Medicine · 2025
A case of IgG4-related disease misdiagnosed as perirenal abscess: Case report and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhou Zhongze, Gan Fengxiang, Zhao Kun, Liu Shuai, Xiao Xi, Li Wenxuan, Han Xinling, Wang Wenyun, Dong Zhilong
Аннотация
RATIONALE: Immunoglobulin G4-related disease (IgG4-RD) is a chronic immune-mediated fibroinflammatory condition that can mimic infection or malignancy. Renal involvement may present as a perirenal mass suggestive of an abscess. This case highlights a diagnostic pitfall and a favorable response to therapy.
PATIENT CONCERNS: A 48-year-old man had a persistent fever for over 20 days. Imaging revealed a left renal mass. Empirical antibiotics were initiated without improvement, and he was transferred for further evaluation.
DIAGNOSES: Laboratory tests showed elevated inflammatory markers, including C-reactive protein and interleukin-6, positive proteinase 3 antineutrophil cytoplasmic antibody, and markedly increased serum immunoglobulin G4 (IgG4). Computed tomography and magnetic resonance imaging demonstrated renal and pulmonary abnormalities. Renal biopsy confirmed dense infiltration of IgG4-positive plasma cells. The final diagnosis was IgG4-RD involving the kidneys and lungs, initially misdiagnosed as a perirenal abscess.
INTERVENTIONS: Systemic corticosteroid therapy was started.
OUTCOMES: The patient experienced rapid resolution of fever and clinical improvement, with reductions in serum IgG4 and interleukin-6 levels.
LESSONS: IgG4-RD should be considered in patients with unexplained fever and space-occupying renal lesions unresponsive to antibiotics. Timely recognition and immunosuppressive therapy can lead to favorable outcomes and help prevent irreversible organ damage.
PATIENT CONCERNS: A 48-year-old man had a persistent fever for over 20 days. Imaging revealed a left renal mass. Empirical antibiotics were initiated without improvement, and he was transferred for further evaluation.
DIAGNOSES: Laboratory tests showed elevated inflammatory markers, including C-reactive protein and interleukin-6, positive proteinase 3 antineutrophil cytoplasmic antibody, and markedly increased serum immunoglobulin G4 (IgG4). Computed tomography and magnetic resonance imaging demonstrated renal and pulmonary abnormalities. Renal biopsy confirmed dense infiltration of IgG4-positive plasma cells. The final diagnosis was IgG4-RD involving the kidneys and lungs, initially misdiagnosed as a perirenal abscess.
INTERVENTIONS: Systemic corticosteroid therapy was started.
OUTCOMES: The patient experienced rapid resolution of fever and clinical improvement, with reductions in serum IgG4 and interleukin-6 levels.
LESSONS: IgG4-RD should be considered in patients with unexplained fever and space-occupying renal lesions unresponsive to antibiotics. Timely recognition and immunosuppressive therapy can lead to favorable outcomes and help prevent irreversible organ damage.