Mononeuritis multiplex with tumefactive cellular infiltration in a patient with reactive lymphoid hyperplasia with increased immunoglobulin G4-positive cells.

Abstract

We describe a 54-year-old man with mononeuritis multiplex and reactive lymphoid hyperplasia with increased immunoglobulin G4 (IgG4)-positive cells. Asymmetrical numbness and weakness had advanced stepwise for 6 years. Serum immunoglobulin G, IgG4, and immunoglobulin E levels were elevated, whereas M protein was not detected. Chest and abdominal computed tomography showed generalized lymphadenopathy. Inguinal lymph node biopsy revealed expansion of the interfollicular area with infiltration of IgG4-positive cells, of which the absolute number was greater than 100 per high-power field, and the percentage of IgG4+/immunoglobulin G+ plasma cells was 33%. Sural nerve biopsy disclosed axonal neuropathy with tumefactive lymphoid infiltrate in epineurium, but IgG4-positve plasma cells and fibrosis were not detected. Symptoms and laboratory data were improved with oral glucocorticoid therapy at a dose of 0.6 mg/kg per day. Although the causal mechanisms of neuropathy should be determined in future studies, peripheral nerve involvement may occur in patients with reactive lymphoid hyperplasia with increased IgG4-positive cells.

• Authors: Satoshi Yokoi, Yuichi Kawagashira, Ken Ohyama, Masahiro Iijima, Haruki Koike, Hirohisa Watanabe, Akiko Tatematsu, Shigeo Nakamura, Gen Sobue
• Journal: Human pathology (Hum Pathol) Vol. 45 Issue 2 Pg. 427-30 (Feb 2014) ISSN: 1532-8392 [Electronic] United States
• PMID: 24289971 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014.

Chemical References

• Immunoglobulin G

Topics

• Biopsy
• Humans
• Immunoglobulin G (blood)
• Lymphatic Diseases (pathology)
• Male
• Middle Aged
• Mononeuropathies (pathology)
• Plasma Cells (metabolism)
• Pseudolymphoma (pathology)