Coexistence of immunoglobulin G4-related kidney disease and acute hematogenous disseminated pulmonary tuberculosis: a case report

Front Immunol. 2025 Jan 9:15:1493754. doi: 10.3389/fimmu.2024.1493754. eCollection 2024.

Abstract

Background: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibrous inflammatory disease. Recently, an association between IgG4-RD and tuberculosis (TB) has been reported.

Case summary: We report a 56-year-old man complaining of a cough and poor appetite for 2 months and oliguria for 1 day. The patient was diagnosed with TB due to a manifestation of lymphatic TB and the radiological alterations of acute miliary pulmonary TB. He also presented with greatly elevated serum creatinine, non-albumin proteinuria, immunoglobulin subgroup IgG4, and immunoglobulin free light chain (FLC) levels. A diagnosis of IgG4-RKD was suggested by a renal biopsy. We then administered the patient glucocorticoid and anti-TB treatment for 4 months. The patient's renal function was completely restored and the manifestations of TB were alleviated.

Conclusion: The necessity and complexity of differential diagnosis in patients with coexisting IgG4-RD and TB remains challenging. Early recognition and timely treatment are important for averting its progression. Long-term monitoring is required to assess for recurrence of IgG4-RD and TB activity.

Keywords: IgG4-related kidney disease; acute kidney injury; case report; free light chain (FLC); tuberculosis.

Publication types

  • Case Reports

MeSH terms

  • Antitubercular Agents / therapeutic use
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin G / immunology
  • Immunoglobulin G4-Related Disease* / complications
  • Immunoglobulin G4-Related Disease* / diagnosis
  • Immunoglobulin G4-Related Disease* / drug therapy
  • Kidney Diseases / diagnosis
  • Kidney Diseases / etiology
  • Kidney Diseases / immunology
  • Male
  • Middle Aged
  • Tuberculosis, Pulmonary* / complications
  • Tuberculosis, Pulmonary* / diagnosis
  • Tuberculosis, Pulmonary* / drug therapy
  • Tuberculosis, Pulmonary* / immunology

Substances

  • Immunoglobulin G
  • Antitubercular Agents
  • Glucocorticoids