Leptomeningeal Immunoglobulin G4–Related Disease: A Case Report

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Abstract

We present the case of an older man with history of rheumatoid arthritis, taking etanercept who developed focal neurologic deficits with imaging findings that raised concern for central nervous system neoplasia, as well as a nondiagnostic initial brain biopsy. Imaging showed left hemispheric leptomeningeal enhancement, as well as left frontal convexity rim-enhancing collections, suspicious for abscess. Empiric antibiotics did not improve the patient’s condition, and a second central nervous system biopsy revealed a diagnosis of leptomeningeal immunoglobulin G4–related disease, a rare fibroinflammatory condition. Awareness of this condition, prompt diagnosis, and treatment are imperative to prevent irreversible organ damage, disability, and potentially death.

Original languageEnglish (US)
Article numbere230907
JournalAnnals of Internal Medicine Clinical Cases
Volume2
Issue number12
DOIs
StatePublished - 2023

Keywords

  • Antibiotics
  • Biopsy
  • Brain
  • Cancer prevention
  • Case reports
  • Cerebrospinal fluid
  • Chronic CNS inflammatory disorders
  • Hospital medicine
  • Inflammation
  • Leptomeningeal disease
  • Neuro oncology
  • Plasma cells
  • Rheumatoid arthritis
  • Staining

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine
  • Clinical Biochemistry

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