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IgG4関連疾患(IgG4-related disease:IgG4-RD)は,血清IgG4高値および全身諸臓器にIgG4陽性形質細胞浸潤を特徴とする疾患である。脳神経内科領域においては,肥厚性硬膜炎,軟膜炎,脳実質疾患,眼疾患,下垂体炎,末梢神経疾患を呈する。本疾患には類似疾患が多いこと,脳神経内科領域は病理組織診断が困難な場合が多いことから,実際の臨床現場では診断に苦慮することがある。国際分類基準「The 2019 ACR/EULAR Classification Criteria for IgG4-RD」と本邦診断基準「2020年改訂IgG4-RD包括診断基準」を紹介し,IgG4-RDに伴う神経疾患の診断・治療のアップデートを解説する。
Abstract
IgG4-related disease is a unique fibroinflammatory disorder with organ system involvement, which was first described in Japan. It is characterized by high serum IgG4 levels and infiltration of IgG4-positive plasma cells in several organs. IgG4-related disease can involve the central and peripheral nervous systems, resulting in hypertrophic pachymeningitis, orbital diseases, hypophysitis, and peripheral nerve disease. Sufficient pathological findings are important for diagnosing IgG4-related disease and distinguishing it from mimics. The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria and the 2020 Revised Comprehensive Diagnostic Criteria have recently been published. Herein, we describe a current update of the clinicopathological features, approach to diagnosis, and management of IgG4-related neurological diseases.
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