{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:23:01Z","timestamp":1791559381267,"version":"4.3.4"},"reference-count":5,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,8,10]]},"abstract":"\n BACKGROUND<\/jats:title>\n ImmunoglobulinG4\u2013related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory condition affecting various organs, mimicking other inflammatory or neoplastic processes. Neurological manifestations, although uncommon, are recognized, with hypertrophic pachymeningitis being the most frequent.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n \n This case is notable for several differences. First, the patient\u2019s age and sex (23-year-old female) contrasts sharply with the typical demographic of middle-aged to elderly males. Second, while spinal involvement is known, this case highlighted involvement of the vertebral disc alongside vertebral bodies, leading to a discitis\/osteomyelitis with a mass effect, which is a less common finding in neurological IgG4-RD. Most critically, the case was uniquely complicated by a superimposed methicillin-sensitive\n Staphylococcus aureus<\/jats:italic>\n infection, resulting in a psoas abscess and discitis\/osteomyelitis. This transpired after initial improvement with glucocorticoids and subsequent worsening despite rituximab treatment.\n <\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case broadens the known spectrum of IgG4-RD, emphasizing its protean manifestations and the importance of considering it across a broader demographic and atypical spinal involvement. It underscores that clinical deterioration in IgG4-RD patients on immunosuppressive therapy necessitates a thorough re-evaluation, ruling out concurrent infections rather than considering primary disease progression or relapse. A comprehensive diagnostic approach, including repeat biopsies and cultures, and a multidisciplinary management, is vital for optimal patient outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25789<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25789","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:01:21Z","timestamp":1786492881000},"source":"Crossref","is-referenced-by-count":1,"title":["Immunoglobulin G4 sclerosing disease of the spine in a young patient: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4098-2608","authenticated-orcid":true,"given":"Kerolous","family":"Eldeeb","sequence":"first","affiliation":[{"name":"Midwestern University, Chicago College of Osteopathic Medicine, Downers Grove, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayah","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Burrell College of Osteopathic Medicine, Las Cruces, New Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Scully","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Texas Health Resources, Arlington, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Tabanda-Lichauco","sequence":"additional","affiliation":[{"name":"Tucson Pathology Associates, Tucson, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Scully","sequence":"additional","affiliation":[{"name":"Neurosurgery, TMCOne Northwest NeuroSpecialists, Tucson, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Curr Treat Options Neurol","first-page":"14","article-title":"Neurological manifestations of IgG4-related disease","volume":"19","author":"Baptista","year":"2017","unstructured":"Baptista BCasian AGunawardena HD\u2019Cruz DRice CM.Neurological manifestations of IgG4-related disease. Curr Treat Options Neurol. 2017;19(4):14. doi:10.1007\/s11940-017-0450-9"},{"issue":"9","key":"bib2","series-title":"Arthritis Rheumatol","first-page":"2466","article-title":"IgG4-related disease: clinical and laboratory features in one hundred twenty-five patients","volume":"67","author":"Wallace","year":"2015","unstructured":"Wallace ZSDeshpande VMattoo HIgG4-related disease: clinical and laboratory features in one hundred twenty-five patients. Arthritis Rheumatol. 2015;67(9):2466-2475. doi:10.1002\/art.39205"},{"key":"bib3","series-title":"Case Reports Immunol","first-page":"3618510","article-title":"IgG4-related sclerosing disease causing spinal cord compression: the first reported case in literature","volume":"2019","author":"Merza","year":"2019","unstructured":"Merza NTaha ALung JBenderman AWWright SE.IgG4-related sclerosing disease causing spinal cord compression: the first reported case in literature. Case Reports Immunol. 2019;2019:3618510. doi:10.1155\/2019\/3618510"},{"issue":"2","key":"bib4","series-title":"Neuroradiol J","first-page":"196","article-title":"Neurological involvement of IgG4-related disease: description of a case and review of the literature","volume":"31","author":"Varrassi","year":"2018","unstructured":"Varrassi MGianneramo CArrigoni FNeurological involvement of IgG4-related disease: description of a case and review of the literature. Neuroradiol J. 2018;31(2):196-202. doi:10.1177\/1971400917698173"},{"issue":"6","key":"bib5","series-title":"JAMA Neurol","first-page":"767","article-title":"Central nervous system manifestation of IgG4-related disease","volume":"71","author":"Regev","year":"2014","unstructured":"Regev KNussbaum TCagnano EGiladi NKarni A.Central nervous system manifestation of IgG4-related disease. JAMA Neurol. 2014;71(6):767-770. doi:10.1001\/jamaneurol.2014.40"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25789.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25789.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25789.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:01:21Z","timestamp":1786492881000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/6\/article-CASE25789.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":5,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/case25789","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}