Multifocal fibrosclerosis and idiopathic fibrosclerosis are disorders of unknown aetiology, characterised by fibrous lesions (co-)occurring at a variety of sites. Known manifestations include retroperitoneal fibrosis, mediastinal fibrosis and Riedel's thyroiditis.[1][2]
| Multifocal fibrosclerosis | |
|---|---|
| Other names | Idiopathic fibrosclerosis |
They are now considered to be manifestations of IgG4-related disease.[3]
Signs and symptoms
editThe illness can present with a variety of symptoms, such as cholangitis, sclerosing pancreatitis, Riedel thyroiditis, and retroperitoneal fibrosis.[4] Apart from the aforementioned characteristics, the syndrome has also been linked to pulmonary fibrosis, parotid gland fibrosis, lacrimal gland fibrosis, kidney fibrosclerosis, pancreatic fibrosis, and testicular fibrosis.[5] Neurological manifestations such as pachymeningitis, cranial nerve palsies, hypopituitarism, and central diabetes insipidus have also been linked to neurological involvement.[6]
Causes
editMultifocal fibrosclerosis's etiology is unknown, but one theory of the cause suggests that an autoimmune process is to blame. This is corroborated by the pathological features of cellular infiltration, which include plasma cells and lymphocytes, the commonly observed focal vasculitis on pathological examination, and the positive response of some multifocal fibrosclerosis patients to systemic corticosteroid treatment.[6]
Diagnosis
editThe diagnosis cannot be definitively confirmed by a test. However, common clinical findings include multiple areas of disseminated fibrosis, an elevated erythrocyte sedimentation rate (ESR), and an increased white cell count, particularly eosinophilia. High titers of autoantibodies are frequently observed, including rheumatoid factor, antinuclear antibody, and antithyroid antibodies.[6] The fibrotic lesion's histology shows fibrosclerosis with noticeable hyalinizing collagen bundles and myofibroblast cell proliferation.[5]
Treatment
editNumerous distinct treatment plans have been documented in the literature. There have been documented cases of treatment with radiotherapy, surgery, cyclophosphamide, and colchicine, frequently with only patchy results. Although the response to treatment varies, glucocorticoids are currently the preferred course of action.[6]
References
edit- ^ Brooks, MS; Robinson, JA (1985). "Idiopathic fibrosclerosis". The Journal of Rheumatology. 12 (3): 575–9. PMID 4045855.
- ^ Kishimoto, M.; Okimura, Y.; Kimura, K.; Mizuno, I.; Iguchi, G.; Fumoto, M.; Takahashi, Y.; Kanda, F.; Kaji, H.; Abe, H.; Hanioka, K.; Chihara, K. (2000). "Multifocal fibrosclerosis as a possible cause of panhypopituitarism with central diabetes insipidus". Endocrine Journal. 47 (3): 335–342. doi:10.1507/endocrj.47.335. PMID 11036878.
- ^ John H. Stone; Arezou Khosroshahi; Vikram Deshpande; et al. (October 2012). "Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations". Arthritis & Rheumatism. 64 (10): 3061–3067. doi:10.1002/art.34593. PMC 5963880. PMID 22736240.
- ^ Kromer, Courtney; Winfield, Harry; Franklin, Matthew (2020). "Cutaneous involvement in a case of multifocal idiopathic fibrosclerosis". JAAD Case Reports. 6 (4). Elsevier BV: 357–358. doi:10.1016/j.jdcr.2020.02.020. ISSN 2352-5126. PMC 7103662. PMID 32258321.
- ^ a b Oguz, Kader; Kiratlı, Hayyam; Oguz, Oguzhan; Cila, Aysenur; Oto, Aytekin; Gokoz, Aytac (December 1, 2001). "Multifocal fibrosclerosis: a new case report and review of the literature". European Radiology. 12 (5). Springer Science and Business Media LLC: 1134–1138. doi:10.1007/s00330-001-1158-4. ISSN 0938-7994. PMID 11976858. S2CID 274033.
- ^ a b c d Sommerfield, A J; Lockman, K A; Bathgate, A J; Patrick, A W (2008). "Multifocal fibrosclerosis: a new case report". Annals of Clinical Biochemistry: International Journal of Laboratory Medicine. 45 (1): 99–101. doi:10.1258/acb.2007.007049. ISSN 0004-5632. PMID 18275684.
Further reading
edit- COMINGS, DAVID E. (May 1, 1967). "Familial Multifocal Fibrosclerosis". Annals of Internal Medicine. 66 (5). American College of Physicians: 884–892. doi:10.7326/0003-4819-66-5-884. ISSN 0003-4819. PMID 6025229.
- DRIESKENS, OLIVIER; BLOCKMANS, DANIEL; VAN DEN BRUEL, ANNICK; MORTELMANS, LUC (2002). "Riedel's Thyroiditis and Retroperitoneal Fibrosis in Multifocal Fibrosclerosis". Clinical Nuclear Medicine. 27 (6). Ovid Technologies (Wolters Kluwer Health): 413–415. doi:10.1097/00003072-200206000-00005. ISSN 0363-9762. PMID 12045432. S2CID 423062.