{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:06:54Z","timestamp":1756339614199,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,5,24]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>Immunoglobulin G4-related disease (IgG4-RD) is a rare fibroinflammatory immune-mediated condition which can affect multiple organ systems and form mass-like lesions. Initial presentation can mimic other diseases such as pancreatic malignancy when there is pancreatic involvement or tuberculosis (TB) when there are pulmonary lesions or hypertrophic pachymeningitis (HP). Here, we report a novel case of IgG4-RD presenting as bilateral subdural haematomas with additional findings. Our patient is a male who presented with headaches and blurred vision. Physical examination showed disconjugate gaze with a fixed pupil. Trauma survey radiologic imaging revealed a pancreatic mass concerning for malignancy. Subsequent workup found hypophysitis with optic chiasm compression and hypopituitarism, mediastinal lymphadenopathy and HP. Laboratory values showed an elevated serum IgG4 level and latent TB. Our case adds to the existing IgG4-RD literature by highlighting a unique presentation. It is important to maintain it on the differential diagnosis especially in multisystemic presentations with competing diagnoses.<\/jats:p>","DOI":"10.1136\/bcr-2022-250637","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T12:12:17Z","timestamp":1654085537000},"page":"e250637","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["IgG4-related disease presenting with multiorgan involvement"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2104-5489","authenticated-orcid":false,"given":"Roberto","family":"Tellez","sequence":"first","affiliation":[{"name":"Internal Medicine, UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4544-9664","authenticated-orcid":false,"given":"Brittany","family":"Bromfield","sequence":"additional","affiliation":[{"name":"Internal Medicine, UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayden","family":"Basinger","sequence":"additional","affiliation":[{"name":"Radiology, UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Slivka","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, UPMC, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,6,1]]},"reference":[{"key":"2025082711503685000_15.6.e250637.1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-4-23"},{"key":"2025082711503685000_15.6.e250637.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1104650"},{"key":"2025082711503685000_15.6.e250637.3","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204907"},{"key":"2025082711503685000_15.6.e250637.4","first-page":"795","article-title":"[A case of multifocal fibrosclerosis presenting with chronic subdural hematoma]","volume":"63","author":"Miyazaki","year":"2011","journal-title":"Brain Nerve"},{"key":"2025082711503685000_15.6.e250637.5","doi-asserted-by":"crossref","first-page":"e05470","DOI":"10.1002\/ccr3.5470","article-title":"The great imposter: a case report of IgG4-RD hypertrophic pachymeningitis with skull lytic lesion and pulmonary nodules","volume":"10","author":"Wadiwala","year":"2022","journal-title":"Clin Case Rep"},{"key":"2025082711503685000_15.6.e250637.6","doi-asserted-by":"crossref","DOI":"10.1007\/s11940-017-0450-9","article-title":"Neurological manifestations of IgG4-related disease","volume":"19","author":"Baptista","year":"2017","journal-title":"Curr Treat Options Neurol"},{"key":"2025082711503685000_15.6.e250637.7","first-page":"540","article-title":"[A case of idiopathic hypertrophic cranial pachymeningitis presenting as chronic subdural hematoma]","volume":"45","author":"He","year":"2016","journal-title":"Zhejiang Da Xue Xue Bao Yi Xue Ban"},{"key":"2025082711503685000_15.6.e250637.8","doi-asserted-by":"crossref","DOI":"10.1001\/jamaneurol.2014.243","article-title":"Igg4-Related hypertrophic pachymeningitis","volume":"71","author":"Lu","year":"2014","journal-title":"JAMA Neurol"},{"key":"2025082711503685000_15.6.e250637.9","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-2970"},{"key":"2025082711503685000_15.6.e250637.10","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-13-0642"},{"key":"2025082711503685000_15.6.e250637.11","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2018-101001"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-250637","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:50:43Z","timestamp":1756320643000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-250637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":11,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,1]]},"published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1136\/bcr-2022-250637"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-250637","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,6]]}}}