SHM Converge Scientific Abstract ePoster Gallery-Persistent Adenopathy Unmasking Igg4-Related Disease in a Patient With Staph Aureus Bacteremia

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An 81-year-old man with diabetes, hypertension, and autoimmune sclerosing pancreatitis presented with acute painful right neck swelling, low-grade fever, anemia, kidney dysfunction, elevated CRP, and decreased breath sounds on the right. Imaging showed generalized lymphadenopathy, bilateral lung consolidation, and a right pleural effusion. Pleural fluid was a lymphocyte-predominant exudate, and both blood and pleural cultures grew MSSA, indicating disseminated staphylococcal infection with bacteremia, lymphadenitis, and infected hemorrhagic pleural effusion. He was treated with antibiotics and pleural drainage.<br /><br />Despite appropriate antimicrobial therapy, his adenopathy persisted. Workup for other causes was negative: AFB testing did not show mycobacteria, and fine-needle aspiration and bone marrow biopsy were negative for malignancy. Given his prior autoimmune pancreatitis, polyclonal gammopathy, and markedly elevated serum IgG4, clinicians suspected IgG4-related disease. Lymph node biopsy confirmed the diagnosis, showing CD138-positive plasma cell infiltrates, storiform fibrosis, and an elevated IgG4/IgG ratio.<br /><br />He improved after starting high-dose prednisone and was discharged on a taper.<br /><br />The case highlights that persistent lymphadenopathy should not be attributed solely to infection when it fails to improve with treatment. Infectious and immune-mediated disease can coexist, and IgG4-related disease should be considered, especially in patients with compatible history and biopsy findings.

Asset Subtitle

Harleen K. Sidhu

Meta Tag

Author List Adithan Ganesh, Harleen K. Sidhu, Jair Basantes, Mohamed Abdelghffar, Shakthi Raman

Category Clinical Vignettes

Concept Generalized lymphadenopathy

Concept IgG4-Related Disease

Concept Infection

Concept Malignancy

Concept Persistent Lymphadenopathy

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Harleen K. Sidhu

Track Adult

Keywords

IgG4-related disease

disseminated staphylococcal infection

lymphadenopathy

autoimmune sclerosing pancreatitis

MSSA bacteremia

pleural effusion

lymph node biopsy

polyclonal gammopathy

prednisone therapy

storiform fibrosis

Generalized lymphadenopathy

IgG4-Related Disease

Infection

Malignancy

Persistent Lymphadenopathy