Case reveals link between IgG4-related skin disease and lymphocytic colitis

There may be an association between IgG4-related skin disease and lymphocytic colitis, possibly due to immune dysregulation.

Louisa Ochoa

August 21, 2023 | | Reading time: 4 minutes

Clinical photographs showed a well-defined hyperpigmented plaque on the right lower back and upper buttock with healing abrasions and mixed abrasions. Photo: American Academy of Dermatology.

A 25-year-old man of American Indian descent presented with a 3-year history of a persistent itchy rash extending from the lower back to the feet. The patient complained of chronic diarrhea, abdominal pain, and weight loss for 4 years. He denied having a fever or chills, and no relatives had similar illnesses.

The man’s medical history included type 1 diabetes that had been uncontrolled since childhood, leading to peripheral neuropathy, bilateral ankle ulcers, bilateral cataracts, major depression, and medication including insulin.

He was treated with mometasone, betamethasone, triamcinolone, hydrocortisone valerate, tacrolimus, and mupirocin without any improvement in his condition.

Skin examination revealed erythematous papules with scattered erosions on background hyperpigmented macules on the waist and right buttock.

Biopsy revealed acanthotic epidermis with extensive proliferation of perifollicular plasma cells. On the other hand, anti-Treponema antibodies, Steiner stain and PCR for herpes simplex virus and herpes zoster virus were negative.

Diagnosis of IgG4 skin diseases

Morphological and immunohistochemical features were consistent with IgG4 dermatosis. The serum antibody group showed elevated IgE, and the hepatitis group showed immunity to hepatitis B.

According to medical literature reports, IgG4-related skin diseases It is an emerging and rare clinical entity. It primarily affects middle-aged and older Asian men, especially those with a history of and/or exposure to hepatitis B.

After diagnosis, the patient was treated with topical clobetasol and referred to rheumatology and gastroenterology (GI) to rule out systemic disease. A comprehensive gastrointestinal study showed positive H. pylori infection and colonic crypt lymphocytosis consistent with: lymphocytic colitis.

Of note, immunohistochemistry did not reveal an increase in IgG41 plasma cells in gastrointestinal biopsy samples.

The man was treated with budesonide lymphocytic colitis and triple therapy for Helicobacter pylori infection. Pruritus and skin lesions were treated with clobetasol and resolved with budesonide.

IgG4-related skin disease and lymphocytic colitis

This is a rare case of cutaneous IgG4-RD in a young man of Indian origin who was only affected in the setting of infection. lymphocytic colitis.

this lymphocytic colitis is an inflammatory disease of the colon and a common cause of chronic watery diarrhea that leads to weight loss.

Although the relationship between the two conditions is not yet clear, it is estimated that genetic susceptibility, environmental triggers, and infection lead to immune pathways that perpetuate the disease in both conditions.

one of the risk factors IgG4-related skin diseases was exposure to hepatitis, and, among the patients presenting, his type 1 diabetes I lost control.

since your lymphocytic colitis It could lead to abnormal immune dysregulation leading to cutaneous IgG4-RD before his cutaneous IgG4-RD.Therefore, clinicians believe that cutaneous IgG4-RD should be considered a risk factor lymphocytic colitis.

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