A series of biopsy-proven patients with immunoglobulin G4-related neurological disease

Abstract

Aim:To study the clinical presentation, radiological findings, and therapy responsiveness of patients with biopsy-proven immunoglobulin G4 (IgG4)-related neurological disease.Methods:The study was conducted between January 2016 and March 2018 from the Department of Neurology and Pathology of Nizam's Institute of Medical Sciences. Patients with neurological symptoms and biopsy suggestive of IgG4-related disease (IgG4-RD) were included. These patients were studied for their demographic pattern and clinical presentation. The presence of serological markers such as vasculitic profile and IgG4 levels was analyzed. Radiological findings were studied in detail. Therapeutic agents used and the response to therapy were assessed.Results:There were six cases with IgG4-related neurological disease which were all hypertrophic pachymeningitis. The age ranged from 35 to 64 (mean = 46) years. The clinical presentation was acute in one, subacute in two, and chronic in three patients. The most common presenting symptom was headache (4), followed by gait and/or urinary disturbances (2), paraparesis (1), and diplopia (1). IgG4 levels were elevated in 50% of them. Pseudotumor-like mass and sinovenous thrombosis, not described previously, were seen in one patient. All the patients were treated with oral or intravenous steroid. Rituximab was given in three patients; azathioprine was the steroid-sparing agent in one patient. Those with acute/subacute onset of presentation had an excellent response to steroids. All the patients with a chronic duration of their symptoms received empirical anti-tuberculous therapy before a definitive diagnosis of Ig G4-RD was made.Conclusions:The characterization of patients with IgG4-related neurological disease based on the understanding of the clinical spectrum increases the confidence in the clinician to resort to early immunosuppression, thereby having prognostic implications.

IgG4-Related Sclerosing Disease Causing Spinal Cord Compression: The First Reported Case in Literature

“…The manifestations of IgG4-RD when it affects the CNS depends typically on the location of the sclerotic mass. IgG4-RD have been previously described in the literature as it affected the pituitary gland and manifested as hypophysitis [1], the meninges and manifested as intracranial hypertrophic pachymeningitis [2–4], or the brain parenchyma and presented as an inflammatory pseudotumor [5]. We, hereby, present the first case in literature to describe IgG4-RD of the spinal extradural tissue.…”

Aceruloplasminemia with Novel Mutation, with IgG4 Related Pachymeningitis – Occam’s Razor or Hickam’s Dictum?

“…[ 2 ] Clinically it can present with headaches and cranial nerve palsies, both of which were prominent in our patient. [ 3 ] Radiologically, she had diffuse pachymeningeal enhancement along the posterior falx, tentorium cerebelli, and spinal cord, encompassing cerebellar lobes and spinal cord up to D2 level. The final diagnosis of IgG4R-PM was established by biopsy as per consensus criteria published by EULAR in 2019.…”

Epiduritis related to IgG4 disease: A very rare cause for spinal cord compression

“…e authors certify that they have obtained all appropriate patient consent. [1,[3][4][5][6][7][8][9][11][12][13]15,[19][20][21][22][23][24][25][26][27][28][30][31][32][33][34]37,[40][41][42][43][44][45][46][47][48][49]…”