Teaching NeuroImages: Multifocal neurologic involvement as the only manifestation of IgG4-related disease
From the Departments of Medicine (S.I., F.A.), Neurosciences (M.C., C.B.), Neuroradiology (R.M.), and Medical Diagnostic Sciences and Special Therapies (F.M.), University of Padova, Italy.Neurology (Impact Factor: 8.29). 01/2013; 80(4):e40-1. DOI: 10.1212/WNL.0b013e31827f08ae
A 46-year-old man with progressive visual loss underwent brain MRI showing multifocal nodular pachymeningeal thickening involving optic nerve meninges bilaterally and internal acoustic meatus dura mater (figure 1). Diffuse meningiomatosis was diagnosed and radiation therapy was given with symptom stabilization. Four years later, left hearing loss and right hypoacusia occurred, with slight transient improvement after high-dose dexamethasone. Serum immunoglobulin (Ig)G4 was increased. CSF analysis showed increased protein, oligoclonal IgG, plasma cells, and lymphocytes. Cerebral biopsy showed meningeal plasma-cell granuloma with IgG4-positive polyclonal plasma cells and B-lymphocyte infiltration (figure 2). IgG4-related disease was diagnosed.(1) Rituximab was unsuccessful. IgG4-related disease is a fibroinflammatory, multiorgan condition characterized by tumefactive lesions and lymphoplasmacytic infiltrates rich in IgG4-positive plasma cells that may affect every organ; serum IgG4 may be elevated. Although IgG4-related disease with exclusive multifocal CNS localization is extremely rare and often misdiagnosed,(2-4) it should be considered in the differential diagnosis of tumor-like intracranial lesions and hyperthrophic pachymeningitis.
- Pathology 10/2013; 45(7). DOI:10.1097/PAT.0000000000000014 · 2.19 Impact Factor
- Pathology 10/2013; 45(7). DOI:10.1097/PAT.0000000000000018 · 2.19 Impact Factor
- Pathology 11/2013; 45(7). DOI:10.1097/PAT.0000000000000016 · 2.19 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.