Immunoglobulin G4-related disease (IgG4-RD) is a systemic lymphoproliferative disorder characterized by elevated serum IgG4 levels and tumefactive lesions that can involve nearly every organ system. Involvement of the prostate is rare but has been reported in limited cases.
A 28-year-old man of Asian descent with a history of sinusitis and priapism presented to hospital with rigors and voiding symptoms. He was diagnosed with IgG4-RD one month prior to presentation, following pathological analysis of a submandibular mass that demonstrated chronic sclerosing sialadenitis. On presentation, white blood cell count, C-reactive protein, and prostate serum antigen levels were all within normal limits. Examination was notable for a large, firm prostate, and a foley catheter was inserted. Contrast CT of the abdomen was unremarkable. Further workup revealed elevated serum IgG4 levels (9.22 g/L) and he was subsequently started on prednisone 35 mg daily. Imaging to screen for systemic IgG4-RD involvement demonstrated paravertebral soft tissue involvement and he was given rituximab 1000 mg IV × 2 doses. MRI revealed diffuse prostatitis. Five days after starting prednisone and one day after his first dose of rituximab, he successfully passed trial of void and was discharged home.
IgG4-related prostatitis is a rare and underrecognized manifestation of IgG4-RD. Our case highlights the need to consider IgG4-related prostatitis as an etiology of urinary obstruction in young individuals. Resolution of symptoms following treatment with steroids may be diagnostic of IgG4-related prostatitis, and may potentially avoid the need for invasive diagnostic procedures such as prostate biopsy.
BMC urology. 2022 Mar 11*** epublish ***
Aria Jazdarehee, Azin Ahrari, Drew Bowie, Silvia D Chang, Henry Tran, Shahin Jamal, Luke Y C Chen, Karen C Tran
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada., Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada., Division of Urology, University of British Columbia, Vancouver, BC, Canada., Division of Hematology, University of British Columbia, Vancouver, BC, Canada., Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada. .