IgG4-Related Disease Associated With Myotonic Dystrophy Type 2

IgG4-related disease (IgG4-RD) is a rare disease considered an acquired systemic autoimmune condition. Myotonic dystrophy type 2 (DM2) is a rare dominantly inherited multisystem disorder, with a high prevalence of associated autoimmune diseases, but IgG4-RD has not been described in this context.

A case series of three patients with concurrent IgG4-RD and DM2.

All three patients, from a cohort of 47 patients with DM2 (prevalence = 6%), were male, aged 61-80 years and exhibited at least pancreatic involvement. Elevated IgG4 levels were observed in blood, and two patients had lymphoplasmacytic infiltrates rich in IgG4+ plasma cells and CD4+ T cells, with fibrosis present in biopsies. In two cases, DM2 was diagnosed after IgG4-RD. All patients presented with a myopathic phenotype in the lower limbs, with myotonic discharges at myography.

The prevalence of IgG4-RD in the cohort of DM2 herein is more than 1000 times higher than expected. As both diseases display common organ involvement, especially the pancreas, IgG4-RD screening should be considered in DM2 patients with diabetes or/and atypical associated phenotypes. Additionally, genetic testing for DM2 should be considered in IgG4-RD patients with elevated creatine kinase levels, myopathic phenotype, cardiac disorders and/or cataracts. The present report also suggests that IgG4-RD may have a genetic predisposition, potentially elucidating an aspect of the disease's pathophysiology.