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IgG4-related disease presenting with multiorgan involvement
  1. Roberto Tellez1,
  2. Brittany Bromfield1,
  3. Hayden Basinger2 and
  4. Adam Slivka3
  1. 1Internal Medicine, UPMC, Pittsburgh, Pennsylvania, USA
  2. 2Radiology, UPMC, Pittsburgh, Pennsylvania, USA
  3. 3Gastroenterology and Hepatology, UPMC, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Brittany Bromfield; bromfieldbb{at}upmc.edu

Abstract

Immunoglobulin G4-related disease (IgG4-RD) is a rare fibroinflammatory immune-mediated condition which can affect multiple organ systems and form mass-like lesions. Initial presentation can mimic other diseases such as pancreatic malignancy when there is pancreatic involvement or tuberculosis (TB) when there are pulmonary lesions or hypertrophic pachymeningitis (HP). Here, we report a novel case of IgG4-RD presenting as bilateral subdural haematomas with additional findings. Our patient is a male who presented with headaches and blurred vision. Physical examination showed disconjugate gaze with a fixed pupil. Trauma survey radiologic imaging revealed a pancreatic mass concerning for malignancy. Subsequent workup found hypophysitis with optic chiasm compression and hypopituitarism, mediastinal lymphadenopathy and HP. Laboratory values showed an elevated serum IgG4 level and latent TB. Our case adds to the existing IgG4-RD literature by highlighting a unique presentation. It is important to maintain it on the differential diagnosis especially in multisystemic presentations with competing diagnoses.

  • Pancreas and biliary tract
  • Ultrasonography
  • Rheumatology
  • Radiology
  • Gastroenterology

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Footnotes

  • Twitter @brittybb

  • Contributors RT conceptualised the manuscript. RT and BBB were directly involved in the care of the patient and cowrote the manuscript. HB designed and created radiology images. AS served as supervisor critically reviewed and approved final draft of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.