A Case of IgG4-related Sclerosing Mesenteritis Causing Intestinal Perforation

Abstract

A 74-year-old woman presented with a 3-month history of intermittent vomiting and abdominal distension. She was admitted to our hospital due to persistent abdominal pain. Abdominal CT showed free intraperitoneal gas and multiple enlarged mesenteric lymph nodes, with a fluid collection close to the extended jejunum. Emergency surgery was performed on the same day with a diagnosis of intestinal perforation due to malignant lymphoma. Histologic examination showed lymphoplasmacytic sclerosing mesenteritis with significant infiltration of IgG4-positive plasma cells. Her serum IgG4 level was 726 mg/dl. The findings of histological and serum studies were compatible with IgG4-related sclerosing mesenteritis. The patient was discharged without complications and started on steroid therapy as an outpatient. This relatively rare case is reported with a review of the literature.