IgG4-related prostatitis

Low power view of IgG4-related prostatitis

IgG4-related prostatitis is a rare form of prostatitis, which is part of a larger spectrum of diseases known as IgG4-related disease (IgG4-RD). This condition is characterized by the infiltration of IgG4-positive plasma cells in the prostate gland, leading to inflammation and, potentially, organ dysfunction. IgG4-related prostatitis can coexist with other manifestations of IgG4-RD, which can affect various organs, including the pancreas (resulting in autoimmune pancreatitis), salivary glands, kidneys, liver, and bile ducts.

Symptoms and Diagnosis

The symptoms of IgG4-related prostatitis can vary widely among individuals. Some may experience lower urinary tract symptoms (LUTS), such as difficulty urinating, a decreased urine stream, and frequent urination, particularly at night. Others may have systemic symptoms, including fatigue, weight loss, and a general feeling of being unwell, which are common in systemic inflammatory conditions.

Diagnosis of IgG4-related prostatitis involves a combination of clinical evaluation, laboratory tests, imaging studies, and histopathological examination. Elevated serum levels of IgG4 and imaging findings suggestive of prostatitis can raise suspicion for the disease. However, a definitive diagnosis typically requires a biopsy of the prostate, demonstrating dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis, with a significant number of IgG4-positive plasma cells.

Treatment

Treatment of IgG4-related prostatitis primarily involves the use of glucocorticoids, which can lead to a rapid improvement in symptoms and a decrease in the size of the affected organ. In cases where steroids are contraindicated or in patients with recurrent or refractory disease, other immunosuppressive agents, such as rituximab, may be considered. Close monitoring is necessary to assess response to treatment and to detect any potential relapse or involvement of other organs.

Epidemiology

The exact prevalence of IgG4-related prostatitis is unknown, due to the rarity of the condition and the lack of awareness among healthcare providers. It is more commonly diagnosed in middle-aged and elderly men, and it is often identified in the context of other manifestations of IgG4-RD.

Prognosis

With appropriate treatment, the prognosis for patients with IgG4-related prostatitis is generally good. However, the disease can recur, and long-term therapy may be necessary to maintain remission. Regular follow-up is important to monitor for disease progression or the involvement of additional organs.

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