case_images: PMC10511842_01
case_images: Computed tomography findings.. (a) Plain chest CT showing the reticular pattern and bronchial dilatation in the bilateral lower lung fields before therapy; (b) After therapy, the interstitial pattern nearly disappeared from the bilateral lung fields. CT: computed tomography.
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case_images: Figure 1a). Furthermore, bronchial wall thickening, and enlarged cervical, mediastinal, and axillary lymph nodes were identified. Figure 1b). Figure 4 shows the clinical course of this patient.
case_images: Ga-67 scintigraphy findings.. Uptake by kidney revealed using Ga-67 scintigraphy.
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case_images: Ga-67 scintigraphy revealed accumulation in the kidneys ( Figure 2).
case_images: Microscopy findings of the renal biopsy.. (a) The interstitium shows mononuclear cell infiltration and interstitial fibrosis with tubular atrophy with Masson's trichrome stain (x40); (b) PAM stain in the interstitium shows bird's eye pattern of fibrosis (x200); (c) Immunohistochemical analysis for IgG4 shows dominant IgG4+ plasma cell filtration, with an IgG4+/IgG+ ratio of >40% (x100).
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case_images: Consequently, the patient was diagnosed with IgG4-related kidney disease based on the renal pathology with massive tubulointerstitial nephritis, characteristic fibrosis (bird's eye pattern) ( Figure 3a and b), and IgG4-positive cell infiltration, wherein the number of IgG4 positive plasma cells was >10/hpf, and IgG4/IgG ratio was 61.9% ( Figure 3c).
case_images: The clinical course of the patient.. Clinical course treatment was initiated by administering prednisolone at 30mg/day, followed by prompt alleviation of the dyspnea on exertion and cough. Urinary NAG and beta2 MG, and serum IgG4 were significantly decreased after prednisolone treatment. NAG, N-acetyl-beta-D-glucosaminidase; beta2 MG, beta2 microglobulin; PSL, prednisolone.
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case_images: Figure 1b). Figure 4 shows the clinical course of this patient.