Immunoglobulin G4-Related Disease of the Hip

Orthopedics. 2018 Nov 1;41(6):e876-e879. doi: 10.3928/01477447-20180815-06. Epub 2018 Aug 21.

Abstract

The authors report a case of immunoglobulin G4-related disease (IgG4-RD) of the hip. A 60-year-old man diagnosed with osteoarthritis of the right hip was referred to the authors' outpatient clinic for surgical intervention. Laboratory test results revealed elevated C-reactive protein and serum IgG levels. A subsequent laboratory test revealed an IgG4 level of 318 mg/dL. Magnetic resonance imaging revealed an abnormal mass in the right hip joint. The authors suspected IgG4-RD of the hip. The mass was resected during total hip arthroplasty. Immunohistochemical analysis for IgG revealed positive staining of many plasma cells. Most of the IgG-positive plasma cells were positive for IgG4, and the ratio of IgG4/IgG-positive cells was 51%. This case met all criteria for IgG4-RD; thus, the authors made a definitive diagnosis of IgG4-RD of the hip. The C-reactive protein level decreased to a negative value, and the IgG level decreased to a normal range at 3 weeks postoperatively. The IgG4 level gradually decreased to 152 mg/dL at 5 months postoperatively. This is the first reported case of IgG4-RD of the hip joint. [Orthopedics. 2018; 41(6):e876-e879.].

Publication types

  • Case Reports

MeSH terms

  • C-Reactive Protein / metabolism
  • Hip Joint*
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin G4-Related Disease / blood
  • Immunoglobulin G4-Related Disease / diagnostic imaging*
  • Immunoglobulin G4-Related Disease / pathology*
  • Joint Diseases / blood
  • Joint Diseases / diagnostic imaging*
  • Joint Diseases / pathology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged

Substances

  • Immunoglobulin G
  • C-Reactive Protein