{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:40:09Z","timestamp":1756276809095,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,9]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>Often the workup to find the causes of common symptoms can lead to unexpected findings, thereby emphasising the need to keep a broad suspicion and continued search for emerging evidence. In this report, we describe the case of an elderly woman in her late 60s without any comorbidities, who presented with new-onset neck stiffness, progressive headache and continuous fever with no other clue that could lead us to a telltale diagnosis, and in whom the diagnostic staircase ultimately led to the diagnosis of IgG4 hypophysitis and pachymeningitis. Only a prompt clinical suspicion and appropriately timed workup can help in revealing such intricate and uncommon diagnosis among the maze of more common differentials having similar manifestations. Especially in such uncommon scenarios, common aetiologies such as tuberculosis should always be kept in the horizon.<\/jats:p>","DOI":"10.1136\/bcr-2024-260953","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T18:55:47Z","timestamp":1740077747000},"page":"e260953","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute hypophysitis with pachymeningitis"],"prefix":"10.1136","volume":"18","author":[{"given":"Mayank","family":"Sahu","sequence":"first","affiliation":[{"name":"Internal Medicine, Apollo Multispeciality Hospital, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debabrata","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Neurology, Apollo Multispeciality Hospitals, Kolkata, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suddhasatwya","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Internal Medicine, Apollo Multispeciality Hospital, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8800-8047","authenticated-orcid":false,"given":"Abhijit","family":"Das","sequence":"additional","affiliation":[{"name":"Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK"},{"name":"University of Central Lancashire, Preston, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"2025082623104046000_18.2.e260953.1","doi-asserted-by":"crossref","DOI":"10.1186\/s40842-016-0034-8","article-title":"Hypophysitis: Evaluation and Management","volume":"2","author":"Faje","year":"2016","journal-title":"Clin Diabetes Endocrinol"},{"key":"2025082623104046000_18.2.e260953.2","unstructured":"Prete A , Salvatori R . Hypophysitis. In: Feingold KR , Blackman MR , Anawalt B , eds. Endotext. South Dartmouth (MA): MDText.Com, Inc, 2000. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519842\/"},{"key":"2025082623104046000_18.2.e260953.3","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab672"},{"key":"2025082623104046000_18.2.e260953.4","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1007\/s00701-022-05231-9","article-title":"IgG4-related hypophysitis: a retrospective cohort study","volume":"164","author":"Bhargava","year":"2022","journal-title":"Acta Neurochir (Wien)"},{"key":"2025082623104046000_18.2.e260953.5","doi-asserted-by":"crossref","DOI":"10.25259\/SNI_1013_2022","article-title":"IgG4-related hypophysitis: A monocentric experience from North India","volume":"13","author":"Chakraborty","year":"2022","journal-title":"Surg Neurol Int"},{"key":"2025082623104046000_18.2.e260953.6","doi-asserted-by":"publisher","DOI":"10.1002\/art.41120"},{"key":"2025082623104046000_18.2.e260953.7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-2970"},{"key":"2025082623104046000_18.2.e260953.8","doi-asserted-by":"publisher","DOI":"10.1080\/14397595.2020.1859710"},{"key":"2025082623104046000_18.2.e260953.9","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.40"},{"key":"2025082623104046000_18.2.e260953.10","doi-asserted-by":"crossref","first-page":"2466","DOI":"10.1002\/art.39205","article-title":"IgG4-Related Disease: Clinical and Laboratory Features in One Hundred Twenty-Five Patients","volume":"67","author":"Wallace","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"2025082623104046000_18.2.e260953.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-017-1467-x","article-title":"New clues to the nature of immunoglobulin G4-related disease: a retrospective Japanese multicenter study of baseline clinical features of 334 cases","volume":"19","author":"Yamada","year":"2017","journal-title":"Arthritis Res Ther"},{"key":"2025082623104046000_18.2.e260953.12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/NI.Neurol-India-D-23-00016","article-title":"IgG4-Related Neurological Disease: A Single Center Ambispective Study from South India","volume":"72","author":"Reddy","year":"2024","journal-title":"Neurol India"},{"key":"2025082623104046000_18.2.e260953.13","doi-asserted-by":"publisher","DOI":"10.4103\/IJMR.IJMR_382_23"},{"key":"2025082623104046000_18.2.e260953.14","doi-asserted-by":"publisher","DOI":"10.1002\/art.21705"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-260953","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:10:48Z","timestamp":1756275048000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-260953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":14,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,20]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2024-260953"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-260953","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}