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- Masashi Funada, Kazuhisa Nakano, Hiroko Miyata, Aya Nawata, and Yoshiya Tanaka.
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan.
- Intern. Med. 2020 Jan 1; 59 (5): 711-714.
AbstractWe herein report a 65-year-old man with elevated serum IgG4 levels, enlarged thyroid, and renal dysfunction, mimicking IgG4-related disease (IgG4-RD). The definitive diagnosis of IgG4-RD was not established because a tissue biopsy revealed no IgG4-positive cell infiltration or fibrosis. The presence of an M peak in the β fraction, Bence Jones protein in urine, and progressive anemia suggested multiple myeloma (MM). The κ/λ ratio was >100, tumor plasma cells were present at >20% in bone marrow, and immunostaining revealed IgG4-positive plasma cells; therefore, he was diagnosed with IgG4-type MM. Patients with elevated IgG4 levels with no significant mass lesions should undergo systemic examinations to exclude malignancy.
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