IgG4-related prostatitis manifesting as urinary obstruction in a 28-year-old male.
Case report
IgG4-related disease
Priapism
Prostatitis
Sialadenitis
Journal
BMC urology
ISSN: 1471-2490
Titre abrégé: BMC Urol
Pays: England
ID NLM: 100968571
Informations de publication
Date de publication:
11 Mar 2022
11 Mar 2022
Historique:
received:
23
10
2021
accepted:
23
02
2022
entrez:
12
3
2022
pubmed:
13
3
2022
medline:
18
3
2022
Statut:
epublish
Résumé
Immunoglobulin G4-related disease (IgG4-RD) is a systemic lymphoproliferative disorder characterized by elevated serum IgG4 levels and tumefactive lesions that can involve nearly every organ system. Involvement of the prostate is rare but has been reported in limited cases. A 28-year-old man of Asian descent with a history of sinusitis and priapism presented to hospital with rigors and voiding symptoms. He was diagnosed with IgG4-RD one month prior to presentation, following pathological analysis of a submandibular mass that demonstrated chronic sclerosing sialadenitis. On presentation, white blood cell count, C-reactive protein, and prostate serum antigen levels were all within normal limits. Examination was notable for a large, firm prostate, and a foley catheter was inserted. Contrast CT of the abdomen was unremarkable. Further workup revealed elevated serum IgG4 levels (9.22 g/L) and he was subsequently started on prednisone 35 mg daily. Imaging to screen for systemic IgG4-RD involvement demonstrated paravertebral soft tissue involvement and he was given rituximab 1000 mg IV × 2 doses. MRI revealed diffuse prostatitis. Five days after starting prednisone and one day after his first dose of rituximab, he successfully passed trial of void and was discharged home. IgG4-related prostatitis is a rare and underrecognized manifestation of IgG4-RD. Our case highlights the need to consider IgG4-related prostatitis as an etiology of urinary obstruction in young individuals. Resolution of symptoms following treatment with steroids may be diagnostic of IgG4-related prostatitis, and may potentially avoid the need for invasive diagnostic procedures such as prostate biopsy.
Sections du résumé
BACKGROUND
BACKGROUND
Immunoglobulin G4-related disease (IgG4-RD) is a systemic lymphoproliferative disorder characterized by elevated serum IgG4 levels and tumefactive lesions that can involve nearly every organ system. Involvement of the prostate is rare but has been reported in limited cases.
CASE PRESENTATION
METHODS
A 28-year-old man of Asian descent with a history of sinusitis and priapism presented to hospital with rigors and voiding symptoms. He was diagnosed with IgG4-RD one month prior to presentation, following pathological analysis of a submandibular mass that demonstrated chronic sclerosing sialadenitis. On presentation, white blood cell count, C-reactive protein, and prostate serum antigen levels were all within normal limits. Examination was notable for a large, firm prostate, and a foley catheter was inserted. Contrast CT of the abdomen was unremarkable. Further workup revealed elevated serum IgG4 levels (9.22 g/L) and he was subsequently started on prednisone 35 mg daily. Imaging to screen for systemic IgG4-RD involvement demonstrated paravertebral soft tissue involvement and he was given rituximab 1000 mg IV × 2 doses. MRI revealed diffuse prostatitis. Five days after starting prednisone and one day after his first dose of rituximab, he successfully passed trial of void and was discharged home.
CONCLUSIONS
CONCLUSIONS
IgG4-related prostatitis is a rare and underrecognized manifestation of IgG4-RD. Our case highlights the need to consider IgG4-related prostatitis as an etiology of urinary obstruction in young individuals. Resolution of symptoms following treatment with steroids may be diagnostic of IgG4-related prostatitis, and may potentially avoid the need for invasive diagnostic procedures such as prostate biopsy.
Identifiants
pubmed: 35277143
doi: 10.1186/s12894-022-00980-2
pii: 10.1186/s12894-022-00980-2
pmc: PMC8915486
doi:
Substances chimiques
Anti-Inflammatory Agents
0
Immunoglobulin G
0
Urological Agents
0
Rituximab
4F4X42SYQ6
Prednisone
VB0R961HZT
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
35Informations de copyright
© 2022. The Author(s).
Références
Intern Med. 2006;45(15):897-901
pubmed: 16946571
Pathol Int. 2008 Feb;58(2):118-25
pubmed: 18199162
Kidney Int. 2011 Dec;80(12):1379-80
pubmed: 22126986
Case Rep Urol. 2020 Mar 3;2020:6045328
pubmed: 32190400
Arthritis Rheumatol. 2015 Jul;67(7):1688-99
pubmed: 25809420
Int J Urol. 2013 Jan;20(1):132-4
pubmed: 23075137
Reumatol Clin. 2017 May - Jun;13(3):160-166
pubmed: 27329319
Rheumatology (Oxford). 2020 May 1;59(Suppl 3):iii123-iii131
pubmed: 32348524
Case Rep Urol. 2013;2013:295472
pubmed: 24349818
Nat Rev Rheumatol. 2020 Dec;16(12):702-714
pubmed: 32939060
N Engl J Med. 2012 Feb 9;366(6):539-51
pubmed: 22316447
Lancet. 2015 Apr 11;385(9976):1460-71
pubmed: 25481618
Allergy. 2014 Feb;69(2):269-272
pubmed: 24266692
Eur Urol. 2013 Dec;64(6):865-72
pubmed: 23266239
Eur J Rheumatol. 2021 Jan;8(1):27-30
pubmed: 33545024
Clin Nucl Med. 2019 Sep;44(9):e537-e539
pubmed: 31283602
Int J Clin Exp Pathol. 2015 Sep 01;8(9):11747-52
pubmed: 26617921
Ann Rheum Dis. 2020 Jan;79(1):77-87
pubmed: 31796497
BJR Case Rep. 2020 Sep 29;6(2):20190110
pubmed: 33029374
Lancet Haematol. 2021 May;8(5):e365-e375
pubmed: 33894171
Hepatology. 2007 Jun;45(6):1538-46
pubmed: 17518371
Haematologica. 2019 Mar;104(3):444-455
pubmed: 30705099
Am J Med Sci. 2018 Jan;355(1):61-66
pubmed: 29289265