Immunoglobulin G4-Related Hypertrophic Pachymeningitis of the Spine: A Case Report and Systematic Review of the Literature.

Autor: Sbeih I; Neurosurgery Department, Farah Medical Campus, Amman, Jordan. Electronic address: ibrahim_sbeih_az@yahoo.com., Darwazeh R; Neurosurgery Department, Farah Medical Campus, Amman, Jordan., Shehadeh M; Neurosurgery Department, Ibn Al-Haytham Hospital, Amman, Jordan., Al-Kanash R; Endoscopic Spine Department, Razi Spine Clinic, Amman, Jordan., Abu-Farsakh H; Pathology Department, First Medical Lab, Amman, Jordan., Sbeih A; Neurosurgery Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2020 Nov; Vol. 143, pp. 445-453. Date of Electronic Publication: 2020 Aug 07.
DOI: 10.1016/j.wneu.2020.07.227
Abstrakt: Background: Spinal immunoglobulin G4-related hypertrophic pachymeningitis (IgG4-HP) is a rare disease. Little information is known regarding the diagnosis, management, and prognosis of patients with spinal IgG4-HP.
Methods: The authors present a case of spinal IgG4-HP with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies (up to April 2020) that reported patients with spinal IgG4-HP, based on the criteria of Japan College of Rheumatology, were identified from the PubMed and Cochrane Library databases.
Results: This systematic review identified 33 patients, including the present case, of whom 21 were male and 12 were female. The mean value of age was 51.2 (±12.6) years. Eight patients had systemic involvement. In addition, among 33 patients, 13 patients had an elevated serum IgG4. Surgery was performed in 31 patients. Steroid therapy alone and steroid therapy with immunosuppressants were effective in 94% and 100% of the cases, respectively. Furthermore, 31 of 33 patients reported improved outcomes, 1 patient died due to infection, and in 2 patients the data were not available.
Conclusions: Spinal IgG4-HP is a rare entity. In addition, it should be considered in the differential diagnosis of space-occupying lesions around the spinal cord. Histopathology with immunohistochemistry results provides the most reliable evidence for diagnosis. Steroid therapy is the first line of treatment. Surgical decompression may be required in patients presenting with nerve root and/or spinal cord compression. Long-term follow-up is necessary for patients with spinal IgG4-HP.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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