15 April 2022 : Case report
A 61-Year-Old Woman Presenting with Low Back Pain Diagnosed with IgG4-Related Disease Affecting the Thoracoabdominal Aorta and Retroperitoneum
Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)Mi Ra Kim1ABCDEF, Hyekyung Shim2ABCDEF*
Am J Case Rep 2022; 23:e935007
BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) includes several immune-mediated fibro-inflammatory conditions affecting multiple organs. Increased IgG4 serum levels support the diagnosis of IgG4-RD and characteristic histopathology of fibrous infiltrates or masses containing IgG4-positive plasma cells. We present the case of a 61-year-old woman with low back pain who was diagnosed with IgG4-RD involving the thoracoabdominal aorta and retroperitoneum.
CASE REPORT: A 61-year-old woman who had persistent low back pain was referred to a university hospital in South Korea. Computed tomography (CT) and 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/CT (F-18-FDG-PET/CT) demonstrated diffuse circumferential infiltrates from the thoracoabdominal aorta, iliac vessels, and retroperitoneum associated with right obstructive uropathy. The serum IgG4 concentration was 418.0 mg/L (reference range: 30-2000). She underwent laparoscopic retroperitoneal biopsy and received a cystoscopic double-J ureteral stent. IgG4-positive plasma cells, lymphoplasmacytic infiltration, and fibrosis were observed on histopathological examination. She was diagnosed with IgG4-RD and treated with glucocorticoids (GCs) for 6 months. She underwent femoral-to-femoral bypass graft surgery for revascularization due to occlusion of the right iliac arteries. She experienced relapse after GC discontinuation, and GC administration was resumed. She had difficulty tapering GC use owing to persistent low back pain, which improved with combined treatment of GC and immunosuppressant.
CONCLUSIONS: We present a case of IgG4-RD involving the thoracoabdominal aorta and retroperitoneum based on the 2019 classification criteria. The importance of radiological studies of IgG4-RD has increased, and F-18-FDG-PET/CT, which is a functional imaging modality of the whole body, is a valuable evaluation method for diagnosis and clinical outcomes.
Keywords: Glucocorticoids, Immunoglobulin G4-Related Disease, Mediastinal Fibrosis, Retroperitoneal Fibrosis, Aorta, Female, Fluorodeoxyglucose F18, Humans, Immunoglobulin G, Low Back Pain, Middle Aged, Positron Emission Tomography Computed Tomography
05 Jun 2023 : Case reportSuccessful Treatment of Recurrent Colonic Adenocarcinoma with Metastatic Tumor Thrombus in the Superior Mes...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939156
05 Jun 2023 : Case reportDelayed Right Ventricular Pacemaker Lead Perforation 9 Years After Implantation
Am J Case Rep In Press; DOI: 10.12659/AJCR.940291
05 Jun 2023 : Case reportAn 81-Year-Old Man Presenting with Asthenia and Anorexia After an Alcohol-Induced Hypoglycemic Coma and a D...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939840
02 Jun 2023 : Case reportSingle Pterional Burr Hole Coupled with Coagulation of the Middle Meningeal Artery for Management of a Chro...
Am J Case Rep In Press; DOI: 10.12659/AJCR.940045
Most Viewed Current Articles
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
07 Dec 2021 : Case reportEdwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...
Am J Case Rep 2021; 22:e934347
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250