Nontuberculous mycobacterial infection with concurrent IgG4-related lymphadenopathy

• Published in: APMIS : acta pathologica, microbiologica et immunologica Scandinavica Vol. 124; no. 3; pp. 216 - 220
• Main Authors: Liu, Ting-Ting, Weng, Shao-Wen, Wang, Ming-Chung, Huang, Wan-Ting
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.03.2016; Wiley Subscription Services, Inc
• Subjects: adult-onset immunodeficiency; anti-interferon-gamma autoantibody; Asian Continental Ancestry Group; Autoantibodies - blood; Humans; IgG4-related lymphadenopathy; Immunoglobulin G - blood; Immunohistochemistry; Infections; Lymph nodes; Lymph Nodes - microbiology; Lymphatic Diseases - blood; Lymphatic Diseases - microbiology; Lymphoma; Lymphoma, T-Cell - metabolism; Male; Middle Aged; Mycobacterium; Mycobacterium abscessus; Mycobacterium Infections, Nontuberculous - blood; Mycobacterium Infections, Nontuberculous - microbiology; nontuberculous mycobacteria; Nontuberculous Mycobacteria - growth & development; Nontuberculous Mycobacteria - isolation & purification; Plasma Cells - metabolism; Skin diseases; Skin Diseases - blood; Skin Diseases - microbiology; Taiwan; Taiwan; nontuberculous mycobacteria; adult-onset immunodeficiency; anti-interferon-gamma autoantibody; Mycobacterium abscessus; IgG4-related lymphadenopathy
• ISSN: 0903-4641; 1600-0463
• DOI: 10.1111/apm.12492

Disseminated nontuberculous mycobacteria (NTM) infection with concurrent IgG4‐related lymphadenopathy has not been reported. We described a patient with neutralizing autoantibodies to interferon‐gamma (IFN‐γ) and elevated levels of serum IgG4 presenting with generalized lymphadenopathy and reactive dermatosis. Histologically, lymph nodes (LNs) showed effaced nodal architecture with polymorphic infiltrates, mimicking angioimmunoblastic T‐cell lymphoma. Both the absolute number and the ratio of IgG4+ plasma cells to IgG+ plasma cells were increased. Mycobacterium abscessus was isolated from cultures of LNs, and demonstrated by polymerase chain reaction‐restriction fragment length polymorphism. The skin biopsy showed neutrophilic dermatosis, consistent with Sweet syndrome. The patient met the criteria of both adult‐onset immunodeficiency syndrome and IgG4‐related lymphadenopathy. This case provides evidence of disseminated NTM infection with concurrent type III IgG4‐related lymphadenopathy in the patient with anti‐IFN‐γ autoantibodies.