Treatment of IgG4-related pachymeningitis in a patient with steroid intolerance: The role of early use of rituximab

Vadim Gospodarev; Justin Câmara; Vikram Chakravarthy; Arie Perry; Matthew Wood; Robin Dietz; Jun Wang; Kenneth De Los Reyes; Ravi Raghavan

doi:10.1016/j.jneuroim.2016.08.009

Treatment of IgG4-related pachymeningitis in a patient with steroid intolerance: The role of early use of rituximab

Vadim Gospodarev, Justin Câmara, Vikram Chakravarthy, Arie Perry, Matthew Wood, Robin Dietz, Jun Wang, Kenneth De Los Reyes, Ravi Raghavan

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

IgG4-related pachymeningitis is a serious inflammatory condition that can present with symptoms of mass effect and focal deficits. The first-line therapy is steroids and second-line is chemotherapy (methotrexate, azathioprine, etc.). We describe a patient with IgG4-related pachymeningitis in whom steroid use was contraindicated and methotrexate was ineffective. During the course of treatment, the patient presented to the emergency department with receptive and expressive aphasia, slurred speech, right-sided neglect, and loss of sensation. After a single infusion of rituximab and anticonvulsants, her symptoms resolved. Our unique case suggests that patients with IgG4-related pachymeningitis might benefit from early initiation of rituximab.

Original language	English (US)
Pages (from-to)	62-65
Number of pages	4
Journal	Journal of Neuroimmunology
Volume	299
DOIs	https://doi.org/10.1016/j.jneuroim.2016.08.009
State	Published - Oct 15 2016
Externally published	Yes

Keywords

IgG4-related diseases
IgG4-related pachymeningitis
methotrexate
rituximab

ASJC Scopus subject areas

Immunology and Allergy
Immunology
Neurology
Clinical Neurology

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10.1016/j.jneuroim.2016.08.009

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title = "Treatment of IgG4-related pachymeningitis in a patient with steroid intolerance: The role of early use of rituximab",

abstract = "IgG4-related pachymeningitis is a serious inflammatory condition that can present with symptoms of mass effect and focal deficits. The first-line therapy is steroids and second-line is chemotherapy (methotrexate, azathioprine, etc.). We describe a patient with IgG4-related pachymeningitis in whom steroid use was contraindicated and methotrexate was ineffective. During the course of treatment, the patient presented to the emergency department with receptive and expressive aphasia, slurred speech, right-sided neglect, and loss of sensation. After a single infusion of rituximab and anticonvulsants, her symptoms resolved. Our unique case suggests that patients with IgG4-related pachymeningitis might benefit from early initiation of rituximab.",

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author = "Vadim Gospodarev and Justin C{\^a}mara and Vikram Chakravarthy and Arie Perry and Matthew Wood and Robin Dietz and Jun Wang and {De Los Reyes}, Kenneth and Ravi Raghavan",

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T1 - Treatment of IgG4-related pachymeningitis in a patient with steroid intolerance

T2 - The role of early use of rituximab

AU - Gospodarev, Vadim

AU - Câmara, Justin

AU - Chakravarthy, Vikram

AU - Perry, Arie

AU - Wood, Matthew

AU - Dietz, Robin

AU - Wang, Jun

AU - De Los Reyes, Kenneth

AU - Raghavan, Ravi

PY - 2016/10/15

Y1 - 2016/10/15

N2 - IgG4-related pachymeningitis is a serious inflammatory condition that can present with symptoms of mass effect and focal deficits. The first-line therapy is steroids and second-line is chemotherapy (methotrexate, azathioprine, etc.). We describe a patient with IgG4-related pachymeningitis in whom steroid use was contraindicated and methotrexate was ineffective. During the course of treatment, the patient presented to the emergency department with receptive and expressive aphasia, slurred speech, right-sided neglect, and loss of sensation. After a single infusion of rituximab and anticonvulsants, her symptoms resolved. Our unique case suggests that patients with IgG4-related pachymeningitis might benefit from early initiation of rituximab.

AB - IgG4-related pachymeningitis is a serious inflammatory condition that can present with symptoms of mass effect and focal deficits. The first-line therapy is steroids and second-line is chemotherapy (methotrexate, azathioprine, etc.). We describe a patient with IgG4-related pachymeningitis in whom steroid use was contraindicated and methotrexate was ineffective. During the course of treatment, the patient presented to the emergency department with receptive and expressive aphasia, slurred speech, right-sided neglect, and loss of sensation. After a single infusion of rituximab and anticonvulsants, her symptoms resolved. Our unique case suggests that patients with IgG4-related pachymeningitis might benefit from early initiation of rituximab.

KW - IgG4-related diseases

KW - IgG4-related pachymeningitis

KW - methotrexate

KW - rituximab

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ER -

Treatment of IgG4-related pachymeningitis in a patient with steroid intolerance: The role of early use of rituximab

Abstract

Keywords

ASJC Scopus subject areas

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