title: A rare cause for lower back pain: a case of an IgG4-related periaortitis.
abstract: IgG4-related disease (IgG4-RD) are a group of autoinflammatory diseases often presenting as tumor-like lesions because of their infiltrative or mass forming behavior. They are characterized by a typical histology consisting of storiform fibrosis, high numbers of infiltrating IgG4-positive plasma cells, obliterative phlebitis, and a moderate presence of eosinophilic cells. Serum IgG4 levels can be elevated. We present a case of a 57 year-old male patient with immobilizing lower back pain, fever, and night sweats. We diagnosed IgG4-related periaortitis using serum IgG4 levels, abdominal ultrasound, PET/CT, and histology. We successfully treated the patient with glucocorticoids (GC) and azathioprine. Periaortitis is a rare presentation of IgG4-RD and therefore noteworthy. It has to be considered in patients with a retroperitoneal mass.
authors.affiliation: Medizinische Klinik A, Klinikum Ludwigshafen, Ludwigshafen, Germany. loefflec@klilu.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Löffler
authors.affiliation: Klinik für diagnostische und interventionelle Radiologie, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Hoffend
authors.affiliation: Institut für Pathologie, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Rebel
authors.affiliation: Institut für Pathologie und Zytologie, Prof. Waldherr, Heidelberg, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Waldherr
authors.affiliation: Medizinische Klinik A, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uppenkamp
authors.affiliation: Medizinische Klinik A, Klinikum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Raoul
authors.initials: R
authors.lastname: Bergner
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use; D005334:Fever / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012185:Retroperitoneal Fibrosis / Q000175:diagnosis* / Q000188:drug therapy*; D013546:Sweating; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G; D001379:Azathioprine
keywords: Aortitis; Azathioprine; IgG4; PET/CT; Steroids; Therapy