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IgG4-related pleurisy with suspected asbestos involvement
Tomoyuki Ogata1, Kentaro Nakamura2, Tomohiro Moriya2
1Pulmonology, JA Toride Sogo Iryo Center, Toride, Japan ogatatomoyuki262626@gmail.com.
BMJ Case Reports
|November 23, 2025
Summary
Immunoglobulin G4 (IgG4)-related pleurisy can mimic malignant pleural mesothelioma in patients with asbestos exposure. This case underscores the importance of considering IgG4-related pleurisy in diagnosing pleural disease.
Area of Science:
- Pulmonology
- Immunology
- Radiology
Background:
- Pleural thickening can be challenging to diagnose, often mimicking malignant pleural mesothelioma.
- Asbestos exposure is a known risk factor for various pleural diseases.
Purpose of the Study:
- To highlight a case of immunoglobulin G4 (IgG4)-related pleurisy.
- To emphasize the differential diagnosis of pleural disease that mimics malignant pleural mesothelioma.
Main Methods:
- Case report of a patient with progressive pleural thickening.
- Utilized high-resolution CT and FDG-PET/CT imaging.
- Performed CT-guided pleural biopsy and EBUS-guided FNA.
- Immunostaining of tissue samples for definitive diagnosis.
Main Results:
- Initial imaging suggested malignant pleural mesothelioma.
- Biopsy and FNA were inconclusive for malignancy.
- Immunostaining confirmed immunoglobulin G4 (IgG4)-related pleurisy.
- Steroid therapy led to reduced pleural thickening.
Conclusions:
- Immunoglobulin G4 (IgG4)-related pleurisy should be considered in the differential diagnosis of pleural thickening.
- Accurate diagnosis is crucial for appropriate management and can prevent misdiagnosis of malignancy.
- This case emphasizes the importance of comprehensive diagnostic workup in complex pleural diseases.
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