98%
921
2 minutes
20
Immunoglobulin G4 (IgG4) related hypertrophic pachymeningitis of the spinal cord is a rare condition, characterized by infiltration of the spinal meninges with IgG4-producing plasma cells and subsequent hypertrophic fibrosis. Here, we report on a 65-year-old woman with IgG4 associated hypertrophic spinal pachymeningitis, in whom cerebrospinal fluid (CSF) analysis was a decisive diagnostic tool. Not only could we demonstrate an intrathecal IgG4 production, but also IgG4 positive plasma cells in CSF. Following decompressive surgery, diagnosis of IgG4 associated hypertrophic pachymeningitis was confirmed histologically. Surgery and immunosuppressive therapy with rituximab were associated with clinical improvement. This case highlights CSF analyses as diagnostic tool for detection of IgG4 related hypertrophic pachymeningitis.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11360877 | PMC |
http://dx.doi.org/10.1186/s42466-024-00343-2 | DOI Listing |
Rheumatology (Oxford)
September 2025
Department of Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Background: Surgical pathology specimens from patients with hypertrophic pachymeningitis are infrequently encountered. After excluding infectious and neoplastic causes, autoimmune conditions should be considered, especially neurosarcoidosis, rheumatoid arthritis, granulomatosis with polyangiitis (GPA), and IgG4-related disease (IgG4-RD) before the case is designated "idiopathic". However, even if histological findings strongly favor one of these conditions, clinical and serological correlation is mandatory.
View Article and Find Full Text PDFIntern Med
August 2025
Department of Neurology, Hakodate Municipal Hospital, Japan.
Rheumatoid meningitis (RM), a rare neurological complication of rheumatoid arthritis (RA), presented as hypertrophic pachymeningitis and leptomeningitis in two octogenarian patients. Case 1 had established RA, while Case 2 was diagnosed with RA after neurological onset. Both patients initially received high doses of corticosteroids.
View Article and Find Full Text PDFMod Rheumatol Case Rep
July 2025
Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
Microscopic polyangiitis (MPA) is a subtype of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), a small-vessel vasculitis that can cause organ-threatening complications. Hypertrophic pachymeningitis is a rare, central nervous system manifestation of AAV rarely involving the spine. We herein report a patient with myeloperoxidase-ANCA-positive MPA presenting with progressive cognitive decline and gait disturbance associated with communicating hydrocephalus secondary to spinal hypertrophic pachymeningitis.
View Article and Find Full Text PDFBJR Case Rep
July 2025
Institute of Diagnostic and Interventional Neuroradiology, Inselspital, 3010, Bern, Switzerland.
Primary central nervous system (CNS) mucosa-associated lymphoid tissue (MALT) lymphoma is a rare condition frequently mistaken for meningioma. Since these conditions require distinct treatment approaches, recognizing their imaging characteristics is essential for accurate clinical decision-making. A 69-year-old woman presented with headaches and forehead swelling, prompting MRI of the CNS.
View Article and Find Full Text PDF