Carotid aneurism with acute dissection: an unusual case of IgG4-related diseases

Cardiovasc Pathol. 2016 Jan-Feb;25(1):59-62. doi: 10.1016/j.carpath.2015.08.006. Epub 2015 Aug 22.

Abstract

Aim: IgG4-related disease is a systemic disease that involves organs and vascular structures, in particular, the aorta. This is the first case that showed the carotid artery involvement with dissection evolution.

Methods and results: In a 67-year-old man with speech impairment and right-hand clumsiness, a brain computed tomography revealed signs of acute ischemia in the left frontal lobe while an echo-color Doppler sonography of the cervical vessels showed a tight stenosis of left internal carotid artery with a large pseudoaneurysm. Histological findings performed on the surgical specimen disclosed IgG4-related disease.

Conclusions: To the best of our knowledge, this is the first manifestation of IgG4-related disease with carotid artery dissection complicated by pseudoaneurysm. Even though unsuccessful since the patients died within 48 h, this case highlights the diverse facets of the IgG4-related disease representing a new complication with important clinical implications of such a diagnosis targeting immunosuppressive therapy particularly B-cell depletion.

Keywords: Carotid dissection; IgG4-related disease.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aneurysm, False / immunology*
  • Aneurysm, False / pathology
  • Aneurysm, False / surgery
  • Aortic Dissection / immunology*
  • Aortic Dissection / pathology
  • Aortic Dissection / surgery
  • Biomarkers / analysis
  • Biopsy
  • Carotid Artery Diseases / immunology*
  • Carotid Artery Diseases / pathology
  • Carotid Artery Diseases / surgery
  • Carotid Artery, Internal / immunology*
  • Carotid Artery, Internal / pathology
  • Carotid Artery, Internal / surgery
  • Fatal Outcome
  • Humans
  • Immunoglobulin G / analysis*
  • Male
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography, Doppler, Color

Substances

  • Biomarkers
  • Immunoglobulin G