Hornstein Nicholas, Razmjou Amir, Weinreb Ari, El-Masry Monica
Internal Medicine, University of California Los Angeles, Los Angeles, California, USA
Internal Medicine, University of California Los Angeles, Los Angeles, California, USA.
BMJ Case Rep. 2021 Mar 3;14(3):e237466. doi: 10.1136/bcr-2020-237466.
Here, we describe the case of a 74-year-old man who was incidentally found to have a hepatic lesion during routine screening. Additional diagnostic studies demonstrated elevated IgG4 levels, IgG4 plasma cell-predominant lymphadenopathy and an inflammatory retroperitoneal mass encasing the bilateral ureters and the aorta. Given the concurrence of a lymphomatous process and IgG4-related disease (IgG4-RD), a multidisciplinary approach was required to determine whether targeting the lymphoma or IgG4-RD would be most efficacious. Discussions led to the decision to target treatment against IgG4-RD with systemic glucocorticoids, and subsequent imaging showed resolution of all lesions. To date, the patient remains symptom-free and has not experienced recurrence of his disease. This case highlights the importance of multidisciplinary care and the challenge inherent in targeting treatment between IgG4-RD and a concomitant lymphomatous process.
在此，我们描述了一例74岁男性患者的病例，该患者在常规筛查中偶然发现肝脏有病变。进一步的诊断研究显示IgG4水平升高、以IgG4浆细胞为主的淋巴结病以及包裹双侧输尿管和主动脉的炎性腹膜后肿块。鉴于淋巴瘤过程与IgG4相关疾病（IgG4-RD）并存，需要采取多学科方法来确定针对淋巴瘤还是IgG4-RD进行治疗最为有效。讨论后决定用全身性糖皮质激素针对IgG4-RD进行治疗，随后的影像学检查显示所有病变均消退。迄今为止，该患者无症状，疾病未复发。本病例突出了多学科护理的重要性以及在IgG4-RD与并发淋巴瘤过程之间进行靶向治疗所固有的挑战。
