Integrated therapy reduces serum IgG4 in patients with IgG4-related sclerosing mesenteritis: A Case Report.

Objectives: To evaluate the potential effectiveness of Chinese herbal medicine (CHM) as an adjunct to conventional corticosteroid therapy in the management of IgG4-related sclerosing mesenteritis.

Clinical features and outcome: A 61-year-old male presented with a two-month history of persistent diarrhea, anorexia, postprandial bloating, and significant weight loss. Diagnostic evaluation, including serum IgG4 measurement and tissue biopsy, confirmed a diagnosis of IgG4-related sclerosing mesenteritis. Despite initial treatment with oral corticosteroids, the patient's serum IgG4 level increased from 1080 mg/dL to 1240 mg/dL, prompting the initiation of integrated therapy with CHM. The patient was treated with a modified CHM regimen primarily composed of San-Tsung-Kuei-Chien-Tang, Zhen-Ren-Huo-Ming-Yin, Wen-Dan-Tang, and Zhu-Ling-Tang. At 217 days after starting CHM, serum IgG4 levels decreased to 606 mg/dL, with marked clinical improvement. Continued CHM therapy further reduced the serum IgG4 concentration to 68 mg/dL, and clinical symptoms remained well controlled without recurrence.

Conclusions: Integrated therapy combining CHM with corticosteroid treatment may effectively lower serum IgG4 levels and ameliorate clinical symptoms in IgG4-related sclerosing mesenteritis. Further research is warranted to confirm these findings and clarify the underlying mechanisms.