IgG4-related disease presenting as an omental mass

A woman in her late 20s presented with severe subacute right-sided abdominal pain. Laboratory investigations revealed elevated inflammatory markers and normal serum IgG4 levels. Abdominal and pelvic CT revealed an omental lesion, with inflammatory stranding along the right paracolic gutter. Colonoscopy revealed an inflamed right colon with no specific lesions. Right colonic and omental biopsies showed inflammatory changes with a prominent plasma cell infiltrate in the omental mass, with IgG4-positive plasma cells on immunohistochemistry (IgG4:IgG ratio 40%–50%), but no storiform fibrosis or venulitis. After considering an extensive differential diagnosis, these findings were most consistent with IgG4-related disease (IgG4-RD). The patient responded to high-dose glucocorticoids but was unable to taper it below 10 mg/day. She received rituximab with complete resolution of symptoms and almost radiographic improvement.

Intraperitoneal and omental tumoral manifestations of IgG4-RD are rare.