Pulmonary vascular involvement of IgG4-related disease: Case series with a PRISMA-compliant systemic review

摘要

Background: Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized, immune-mediated chronic fibrotic inflammation that can involve almost all organs, causing tumefaction and dysfunction. Its presence in pulmonary circulation is underestimated and has not yet been investigated. Objectives: We describe a representative IgG4-RD patient with pulmonary artery stenosis and pulmonary embolism , leading to reversible pulmonary hypertension . Literature review of IgG4-RD with pulmonary circulation involvement was conducted. Data sources: References for this review were identified through searches via PubMed, EBSCO, and Web of Science for published articles before November 2016. Results: There were 15 published cases of IgG4-RD with pulmonary vascular involvement, 3 with pulmonary arteritis , 2 with pulmonary artery aneurysm, 3 with pulmonary artery stenosis, 1 with obliterative phlebitis, and 1 with pulmonary embolism . Possible immunity and inflammation mechanisms were summarized. Conclusions: IgG4-RD with pulmonary vascular involvement is rare. Echocardiogram and contrast-enhanced chest CT are helpful to screen the disease. Clinical manifestations were found from asymptomatic to dyspnea or even syncope. And nearly all cases had more than 1 organ affected, with significantly increased serum IgG4 levels. PET/CT aided in identifying affected organs and determining candidate biopsy sites. More awareness is urged to evaluate the pulmonary vascular manifestations of this disease.