Refractory IgG4-related intracranial hypertrophic pachymeningitis responded to rituximab

Abstract

Immunoglobulin G4-related disease (IgG4-RD) is a novel clinical entity characterized by elevated serum IgG4 levels and histopathologic features of storiform fibrosis, obliterative phlebitis, tissue eosinophilia, and infiltration of IgG4-positive plasma cells. Although it can involve almost any organ, IgG4-RD rarely involves the nervous system. The principal neurologic manifestations include hypophysitis and hypertrophic pachymeningitis (HP). In some patients, previously known idiopathic HP may in fact be IgG4-related. Acknowledgment: The authors thank Dr. Suzanne Z. Powell for her assistance in IgG4 antibody staining.