Clivus-involved immunoglobulin G4 related hypertrophic pachymeningitis mimicking meningioma:A case report  

作　　者：Yang Yu Liang Lv Sen-Lin Yin Cheng Chen Shu Jiang Pei-Zhi Zhou 

机构地区：[1]Department of Neur-osurgery,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China

出　　处：《World Journal of Clinical Cases》2022年第18期6269-6276,共8页世界临床病例杂志

基　　金：Supported by 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project,West China Hospital,Sichuan University,No.2019HXFH018。

摘　　要：BACKGROUND Immunoglobulin G4 related disease(Ig G4-RD)is a fibroinflammatory disease with markedly elevated serum Ig G4 levels and fibrous tissue proliferation,accompanied by numerous plasma cells.Ig G4 related hypertrophic pachymeningitis(Ig G4-RHP)is relatively rare and indistinguishable from other phymatoid diseases before the operation.The risk of long-term immunosuppression needs to be balanced with disease activity.CASE SUMMARY A 40-year-old man presented with headache and bilateral abducent paralysis.He was also diagnosed with pulmonary tuberculosis 10 years ago and was on regular treatment for the same.Before the operation and steroid therapy,the patient was suspected of having tubercular meningitis at a local hospital.A clivus lesion was found via brain magnetic resonance imaging(MRI)at this presentation.He was preliminarily diagnosed with meningioma and underwent Gamma Knife Surgery.Transnasal endoscopic resection was performed to treat deterioration of nerve function.Postoperative pathologic examination suggested Ig G4-RD.Moreover,the serum Ig G4 was elevated at 1.90 g/L(reference range:0.035-1.500 g/L).After steroid therapy for 2 mo,the lesion size diminished on MRI,and the function of bilateral abducent nerves recovered.CONCLUSION Ig G4-RHP is relatively rare and indistinguishable before the operation.Elevated serum Ig G4 levels and imaging examination help in the diagnosis of Ig G4-RHP.Surgery is necessary when lesions progress and patients start to develop cranial nerve function deficit.

关 键 词：Immunoglobulin G4 related disease Hypertrophic pachymeningitis Immu-noglobulin G4 related hypertrophic pachymeningitis CLIVUS Case report 

分 类 号：R651.1[医药卫生—外科学]