Pancreatobiliary Versus Head and Neck Manifestations in Immunoglobulin G4-related Disease: Distinct Subsets of the Same Disease?

• Published in: Pancreas Vol. 48; no. 6; p. 799
• Main Authors: Mohapatra, Sonmoon, Sharma, Ayush, Chari, Suresh T
• Format: Journal Article
• Language: English
• Published: United States 01.07.2019
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Autoimmune Diseases - diagnostic imaging; Autoimmune Diseases - pathology; Biliary Tract - diagnostic imaging; Diagnostic Imaging - methods; Female; Humans; Immunoglobulin G - blood; Immunoglobulin G4-Related Disease - diagnostic imaging; Lacrimal Apparatus - diagnostic imaging; Lung - diagnostic imaging; Male; Middle Aged; Pancreas - diagnostic imaging; Salivary Glands - diagnostic imaging; Sinusitis - diagnostic imaging; Young Adult
• ISSN: 1536-4828
• DOI: 10.1097/MPA.0000000000001332

We compared the clinical profiles and organ manifestations of the commonly encountered immunoglobulin G4-related diseases (IgG4-RDs) on either side of the diaphragm: head and neck (HN) versus pancreatobiliary (PB) in IgG4-RD. From the Mayo Clinic, Rochester, database, we identified 53 HN and 88 PB IgG4-RD based on the first affected organ manifestation. Compared with HN IgG4-RD, subjects with PB IgG4-RD were likely to be older (median, 64.8 vs 50.2 years; P < 0.0001), male (83% vs 60.4%; P = 0.003), and with a shorter duration of follow-up (24.4 vs 48.7 months; P < 0.0001). In HN versus PB-IgG4-RD orbital, lacrimal gland, submandibular, parotid gland, asthma, and sinusitis manifestations were more common (77% vs 4.5%, 21% vs 0%, 32% vs 8%, 13% vs 0%, 36% vs 9%, and 51% vs 6.8%; P < 0.0001, respectively), whereas lung manifestations were similar (13.2% vs 5.6%; P = 0.12). In contrast, in PB versus HN IgG4-RD, pancreas and biliary were more frequent (98.8% vs 15%, 56.8% vs 3.7%; P < 0.0001), whereas renal lesions were similar (12.5% vs 7.5%; P = 0.36). Pancreatobiliary and HN IgG4-RD have distinct clinical profiles. Proximity matters in other organ involvement in IgG4-RD, and organs involved tend to cluster close to each.