Journal d'ophtalmologie clinique et expérimentale
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A Case of Hypertrophic Pachymeningitis with Elevated Serum IgG4

Shinji Makino and Yoshiaki Tanaka

Hypertrophic pachymeningitis is a rare disorder in which intracranial dura mater thickens focally or diffusely. To our knowledge, there are few reports of Immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis. Here, we report the case of such a patient. A 68-year-old woman was referred to our hospital complaining of visual disturbance in her left eye that had persisted for several weeks. There was a history of tuberculosis in her childhood. Brain magnetic resonance imaging showed dural thickening at the bilateral skull base and near the left orbital apex. Visual acuity in her left eye developed marked deterioration. The patient was treated with steroids combined with antituberculosis agents. Following steroid pulse therapy, her symptoms showed rapid amelioration and her visual acuity improved without reactivation of the tuberculosis. Thus, steroid combined with antituberculosis agents is a potential beneficial therapeutic option for patients with IgG4-related disease and tuberculosis.