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Images in Thorax
Pulmonary inflammatory myofibroblastic tumour and IgG4-related disease presenting with lower limb paralysis
  1. Shuo Zhang1,
  2. Shangzhu Zhang1,
  3. Wen Zhang1,
  4. Jia He2,
  5. Juhong Shi3,
  6. Xiaofeng Zeng1
  1. 1 Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  2. 2 Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  3. 3 Department of Respiratory Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  1. Correspondence to Dr Shangzhu Zhang, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; irenezhangpumch{at}sina.com

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Case presentation

A 40-year-old man presented with numbness of the lower limbs and pain in the lower back for 11 months. Abdominal CT revealed multiple retroperitoneal masses around the left renal hilus and abdominal aorta. Over the subsequent 4 months, the lesions progressed, resulting in hydronephrosis of the left kidney and bone destruction in the L2 vertebral body (figure 1). Three biopsies (two from the L2 vertebral body and one from the retroperitoneal mass) had been previously taken at another hospital. Pathological examination of all three biopsies had resulted in a diagnosis of IgG4-related disease (IgG4-RD) (figure 2). He had been taking a moderate dose of methylprednisolone (20 mg/day) for 4 months. Chest CT revealed a nodule in the apical segment of the right lung, 7 months after initial presentation. His symptoms did not improve on treatment with steroids. By 9 months after presentation, the patient had developed paralysis, hypoaesthesia, numbness and pain in both lower limbs. Intravenous methylprednisolone (250 mg/day) …

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