Dense IgG4 plasma cell infiltrates associated with chronic infectious aortitis: implications for the diagnosis of IgG4-related disease
Dense IgG4 plasma cell infiltrates associated with chronic infectious aortitis: implications for the diagnosis of IgG4-related disease
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DOI：
10.1016/j.carpath.2012.02.001
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发表时间：
2012-11-01
影响因子：
3.7
通讯作者：
Stone, James R.
中科院分区：
文献类型：
--
作者：
Siddiquee, Zakir;Zane, Nicholas A.;Stone, James R.
背景资料：IgG4相关性肠炎是一种新发现的非感染性肠炎，是称为IgG4相关性疾病的全身性疾病谱的一部分。IgG4相关性乳腺炎与巨细胞性乳腺炎和Takayasu乳腺炎的区别部分在于存在增加数量的IgG4表达浆细胞。慢性感染性乳腺炎也可表现为淋巴浆细胞浸润，但这些病例中IgG 4表达的程度尚未进行专门评估。方法：前瞻性地确定了两例慢性活动性感染性腹部炎症。这两例都是由革兰氏阳性菌引起的，其中至少一例是由慢性活动性金黄色葡萄球菌感染引起的。免疫组化检测IgG 4浆细胞浸润程度。结果如下：2例慢性感染性乳腺炎均局灶性显示高水平的IgG 4表达浆细胞，大于50%的IgG表达浆细胞，每个高倍视野中大于50个IgG 4表达浆细胞。结论：局灶性致密IgG4浆细胞浸润与革兰氏阳性菌（包括金黄色葡萄球菌）引起的慢性感染性肠炎相关。这一观察结果支持了慢性金黄色葡萄球菌感染可能刺激Th2介导的IgG4升高的提议。IgG4相关性乳腺炎的病理诊断不应仅基于免疫组化显示的IgG4浆细胞计数增加，而需要考虑整体病理学，包括仔细排除感染性乳腺炎。(C)2012 Elsevier Inc. All rights reserved.
Background: IgG4-related aortitis is a newly recognized form of noninfectious aortitis that occurs as part of the spectrum of a systemic disease referred to as IgG4-related disease. IgG4-related aortitis is distinguished from giant cell aortitis and Takayasu aortitis in part by the presence of increased numbers of IgG4-expressing plasma cells. Chronic infectious aortitis can also display lymphoplasmacytic infiltrates, but the degree of IgG4 expression in these cases has not been specifically evaluated. Methods: Two cases of chronic active infectious abdominal aortitis were prospectively identified. Both were due to gram-positive bacteria, and at least one of the cases was due to chronic active Staphylococcus aureus infection. The degree of IgG4 plasma cell infiltration was assessed by immunohistochemistry. Results: Both cases of chronic infectious aortitis focally displayed high levels of IgG4-expressing plasma cells, greater than 50% of the IgG-expressing plasma cells, and greater than 50 IgG4-expressing plasma cells per high-power field. Conclusions: Focal dense IgG4 plasma cell infiltrates can be seen in association with chronic infectious aortitis due to gram-positive bacteria, including Staphylococcus aureus. This observation supports the proposal that chronic Staphylococcus aureus infection may stimulate a Th2-mediated elevation in IgG4. The pathologic diagnosis of IgG4-related aortitis should not be based solely on the presence of increased IgG4 plasma cell counts from immunohistochemistry, but requires consideration of the overall pathology, including careful exclusion of infectious aortitis. (C) 2012 Elsevier Inc. All rights reserved.