, Taku Tabata*, Seiichi Hara*, Sawako Kuruma*,
More informationRethinking Ormond s Disease: Idiopathic Retroperitoneal Fibrosis in the Era of IgG4-Related Disease
Rethinking Ormond s Disease: Idiopathic Retroperitoneal Fibrosis in the Era of IgG4-Related Disease The Harvard community has made this article openly available. Please share how this access benefits you.
More informationAutoimmune pancreatitis (AIP), a clinical entity originally
Autoimmune Pancreatitis: A Multiorgan Disease Presenting a Conundrum for Clinicians in the West Eileen Kim, MD, Rebecca Voaklander, MD, Franklin E. Kasmin, MD, William H. Brown, MD, Rifat Mannan, MD, and
More informationEarly Detection and Intervention of Coronary Artery Involvement in Immunoglobulin G4-related Disease
doi: 10.2169/internalmedicine.7816-16 http://internmed.jp CASE REPORT Early Detection and Intervention of Coronary Artery Involvement in Immunoglobulin G4-related Disease Yoji Komiya 1, Makoto Soejima
More informationUnusual Involvement of IgG4-Related Sclerosing Disease in Lacrimal and Submandibular Glands and Extraocular Muscles
pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2012;26(3):216-221 http://dx.doi.org/10.3341/kjo.2012.26.3.216 Case Report Unusual Involvement of IgG4-Related Sclerosing Disease in Lacrimal and Submandibular
More informationIgG-4 related disease: A mini-review
www.rarediseasesjournal.com Journal of Rare Diseases Research & Treatment Mini review Open Access IgG-4 related disease: A mini-review Ramy Sedhom 1*, Daniel Sedhom 1 and Roger Strair 2 1 Department of
More informationCase Report IgG4-Related Nasal Pseudotumor
Case Reports in Otolaryngology Volume 2015, Article ID 749890, 4 pages http://dx.doi.org/10.1155/2015/749890 Case Report IgG4-Related Nasal Pseudotumor L. K. Døsen, 1 P. Jebsen, 2 B. Dingsør, 3 and R.
More informationCase Report An IgG4-Related Salivary Gland Disorder: A Case Series Presenting with a Different Clinical Setting
Case Reports in Immunology Volume 2011, Article ID 236079, 4 pages doi:10.1155/2011/236079 Case Report An IgG4-Related Salivary Gland Disorder: A Case Series Presenting with a Different Clinical Setting
More informationRetroperitoneal fibrosis from bedside to bench
Retroperitoneal fibrosis from bedside to bench Augusto Vaglio, MD PhD UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma augusto.vaglio@virgilio.it THE CONCEPT OF FIBRO-INFLAMMATORY DISEASES Tumour-like,
More informationIgG4-related disease and its pathogenesis cross-talk between innate and acquired immunity
International Immunology, Vol. 26, No. 11, pp. 585 595 doi:10.1093/intimm/dxu074 Advance Access publication 14 July 2014 The Author 2014. Published by Oxford University Press on behalf of The Japanese
More informationIgG4 Disease. General Principles of IgG4-related disease. EL Cluvar, AC Bateman
IgG4 Disease General Principles of IgG4-related disease. EL Cluvar, AC Bateman Diagnostic Guidelines for IgG4-related disease with a focus on histopathological criteria. V Deshpande, A Khosroshahi Diagnostic
More informationR J M E Romanian Journal of Morphology & Embryology
Rom J Morphol Embryol 2014, 55(2):419 423 CASE REPORT R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/ Inflammatory pseudotumors of the kidney due to IgG4- related tubulointerstitial
More informationImmunoglobulin G4 related disease (IgG4-RD) is a
CASE REPORT J Neurosurg Spine 26:688 693, 2017 Immunoglobulin G4 related epidural inflammatory pseudotumor presenting with pulmonary complications and spinal cord compression: case report Kavelin Rumalla,
More informationOverview of Diagnostic Criteria for Autoimmune Pancreatitis
2007 년도대한췌담도학회추계학술대회 Session II: Comparison of Diagnostic Criteria for AIP: Japan, USA & Korea Overview of Diagnostic Criteria for Autoimmune Pancreatitis Department of Internal Medicine, Seoul National
More informationIn Vitro Diagnostic Glucose Test System
CDRH Final Guidance 2-Page Cover Sheet Guidance for Industry In Vitro Diagnostic Glucose Test System Document issued on: July 6, 1998 U.S. Department Of Health and Human Services Food and Drug Administration
More informationIncrease of circulating memory B cells after glucocorticoid-induced remission identifies patients at risk of IgG4-related disease relapse
Lanzillotta et al. Arthritis Research & Therapy (2018) 20:222 https://doi.org/10.1186/s13075-018-1718-5 RESEARCH ARTICLE Increase of circulating memory B cells after glucocorticoid-induced remission identifies
More informationDiagnostic Algorithm for Autoimmune Pancreatitis in Korea
Review Article The Korean Journal of Pancreas and Biliary Tract 2014;19(1):7-12 pissn 1976-3573 eissn 2288-0941 한국에서자가면역췌장염의진단전략 성균관대학교의과대학삼성서울병원내과학교실 이종균 Diagnostic Algorithm for Autoimmune Pancreatitis
More informationCase Reports in Clinical Pathology, 2015, Vol. 2, No. 1
CASE REPORT A case of IgG4-related interstitial lung disease showing usual interstitial pneumonia pattern: Unusual case for histological features with pathological proof Seidai Sato 1, Masaki Hanibuchi
More informationA Case of IgG4-Related Disease with Bronchial Asthma and Chronic Rhinosinusitis in Korea
CSE REPORT Immunology, llergic Disorders & Rheumatology http://dx.doi.org/10.3346/jkms.2014.29.4.599 J Korean Med Sci 2014; 29: 599-603 Case of IgG4-Related Disease with ronchial sthma and Chronic Rhinosinusitis
More informationAzathioprine Induced Pancreatitis in a Patient with Co-Existing Autoimmune Pancreatitis and Hepatitis
CASE REPORT Azathioprine Induced Pancreatitis in a Patient with Co-Existing Autoimmune Pancreatitis and Hepatitis Preethi GK Venkatesh, Udayakumar Navaneethan Digestive Disease Institute, Cleveland Clinic
More informationgg4-related inflammatory pseudotumour of the trigeminal nerve: imaging findings and clinical features
gg4-related inflammatory pseudotumour of the trigeminal nerve: imaging findings and clinical features Poster No.: C-2603 Congress: ECR 2013 Type: Scientific Exhibit Authors: Y. Kawamura, Y. Kikuchi, I.
More informationSuccessful Treatment of Multi-system IgG4-related Disease with Cyclophosphamide: A Case Report X Zhang, W Qin, J Zhou, L Yang ABSTRACT
Successful Treatment of Multi-system IgG4-related Disease with Cyclophosphamide: A Case Report X Zhang, W Qin, J Zhou, L Yang ABSTRACT Immunoglobulin G4-related disease (IgG4-RD) is increasingly recognized
More informationDifferentiating Immunoglobulin G4-Related Sclerosing Cholangitis from Hilar Cholangiocarcinoma
Gut and Liver, Vol. 7, No. 2, March 2013, pp. 234-238 ORiginal Article Differentiating Immunoglobulin G4-Related Sclerosing Cholangitis from Hilar Cholangiocarcinoma Taku Tabata*, Terumi Kamisawa*, Seiichi
More informationCase Report Concomitant occurrence of IgG4-related pleuritis and periaortitis: a case report with review of the literature
Int J Clin Exp Pathol 2014;7(2):808-814 www.ijcep.com /ISSN:1936-2625/IJCEP1312050 Case Report Concomitant occurrence of IgG4-related pleuritis and periaortitis: a case report with review of the literature
More informationThe Virtues and Pitfalls of Implementing a New Test
The Virtues and Pitfalls of Implementing a New Test James H. Nichols, Ph.D., DABCC, FACB Professor of Clinical Pathology, Microbiology and Immunology Associate Medical Director for Clinical Operations
More informationAutoimmune pancreatitis can develop into chronic pancreatitis
Maruyama et al. Orphanet Journal of Rare Diseases 2014, 9:77 REVIEW Autoimmune pancreatitis can develop into chronic pancreatitis Open Access Masahiro Maruyama 1, Takayuki Watanabe 1, Keita Kanai 1, Takaya
More informationInternational Immunology. International Immunology Advance Access published July 14, 2014
International Immunology International Immunology Advance Access published July 14, 2014 IgG4-related disease (IgG4-RD) and its pathogenesis -Crosstalk between Innate and Acquired immunity- Journal: International
More information