PMC8097037_01
Imaging, histologic and laboratory findings of the case. (A) The abduction of both eyes was limited (arrows indicate the direction of movement), and contrast-enhancing brain magnetic resonance imaging (MRI) showed a 3.8x2.9x2.9 cm mass overlying clivus with dural tail sign (arrow head). (B) Abduction of both eyes recovered after treatment and MRI showed the mass in the clivus area was remarkably smaller. (C) Histologic features of the lesion revealed fibro-connective tissue with mixed inflammation containing predominantly plasma cells and immunochemical analysis revealed an increased number of IgG4-positive plasma cells (x200). (D, E) Serum levels of IgG and IgG4 (D) and T cell-released INF-gamma in TB-IGRA (E) of the patient during the follow-up.
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On examination, the patient had bitemporal hemianopsia and limited abduction of both eyes (Figure 1A, upper). Contrast-enhancing MRI showed a 3.8x2.9x2.9 cm mass overlying clivus with dural tail sign (Figure 1A, lower). Immunostaining showed increased number of IgG4-positive plasma cells (>200/HPF) and elevated ratio of IgG4-positive cells to CD138-positive cells (approximately 55%, Figure 1C). In a follow-up of 3 months, he had attenuated bitemporal hemianopsia and better abduction of both eyes, and MRI showed the clivus mass shrank remarkably (Figure 1B). IgG consecutively decreased to 8g/L and became stable, while IgG4 level decreased to between 0.4-0.6 g/L along 9 months follow-up (Figure 1D). In addition, the patient did not complain any TB related syndromes and the IFN-gamma level in the TB-IGRA test decreased gradually (Figure 1E). We performed an additional retrospective study to explore the frequency of TB infection in IgG4-RD patients at our institute (Supplementary Figure S1). In 17/47 (36.2%) patient with IgG4-RD, a TB disease (positive signs of TB disease symptoms and chest computed tomography and positive TB tests) or LTBI diagnosis (negative signs of TB diseases and chest computed tomography (CT), M. tb was not isolated from a clinical specimen, but positive TB-IGRA and/or TST) was present (Supplementary Figure S1).