{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:15:56Z","timestamp":1788315356227,"version":"build-2803163510"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":73,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>IgG4-Related Disease (IgG4-RD) is a fibroinflammatory disorder initially identified as autoimmune pancreatitis but subsequently shown in numerous other organs with common pathological hallmarks. Constrictive pericarditis is an unusual presentation of IgG4-RD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>This case report is about a 45-year-old previously healthy Slavic male patient with complicated course of IgG4-Related Disease (IgG4-RD) with pancreatic cyst, constrictive-effusive pericarditis potentially triggered by 3-month antecedent Coxsackie virus infection with hand foot and mouth syndrome, who had 495 cc pericardial fluid drained, bilateral pleural effusions with 1\u00a0L fluid drained from the right side. He was treated with methylprednisolone oral up to 48\u00a0mg daily. With each decrease in steroid dose (given maximum glucose on metabolic panel to 903) or holiday in steroid up to 6\u00a0weeks, he experienced worsening of positional and exertional shortness of breath. Final diagnosis and resolution of symptoms were obtained after pericardiectomy showing abundant fibrosis and plasma cells staining for IgG4. Remission was maintained on rituximab infusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights difficulty in diagnosing and treating IgG4-RD. His initial IgG4 serum level was normal to only mildly elevated. Definitive diagnosis was via tissue biopsy which required open heart surgery to access. Prior to the diagnosis, he was treated with methylprednisolone which led to severely elevated glucose levels. Oral steroids could not stop the progression of constrictive pericarditis. Pericardiectomy and subsequent treatment with rituximab led to continued remission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13256-026-06239-w","type":"journal-article","created":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T08:07:26Z","timestamp":1782029246000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Constrictive-effusive pericarditis as presenting feature of IgG4-related disease (IgG4-RD): a case report"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0627-8340","authenticated-orcid":false,"given":"Robert","family":"Fekete","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"issue":"3","key":"6239_CR1","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1080\/14397595.2020.1859710","volume":"31","author":"H Umehara","year":"2021","unstructured":"Umehara H, Okazaki K, Kawa S, et al. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021;31(3):529\u201333. https:\/\/doi.org\/10.1080\/14397595.2020.1859710.","journal-title":"Mod Rheumatol"},{"issue":"20","key":"6239_CR2","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.167910","volume":"9","author":"A Hara","year":"2024","unstructured":"Hara A, Watanabe T, Minaga K, et al. A positive cytokine\/chemokine feedback loop establishes plasmacytoid DC\u2013driven autoimmune pancreatitis in IgG4- related disease Akane Hara. JCI Insight. 2024;9(20): e167910. https:\/\/doi.org\/10.1172\/jci.insight.167910.","journal-title":"JCI Insight"},{"issue":"31","key":"6239_CR3","doi-asserted-by":"publisher","first-page":"2946","DOI":"10.1093\/eurheartj\/ehab452","volume":"43","author":"M Imazio","year":"2022","unstructured":"Imazio M, Lazaros G, Gattorno M, LeWinter M, Abbate A, Brucato A, Klein A. Anti-interleukin-1 agents for pericarditis: a primer for cardiologists. Eur Heart J. 2022;43(31):2946\u201357. https:\/\/doi.org\/10.1093\/eurheartj\/ehab452.","journal-title":"Eur Heart J"},{"issue":"2018","key":"6239_CR4","doi-asserted-by":"publisher","first-page":"6103064","DOI":"10.1155\/2018\/6103064","volume":"1","author":"AF Karim","year":"2018","unstructured":"Karim AF, Eurelinks LEM, Bansie RD, et al. Soluble interleukin-2 receptor: a potential marker for monitoring disease activity in IgG4-related disease. Mediators Inflamm. 2018;1(2018):6103064. https:\/\/doi.org\/10.1155\/2018\/6103064.","journal-title":"Mediators Inflamm"},{"issue":"13","key":"6239_CR5","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s13000-018-0684-1","volume":"17","author":"A Masunaga","year":"2018","unstructured":"Masunaga A, Ishibashi F, Koh E, et al. Possible relationship between fibrosis of IgG4-related thymitis and the profibrotic cytokines, transforming growth factor beta 1, interleukin 1 beta and interferon gamma: a case report. Diagn Pathol. 2018;17(13):6. https:\/\/doi.org\/10.1186\/s13000-018-0684-1.","journal-title":"Diagn Pathol"},{"issue":"2","key":"6239_CR6","doi-asserted-by":"publisher","first-page":"101","DOI":"10.14503\/THIJ-16-5772","volume":"44","author":"BC Depboylu","year":"2017","unstructured":"Depboylu BC, Mootoosamy P, Vistarini N, Testuz A, El-Hamamsy I, Cikirikcioglu M. Surgical treatment of constrictive pericarditis. Tex Heart Inst J. 2017;44(2):101\u20136. https:\/\/doi.org\/10.14503\/THIJ-16-5772.","journal-title":"Tex Heart Inst J"},{"issue":"4","key":"6239_CR7","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.pcad.2016.12.008","volume":"59","author":"WR Miranda","year":"2017","unstructured":"Miranda WR, Oh JK. Constrictive pericarditis: a practical clinical approach. Prog Cardiovasc Dis. 2017;59(4):369\u201379. https:\/\/doi.org\/10.1016\/j.pcad.2016.12.008.","journal-title":"Prog Cardiovasc Dis"},{"issue":"42","key":"6239_CR8","doi-asserted-by":"publisher","first-page":"2921","DOI":"10.1093\/eurheartj\/ehv318","volume":"36","author":"Y Adler","year":"2015","unstructured":"Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36(42):2921\u201364. https:\/\/doi.org\/10.1093\/eurheartj\/ehv318.","journal-title":"Eur Heart J"},{"issue":"1","key":"6239_CR9","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1056\/NEJMoa2027892","volume":"384","author":"AL Klein","year":"2021","unstructured":"Klein AL, Imazio M, Cremer P, Brucato A, Abbate A, Fang F, Insalaco A, LeWinter M, Lewis BS, Lin D, Luis SA, Nicholls SJ, Pano A, Wheeler A, Paolini JF. Phase 3 trial of interleukin-1 trap rilonacept in recurrent pericarditis. 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Eur J Intern Med. 2020;74:92\u20138. https:\/\/doi.org\/10.1016\/j.ejim.2019.12.029.","journal-title":"Eur J Intern Med"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-026-06239-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06239-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06239-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:59:06Z","timestamp":1788314346000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13256-026-06239-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,21]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6239"],"URL":"https:\/\/doi.org\/10.1186\/s13256-026-06239-w","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,21]]},"assertion":[{"value":"25 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Written informed consent was obtained from the patient for participation in this case report; however, no ethical approval was needed. \"The institution\u2019s policy, therefore, is that a case report is not research that must be approved by the IRB.\" New York Medical College Policies and Procedures for the Conduct of Research Involving Human Subjects. [\n                      \n                      ] Accessed on 3\/24\/2025.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The author declares that he does not have any competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"517"}}