{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:30:03Z","timestamp":1780450203883,"version":"3.54.1"},"reference-count":25,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    In some cases, higher IgG4 levels are accompanied by increased circulating IgE, higher eosinophil counts, and various autoantibodies. Among these cases, IgG4-related disease (IgG4-RD) is one of the most frequently diagnosed conditions. This study reported two particularly complex and rare cases of hypereosinophilic syndrome (HES) associated with elevated IgG4 and T-cell clonality. The first case involved T-cell clonality complicated by HES and IgG4-RD, presenting with clinical features resembling eosinophilic granulomatosis with polyangiitis (EGPA). Laboratory findings showed a serum IgG4 concentration of 8.74\u2009g\/L, an IgG4\/IgG ratio of 40.58%, and positive results for P-anti-neutrophil cytoplasmic antibodies (ANCA) and myeloperoxidase-ANCA. Renal biopsy findings were consistent with IgG4-related interstitial nephritis. However, routine hematological testing revealed a markedly elevated eosinophil count of 14.75 \u00d7 10\n                    <jats:sup>9<\/jats:sup>\n                    \/L and eosinophilic infiltration in both lymph nodes and kidney tissue. Furthermore, monoclonal rearrangements of the T-cell receptor gamma and delta genes were identified. The second patient was ultimately diagnosed with HES with elevated IgG4 and T-cell clonality, with an elevated IgG4 concentration of 2.458\u2009g\/L and an eosinophil count of 14.75 \u00d7 10\n                    <jats:sup>9<\/jats:sup>\n                    \/L. In conclusion, in cases presenting with elevated IgG4 levels and hypereosinophilia, further pathological and genetic evaluations may be essential to guide appropriate and timely treatment, improving patient prognosis.\n                  <\/jats:p>","DOI":"10.1515\/biol-2025-1138","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T08:56:28Z","timestamp":1753347388000},"source":"Crossref","is-referenced-by-count":2,"title":["Hypereosinophilic syndrome with elevated IgG4 and T-cell clonality: A report of two cases"],"prefix":"10.1515","volume":"20","author":[{"given":"Meichun","family":"Huang","sequence":"first","affiliation":[{"name":"Renal Department, Tongde Hospital of Zhejiang Province , No. 234 Gucui Road , Hangzhou , 310012 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limin","family":"Wang","sequence":"additional","affiliation":[{"name":"Renal Department, Tongde Hospital of Zhejiang Province , No. 234 Gucui Road , Hangzhou , 310012 , China"},{"name":"Renal Department, Tongxiang First People\u2019s Hospital , Tongxiang , 314500 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuxiu","family":"Li","sequence":"additional","affiliation":[{"name":"Renal Department, Tongde Hospital of Zhejiang Province , No. 234 Gucui Road , Hangzhou , 310012 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Lu","sequence":"additional","affiliation":[{"name":"Renal Department, Tongde Hospital of Zhejiang Province , No. 234 Gucui Road , Hangzhou , 310012 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"2025122123390931738_j_biol-2025-1138_ref_001","doi-asserted-by":"crossref","unstructured":"Motta RV, Culver EL. 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