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Multicentric Castleman Disease With Tubulointerstitial Nephritis Mimicking IgG4-related Disease: Two Case Reports.

伴有肾小管间质性肾炎并类似于IgG4相关性疾病的多中心性 Castleman病2例报道

Zoshima T,Yamada K,Hara S,Mizushima I,Yamagishi M,Harada K,Sato Y,Kawano M

Abstract

Multicentric Castleman disease is a benign lymphoproliferative disorder with heterogenous clinical symptoms and involves systemic organs in addition to lymph nodes. Elevated serum IgG4 levels and IgG4-positive plasma cell (IgG4+PC) infiltrates have been reported in lymph nodes, lung and skin in some multicentric Castleman disease cases, resembling IgG4-related disease (IgG4-RD) histologically. However, no report has been available regarding IgG4+PC infiltration in the kidneys of multicentric Castleman disease. Here, we report 2 cases of multicentric Castleman disease complicated by IgG4-related disease (IgG4-RD) histologically. However, there has been no report published on PC-rich tubulointerstitial nephritis, lymphadenopathy, with numerous IgG4+PC infiltration, and elevated serum IgG4 levels, mimicking IgG4-RD. The blood examinations revealed systemic inflammation and elevated C-reactive protein and interleukin-6 levels. Corticosteroid therapy was partially effective in both cases, and combination therapy of corticosteroid and tocilizumab was needed in both cases. Moreover, after triple therapy with corticosteroid, rituximab and cyclophosphamide were used in 1 case to tame the severe inflammation. The present cases suggest that if continuously elevated serum C-reactive protein levels and partial corticosteroid responsiveness are encountered, multicentric Castleman disease should be considered rather than IgG4-RD as a differential diagnosis even if serum IgG4 is elevated and IgG4+PCs infiltrate systemic organs.

摘要

多中心性 Castleman病是一种良性淋巴组织增生性病变,临床表现不一,可累及全身器官和淋巴结。已报道发生于淋巴结、肺、皮肤的组织学类似于IgG4相关性疾病的多中心性 Castleman病,其血清IgG4水平升高,组织学有IgG4+浆细胞浸润。然而,多中心性 Castleman病中肾脏的IgG4+浆细胞浸润性病变尚未见报道。我们现报道2例多中心性 Castleman病,组织学伴有IgG4相关性疾病(IgG4-RD)。富于浆细胞浸润的肾小管间质性肾炎、淋巴结病变,类似IgG4-RD,组织中有大量IgG4+浆细胞浸润,血清IgG4水平升高,目前尚无这样的病例报道。血液学检查显示有全身性炎症,血清C-反应蛋白和IL-6水平升高。这2例皮质激素治疗效果不佳,必须联合应用皮质激素和托珠单抗。其中1例应用皮质激素、利托昔单抗和环磷酰胺三联疗法后炎症减轻。本病例表明:如果血清C-反应蛋白水平持续升高,皮质激素疗效不佳,即使血清IgG4水平升高且多器官IgG4+浆细胞浸润,也应考虑为多中心性 Castleman病,而不是IgG4-RD。这可作为鉴别诊断的要点。

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