Progression of immunoglobulin G4-related disease to systematic lupus erythematosus after gastric cancer surgery: A case report

Haruna Arai, Hiroki Hayashi, Soshiro Ogata, Kenichi Uto, Jun Saegusa, Kazuo Takahashi, Shigehisa Koide, Daijo Inaguma, Midori Hasegawa, Yukio Yuzawa

Research output: Contribution to journalArticle

Abstract

Rationale: Immunoglobulin G4 related disease (IgG4-RD) rarely coexists with other autoimmune diseases, though we had a patient whose primary clinical problem was shifted from IgG4-RD to systemic lupus erythematosus (SLE) after gastrectomy. The present paper aimed to report pathological findings and clinical course of the patient. Patient concerns: The patient was a male aged 74 years old with gastric cancer characterized by the following symptoms: Raynaud phenomenon, polyarthralgia, and swollen parotid glands on both sides. Before gastrectomy, laboratory examination results showed renal dysfunction, hypocomplementemia, antinuclear antibodies (ANAs) positivity, and elevated serum IgG and IgG4 levels. Diagnosis: Based on postoperative renal biopsy showing severe plasma cell infiltration with tubulointerstitial fibrosclerosis, the patient was diagnosed with IgG4-RD. Despite significant improvement in renal function and reduction in parotid gland swelling during the postoperative follow-up period, after 7 months of the gastrectomy, anti-DNA antibody levels were increased and serositis was detected, which indicated the onset of SLE. IgG4-type ANA were also detected in the sera of the patient. Interventions: Treatment by oral prednisolone at 30 mg/day was initiated. Outcomes: Pericardial fluid, pleural effusions, and thickening of the gallbladder wall improved after 3 months of treatment according to computed tomography. Lessons: This study presented a rare case of comorbidity, wherein the patient’s primary problem progressed from IgG4-type ANA-positive IgG4-RD to SLE after excision of gastric cancer.

Original languageEnglish
Article numbere13545
JournalMedicine (United States)
Volume97
Issue number51
DOIs
Publication statusPublished - 01-12-2018

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Stomach Neoplasms
Immunoglobulins
Antinuclear Antibodies
Gastrectomy
Immunoglobulin G
Systemic Lupus Erythematosus
Parotid Gland
Kidney
Serositis
Raynaud Disease
Arthralgia
Pleural Effusion
Prednisolone
Plasma Cells
Gallbladder
Serum
Autoimmune Diseases
Comorbidity
Tomography
Biopsy

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

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title = "Progression of immunoglobulin G4-related disease to systematic lupus erythematosus after gastric cancer surgery: A case report",
abstract = "Rationale: Immunoglobulin G4 related disease (IgG4-RD) rarely coexists with other autoimmune diseases, though we had a patient whose primary clinical problem was shifted from IgG4-RD to systemic lupus erythematosus (SLE) after gastrectomy. The present paper aimed to report pathological findings and clinical course of the patient. Patient concerns: The patient was a male aged 74 years old with gastric cancer characterized by the following symptoms: Raynaud phenomenon, polyarthralgia, and swollen parotid glands on both sides. Before gastrectomy, laboratory examination results showed renal dysfunction, hypocomplementemia, antinuclear antibodies (ANAs) positivity, and elevated serum IgG and IgG4 levels. Diagnosis: Based on postoperative renal biopsy showing severe plasma cell infiltration with tubulointerstitial fibrosclerosis, the patient was diagnosed with IgG4-RD. Despite significant improvement in renal function and reduction in parotid gland swelling during the postoperative follow-up period, after 7 months of the gastrectomy, anti-DNA antibody levels were increased and serositis was detected, which indicated the onset of SLE. IgG4-type ANA were also detected in the sera of the patient. Interventions: Treatment by oral prednisolone at 30 mg/day was initiated. Outcomes: Pericardial fluid, pleural effusions, and thickening of the gallbladder wall improved after 3 months of treatment according to computed tomography. Lessons: This study presented a rare case of comorbidity, wherein the patient’s primary problem progressed from IgG4-type ANA-positive IgG4-RD to SLE after excision of gastric cancer.",
author = "Haruna Arai and Hiroki Hayashi and Soshiro Ogata and Kenichi Uto and Jun Saegusa and Kazuo Takahashi and Shigehisa Koide and Daijo Inaguma and Midori Hasegawa and Yukio Yuzawa",
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Progression of immunoglobulin G4-related disease to systematic lupus erythematosus after gastric cancer surgery : A case report. / Arai, Haruna; Hayashi, Hiroki; Ogata, Soshiro; Uto, Kenichi; Saegusa, Jun; Takahashi, Kazuo; Koide, Shigehisa; Inaguma, Daijo; Hasegawa, Midori; Yuzawa, Yukio.

In: Medicine (United States), Vol. 97, No. 51, e13545, 01.12.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Progression of immunoglobulin G4-related disease to systematic lupus erythematosus after gastric cancer surgery

T2 - A case report

AU - Arai, Haruna

AU - Hayashi, Hiroki

AU - Ogata, Soshiro

AU - Uto, Kenichi

AU - Saegusa, Jun

AU - Takahashi, Kazuo

AU - Koide, Shigehisa

AU - Inaguma, Daijo

AU - Hasegawa, Midori

AU - Yuzawa, Yukio

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Rationale: Immunoglobulin G4 related disease (IgG4-RD) rarely coexists with other autoimmune diseases, though we had a patient whose primary clinical problem was shifted from IgG4-RD to systemic lupus erythematosus (SLE) after gastrectomy. The present paper aimed to report pathological findings and clinical course of the patient. Patient concerns: The patient was a male aged 74 years old with gastric cancer characterized by the following symptoms: Raynaud phenomenon, polyarthralgia, and swollen parotid glands on both sides. Before gastrectomy, laboratory examination results showed renal dysfunction, hypocomplementemia, antinuclear antibodies (ANAs) positivity, and elevated serum IgG and IgG4 levels. Diagnosis: Based on postoperative renal biopsy showing severe plasma cell infiltration with tubulointerstitial fibrosclerosis, the patient was diagnosed with IgG4-RD. Despite significant improvement in renal function and reduction in parotid gland swelling during the postoperative follow-up period, after 7 months of the gastrectomy, anti-DNA antibody levels were increased and serositis was detected, which indicated the onset of SLE. IgG4-type ANA were also detected in the sera of the patient. Interventions: Treatment by oral prednisolone at 30 mg/day was initiated. Outcomes: Pericardial fluid, pleural effusions, and thickening of the gallbladder wall improved after 3 months of treatment according to computed tomography. Lessons: This study presented a rare case of comorbidity, wherein the patient’s primary problem progressed from IgG4-type ANA-positive IgG4-RD to SLE after excision of gastric cancer.

AB - Rationale: Immunoglobulin G4 related disease (IgG4-RD) rarely coexists with other autoimmune diseases, though we had a patient whose primary clinical problem was shifted from IgG4-RD to systemic lupus erythematosus (SLE) after gastrectomy. The present paper aimed to report pathological findings and clinical course of the patient. Patient concerns: The patient was a male aged 74 years old with gastric cancer characterized by the following symptoms: Raynaud phenomenon, polyarthralgia, and swollen parotid glands on both sides. Before gastrectomy, laboratory examination results showed renal dysfunction, hypocomplementemia, antinuclear antibodies (ANAs) positivity, and elevated serum IgG and IgG4 levels. Diagnosis: Based on postoperative renal biopsy showing severe plasma cell infiltration with tubulointerstitial fibrosclerosis, the patient was diagnosed with IgG4-RD. Despite significant improvement in renal function and reduction in parotid gland swelling during the postoperative follow-up period, after 7 months of the gastrectomy, anti-DNA antibody levels were increased and serositis was detected, which indicated the onset of SLE. IgG4-type ANA were also detected in the sera of the patient. Interventions: Treatment by oral prednisolone at 30 mg/day was initiated. Outcomes: Pericardial fluid, pleural effusions, and thickening of the gallbladder wall improved after 3 months of treatment according to computed tomography. Lessons: This study presented a rare case of comorbidity, wherein the patient’s primary problem progressed from IgG4-type ANA-positive IgG4-RD to SLE after excision of gastric cancer.

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