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Updated: May 27, 2025

Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
IgG4 Related Disease Presenting With Eosinophilic Pleural Effusion
Ancy Elsa Thomas1, Balamugesh Thangakunam1, Thomas Kodiatte1
1Department of Pulmonary Medicine Christian Medical College Hospital Vellore India.
Abstract:
A 56-year-old man presented with right-sided pleuritic chest pain and intermittent cough for 4 months, with a background history of well-controlled asthma and allergic rhinitis. Chest radiographs revealed right-sided pleural effusion, the fluid chemistry showed an exudate effusion with negative cytology and abundant eosinophils. Thoracoscopic pleural biopsy showed moderate lymphoplasmacytic chronic inflammation. Immunohistochemistry showed IgG4 staining up to 90 plasma cells/hpf (> 10% diagnostic), and the IgG4: IgG ratio was 40% (> 40% diagnostic), confirming the diagnosis of IgG4-related disease (IgG4-RD). Elevated serum IgG4 level (300 mg/dL; normal range: 3-201 mg/dL), further supported the diagnosis. While eosinophilic pleural effusion (EPE) accounts for 5%-16% of all exudative pleural effusions, IgG4-related pleural disease is an extremely rare cause of EPE.
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