{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:52:01Z","timestamp":1787032321541,"version":"build-2736575974"},"reference-count":30,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:p>Immunoglobulin G4\u2013related disease (IgG4-RD) is a systemic disorder characterized by multiorgan fibrosis with IgG4-producing plasma cells, increased IgG4 serum concentration, and responsiveness to steroid therapy. Involvement of the pancreas, salivary glands, orbit, aorta, and other sites has been well documented in the literature; however, there have been limited reports of cases involving the coronary arteries. We report the case of a 53-year-old Hispanic man who was brought to the emergency center and diagnosed with sudden cardiac death. Autopsy was subsequently performed, revealing multiorgan involvement by IgG4-RD, including involvement of the coronary arteries. The inflammation and fibrosis, in combination with concomitant atherosclerotic disease, resulted in severe stenosis of the coronary arteries. Two of the coronary arteries were further occluded by thrombosis. These factors led to cardiac hypoperfusion, myocardial infarction and, ultimately, sudden cardiac death. Fatal involvement of the coronary arteries has not been previously reported, raising a new concern for a severe complication of IgG4-RD.<\/jats:p>","DOI":"10.5858\/arpa.2012-0614-cr","type":"journal-article","created":{"date-parts":[[2014,5,30]],"date-time":"2014-05-30T16:35:26Z","timestamp":1401467726000},"page":"833-836","source":"Crossref","is-referenced-by-count":60,"title":["Sudden Cardiac Death Due to Coronary Artery Involvement by IgG4-Related Disease: A Rare, Serious Complication of a Rare Disease"],"prefix":"10.5858","volume":"138","author":[{"given":"Nimesh R.","family":"Patel","sequence":"first","affiliation":[{"name":"From the Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas (Drs Patel and Elghetany); Medical Examiner Service, Harris County Institute of Forensic Sciences, Houston, Texas (Dr Anzalone); the Department of Pathology & Laboratory Medicine, The University of Texas Health Science Center at Houston (Dr Buja); and the Department of Pathology, Texas Children's Hospital, Houston (Dr Elghetany)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary L.","family":"Anzalone","sequence":"additional","affiliation":[{"name":"From the Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas (Drs Patel and Elghetany); Medical Examiner Service, Harris County Institute of Forensic Sciences, Houston, Texas (Dr Anzalone); the Department of Pathology & Laboratory Medicine, The University of Texas Health Science Center at Houston (Dr Buja); and the Department of Pathology, Texas Children's Hospital, Houston (Dr Elghetany)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Maximilian","family":"Buja","sequence":"additional","affiliation":[{"name":"From the Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas (Drs Patel and Elghetany); Medical Examiner Service, Harris County Institute of Forensic Sciences, Houston, Texas (Dr Anzalone); the Department of Pathology & Laboratory Medicine, The University of Texas Health Science Center at Houston (Dr Buja); and the Department of Pathology, Texas Children's Hospital, Houston (Dr Elghetany)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Tarek","family":"Elghetany","sequence":"additional","affiliation":[{"name":"From the Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas (Drs Patel and Elghetany); Medical Examiner Service, Harris County Institute of Forensic Sciences, Houston, Texas (Dr Anzalone); the Department of Pathology & Laboratory Medicine, The University of Texas Health Science Center at Houston (Dr Buja); and the Department of Pathology, Texas Children's Hospital, Houston (Dr Elghetany)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"issue":"1","key":"i1543-2165-138-6-833-b01","series-title":"Curr Opin Rheumatol","first-page":"57","article-title":"A clinical overview of IgG4-related systemic disease","volume":"23","author":"Khosroshahi\n              A,","year":"2011","unstructured":"Khosroshahi\n              A, \n            \n              Stone\n              JH. \n          \n          A clinical overview of IgG4-related systemic disease. Curr Opin Rheumatol. 2011;23(1):57\u201366."},{"issue":"1","key":"i1543-2165-138-6-833-b02","series-title":"J Clin Exp Hematop","first-page":"13","article-title":"IgG4-related disease: a novel lymphoproliferative disorder discovered and established in Japan in the 21st century","volume":"51","author":"Masaki\n              Y,","year":"2011","unstructured":"Masaki\n              Y, \n            \n              Kurose\n              N, \n            \n              Umehara\n              H. \n          \n          IgG4-related disease: a novel lymphoproliferative disorder discovered and established in Japan in the 21st century. J Clin Exp Hematop. 2011;51(1):13\u201320."},{"issue":"5","key":"i1543-2165-138-6-833-b03","series-title":"Adv Anat Pathol","first-page":"303","article-title":"IgG4-related sclerosing disease: a critical appraisal of an evolving clinicopathologic entity","volume":"17","author":"Cheuk\n              W,","year":"2010","unstructured":"Cheuk\n              W, \n            \n              Chan\n              JKC. \n          \n          IgG4-related sclerosing disease: a critical appraisal of an evolving clinicopathologic entity. Adv Anat Pathol. 2010;17(5):303\u2013332."},{"issue":"1","key":"i1543-2165-138-6-833-b04","series-title":"Mod Rheumatol","first-page":"21","article-title":"Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011","volume":"22","author":"Umehara\n              H,","year":"2012","unstructured":"Umehara\n              H, \n            \n              Okazaki\n              K, \n            \n              Masaki\n              Y, \n            et al\n          . Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol. 2012;22(1):21\u201330."},{"issue":"1","key":"i1543-2165-138-6-833-b05","series-title":"Curr Opin Rheumatol","first-page":"18","article-title":"IgG4-related inflammatory abdominal aortic aneurysm","volume":"23","author":"Kasashima\n              S,","year":"2011","unstructured":"Kasashima\n              S, \n            \n              Zen\n              Y. \n          \n          IgG4-related inflammatory abdominal aortic aneurysm. Curr Opin Rheumatol. 2011;23(1):18\u201323."},{"issue":"1","key":"i1543-2165-138-6-833-b06","series-title":"Curr Opin Rheumatol","first-page":"74","article-title":"Pathological features of IgG4-related sclerosing disease","volume":"23","author":"Smyrk\n              TC.","year":"2011","unstructured":"Smyrk\n              TC. \n          \n          Pathological features of IgG4-related sclerosing disease. Curr Opin Rheumatol. 2011;23(1):74\u201379."},{"issue":"5","key":"i1543-2165-138-6-833-b07","series-title":"Hum Pathol","first-page":"643","article-title":"Use of immunohistochemistry for IgG4 in the distinction of autoimmune pancreatitis from peritumoral pancreatitis","volume":"41","author":"Dhall\n              D,","year":"2010","unstructured":"Dhall\n              D, \n            \n              Suriawinata\n              AA, \n            \n              Tang\n              LH, \n            \n              Shia\n              J, \n            \n              Klimstra\n              DS. \n          \n          Use of immunohistochemistry for IgG4 in the distinction of autoimmune pancreatitis from peritumoral pancreatitis. Hum Pathol. 2010;41(5):643\u2013652."},{"issue":"1","key":"i1543-2165-138-6-833-b08","series-title":"Curr Opin Rheumatol","first-page":"88","article-title":"Aortitis, periaortitis, and retroperitoneal fibrosis, as manifestations of IgG4-related systemic disease","volume":"23","author":"Stone\n              JR.","year":"2011","unstructured":"Stone\n              JR. \n          \n          Aortitis, periaortitis, and retroperitoneal fibrosis, as manifestations of IgG4-related systemic disease. Curr Opin Rheumatol. 2011;23(1):88\u201394."},{"issue":"4","key":"i1543-2165-138-6-833-b09","series-title":"Pathol Int","first-page":"269","article-title":"IgG4-related inflammatory aneurysm of the aortic arch","volume":"59","author":"Ishida\n              M,","year":"2009","unstructured":"Ishida\n              M, \n            \n              Hotta\n              M, \n            \n              Kushima\n              R, \n            \n              Asai\n              T, \n            \n              Okabe\n              H. \n          \n          IgG4-related inflammatory aneurysm of the aortic arch. Pathol Int. 2009;59(4):269\u2013273."},{"issue":"2","key":"i1543-2165-138-6-833-b10","series-title":"J Cardiol","first-page":"132","article-title":"Multifocal fibrosclerosis and IgG4-related disease involving the cardiovascular system","volume":"59","author":"Ishizaka\n              N,","year":"2012","unstructured":"Ishizaka\n              N, \n            \n              Sakamoto\n              A, \n            \n              Imai\n              Y, \n            \n              Terasaki\n              F, \n            \n              Nagai\n              R. \n          \n          Multifocal fibrosclerosis and IgG4-related disease involving the cardiovascular system. J Cardiol. 2012;59(2):132\u2013138."},{"issue":"2","key":"i1543-2165-138-6-833-b11","series-title":"J Cardiol","first-page":"139","article-title":"Idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, and inflammatory pericarditis\u2014retrospective analysis of 11 case histories","volume":"59","author":"Sakamoto\n              A,","year":"2012","unstructured":"Sakamoto\n              A, \n            \n              Nagai\n              R, \n            \n              Saito\n              K, \n            et al\n          . Idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, and inflammatory pericarditis\u2014retrospective analysis of 11 case histories. 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Hum Pathol. 2008;39(6):975\u2013980."},{"issue":"8","key":"i1543-2165-138-6-833-b13","series-title":"Intern Med","first-page":"963","article-title":"A case of multiple giant coronary aneurysms and abdominal aortic aneurysm coexisting with IgG4-related disease","volume":"51","author":"Takei\n              H,","year":"2012","unstructured":"Takei\n              H, \n            \n              Nagasawa\n              H, \n            \n              Sakai\n              R, \n            et al\n          . A case of multiple giant coronary aneurysms and abdominal aortic aneurysm coexisting with IgG4-related disease. Intern Med. 2012;51(8):963\u2013967."},{"issue":"7","key":"i1543-2165-138-6-833-b14","series-title":"Hum Pathol","first-page":"1131","article-title":"Immunoglobulin G4\u2013related coronary periarteritis in a patient presenting with myocardial ischemia","volume":"43","author":"Tanigawa\n              J,","year":"2012","unstructured":"Tanigawa\n              J, \n            \n              Daimon\n              M, \n            \n              Murai\n              M, \n            \n              Katsumata\n              T, \n            \n              Tsuji\n              M, \n            \n              Ishizaka\n              N. \n          \n          Immunoglobulin G4\u2013related coronary periarteritis in a patient presenting with myocardial ischemia. Hum Pathol. 2012;43(7):1131\u20131134."},{"issue":"1","key":"i1543-2165-138-6-833-b15","series-title":"Cardiology","first-page":"22","article-title":"Giant tumorous lesions surrounding the right coronary artery associated with immunoglobulin-G4-related systemic disease","volume":"120","author":"Ikutomi\n              M,","year":"2011","unstructured":"Ikutomi\n              M, \n            \n              Matsumura\n              T, \n            \n              Iwata\n              H, \n            et al\n          . Giant tumorous lesions surrounding the right coronary artery associated with immunoglobulin-G4-related systemic disease. Cardiology. 2011;120(1):22\u201326."},{"issue":"1","key":"i1543-2165-138-6-833-b01","series-title":"Curr Opin Rheumatol","first-page":"57","article-title":"A clinical overview of IgG4-related systemic disease","volume":"23","author":"Khosroshahi\n              A,","year":"2011","unstructured":"Khosroshahi\n              A, \n            \n              Stone\n              JH. \n          \n          A clinical overview of IgG4-related systemic disease. 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J Clin Exp Hematop. 2011;51(1):13\u201320."},{"issue":"5","key":"i1543-2165-138-6-833-b03","series-title":"Adv Anat Pathol","first-page":"303","article-title":"IgG4-related sclerosing disease: a critical appraisal of an evolving clinicopathologic entity","volume":"17","author":"Cheuk\n              W,","year":"2010","unstructured":"Cheuk\n              W, \n            \n              Chan\n              JKC. \n          \n          IgG4-related sclerosing disease: a critical appraisal of an evolving clinicopathologic entity. Adv Anat Pathol. 2010;17(5):303\u2013332."},{"issue":"1","key":"i1543-2165-138-6-833-b04","series-title":"Mod Rheumatol","first-page":"21","article-title":"Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011","volume":"22","author":"Umehara\n              H,","year":"2012","unstructured":"Umehara\n              H, \n            \n              Okazaki\n              K, \n            \n              Masaki\n              Y, \n            et al\n          . Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol. 2012;22(1):21\u201330."},{"issue":"1","key":"i1543-2165-138-6-833-b05","series-title":"Curr Opin Rheumatol","first-page":"18","article-title":"IgG4-related inflammatory abdominal aortic aneurysm","volume":"23","author":"Kasashima\n              S,","year":"2011","unstructured":"Kasashima\n              S, \n            \n              Zen\n              Y. \n          \n          IgG4-related inflammatory abdominal aortic aneurysm. Curr Opin Rheumatol. 2011;23(1):18\u201323."},{"issue":"1","key":"i1543-2165-138-6-833-b06","series-title":"Curr Opin Rheumatol","first-page":"74","article-title":"Pathological features of IgG4-related sclerosing disease","volume":"23","author":"Smyrk\n              TC.","year":"2011","unstructured":"Smyrk\n              TC. \n          \n          Pathological features of IgG4-related sclerosing disease. Curr Opin Rheumatol. 2011;23(1):74\u201379."},{"issue":"5","key":"i1543-2165-138-6-833-b07","series-title":"Hum Pathol","first-page":"643","article-title":"Use of immunohistochemistry for IgG4 in the distinction of autoimmune pancreatitis from peritumoral pancreatitis","volume":"41","author":"Dhall\n              D,","year":"2010","unstructured":"Dhall\n              D, \n            \n              Suriawinata\n              AA, \n            \n              Tang\n              LH, \n            \n              Shia\n              J, \n            \n              Klimstra\n              DS. \n          \n          Use of immunohistochemistry for IgG4 in the distinction of autoimmune pancreatitis from peritumoral pancreatitis. Hum Pathol. 2010;41(5):643\u2013652."},{"issue":"1","key":"i1543-2165-138-6-833-b08","series-title":"Curr Opin Rheumatol","first-page":"88","article-title":"Aortitis, periaortitis, and retroperitoneal fibrosis, as manifestations of IgG4-related systemic disease","volume":"23","author":"Stone\n              JR.","year":"2011","unstructured":"Stone\n              JR. \n          \n          Aortitis, periaortitis, and retroperitoneal fibrosis, as manifestations of IgG4-related systemic disease. Curr Opin Rheumatol. 2011;23(1):88\u201394."},{"issue":"4","key":"i1543-2165-138-6-833-b09","series-title":"Pathol Int","first-page":"269","article-title":"IgG4-related inflammatory aneurysm of the aortic arch","volume":"59","author":"Ishida\n              M,","year":"2009","unstructured":"Ishida\n              M, \n            \n              Hotta\n              M, \n            \n              Kushima\n              R, \n            \n              Asai\n              T, \n            \n              Okabe\n              H. \n          \n          IgG4-related inflammatory aneurysm of the aortic arch. Pathol Int. 2009;59(4):269\u2013273."},{"issue":"2","key":"i1543-2165-138-6-833-b10","series-title":"J Cardiol","first-page":"132","article-title":"Multifocal fibrosclerosis and IgG4-related disease involving the cardiovascular system","volume":"59","author":"Ishizaka\n              N,","year":"2012","unstructured":"Ishizaka\n              N, \n            \n              Sakamoto\n              A, \n            \n              Imai\n              Y, \n            \n              Terasaki\n              F, \n            \n              Nagai\n              R. \n          \n          Multifocal fibrosclerosis and IgG4-related disease involving the cardiovascular system. J Cardiol. 2012;59(2):132\u2013138."},{"issue":"2","key":"i1543-2165-138-6-833-b11","series-title":"J Cardiol","first-page":"139","article-title":"Idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, and inflammatory pericarditis\u2014retrospective analysis of 11 case histories","volume":"59","author":"Sakamoto\n              A,","year":"2012","unstructured":"Sakamoto\n              A, \n            \n              Nagai\n              R, \n            \n              Saito\n              K, \n            et al\n          . Idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, and inflammatory pericarditis\u2014retrospective analysis of 11 case histories. J Cardiol. 2012;59(2):139\u2013146."},{"issue":"6","key":"i1543-2165-138-6-833-b12","series-title":"Hum Pathol","first-page":"975","article-title":"A case of multiple immunoglobulin G4\u2013related periarteritis: a tumorous lesion of the coronary artery and abdominal aortic aneurysm","volume":"39","author":"Matsumoto\n              Y,","year":"2008","unstructured":"Matsumoto\n              Y, \n            \n              Kasashima\n              S, \n            \n              Kawashima\n              A, \n            et al\n          . A case of multiple immunoglobulin G4\u2013related periarteritis: a tumorous lesion of the coronary artery and abdominal aortic aneurysm. Hum Pathol. 2008;39(6):975\u2013980."},{"issue":"8","key":"i1543-2165-138-6-833-b13","series-title":"Intern Med","first-page":"963","article-title":"A case of multiple giant coronary aneurysms and abdominal aortic aneurysm coexisting with IgG4-related disease","volume":"51","author":"Takei\n              H,","year":"2012","unstructured":"Takei\n              H, \n            \n              Nagasawa\n              H, \n            \n              Sakai\n              R, \n            et al\n          . A case of multiple giant coronary aneurysms and abdominal aortic aneurysm coexisting with IgG4-related disease. Intern Med. 2012;51(8):963\u2013967."},{"issue":"7","key":"i1543-2165-138-6-833-b14","series-title":"Hum Pathol","first-page":"1131","article-title":"Immunoglobulin G4\u2013related coronary periarteritis in a patient presenting with myocardial ischemia","volume":"43","author":"Tanigawa\n              J,","year":"2012","unstructured":"Tanigawa\n              J, \n            \n              Daimon\n              M, \n            \n              Murai\n              M, \n            \n              Katsumata\n              T, \n            \n              Tsuji\n              M, \n            \n              Ishizaka\n              N. \n          \n          Immunoglobulin G4\u2013related coronary periarteritis in a patient presenting with myocardial ischemia. Hum Pathol. 2012;43(7):1131\u20131134."},{"issue":"1","key":"i1543-2165-138-6-833-b15","series-title":"Cardiology","first-page":"22","article-title":"Giant tumorous lesions surrounding the right coronary artery associated with immunoglobulin-G4-related systemic disease","volume":"120","author":"Ikutomi\n              M,","year":"2011","unstructured":"Ikutomi\n              M, \n            \n              Matsumura\n              T, \n            \n              Iwata\n              H, \n            et al\n          . Giant tumorous lesions surrounding the right coronary artery associated with immunoglobulin-G4-related systemic disease. 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