Treatment of Leg Ulcers Accompanied by Chronic Venous Insufficiency and Lymphedema Caused by IgG4-Related Disease

IgG4-related disease is a multi-organ immune-medicated condition that mimics malignancies, infections, and inflammatory disorders. This report presents the case of a 62-year-old man with a history of repeated cellulitis and ulcers on his lower extremities who was diagnosed incidentally with IgG4-related disease during treatment. The patient's unhealed ulcer was initially treated by debridement and aseptic dressing several times, but the wounds showed no improvement. Lower extremity venous ultrasound revealed unusually enlarged LN around the great saphenous vein (GSV) near the inguinal area and severe varicosity in both truncal veins. Lymphoscintigraphy was performed according to the ultrasound results, which showed secondary lymphedema in both legs. IgG4-released disease was diagnosed in an excisional biopsy of the lymph node near the great saphenous vein during stripping and ligation of the truncal vein. After continuous wound debridement and the administration of steroids and immunosuppressants, the patient's leg ulcer improved after approximately three months.