Objective To report the clinical and imaging characteristics of a case with the clinical manifestation of multiple lung and liver nodules, diagnosed as IgG₄-related hepatic inflammatory pseudotumor (HIPT) complicated by hepatic tissue-infection, and review the literature in order to facilitate clinical diagnosis and differential identification of IgG₄-related HIPT. Methods A retrospective analysis was conducted on the medical records of a patient with IgG₄-related disease (IgG₄-RD) characterized by multiple lung and liver nodules. A literature review was performed by searching Chinese and English databases to summarize the clinical and imaging characteristics of IgG₄-related HIPT and hepatic tissue infection. Results The case involved a 64-year-old female admitted to the Rheumatology and Immunology Department of the First Medical Center of Chinese PLA General Hospital due to "poor appetite and fatigue for over a year, and dry cough for four months". She presented with multiple nodules in the lungs and liver, without involvement of the eyelids, salivary glands, submandibular glands, or pancreas. Laboratory test results revealed elevated serum IgG₄ levels at 14.1 g/L and C-reactive protein (CRP) at 82.1 mg/L. Pulmonary CT scans indicated multiple solid nodules in both lungs with clear boundaries. Abdominal contrast-enhanced MRI revealed a nodule in liver segment S7 with a pseudocapsule around it, clear boundaries, and uniform enhancement; another nodule in liver segment S5 with blurred boundaries and ring enhancement. The final diagnosis of the liver nodules was confirmed by pathological and metagenomic sequencing to be an IgG₄-related HIPT in segment S7 and hepatic tissue infection in segment S5. After a full course of anti-infection and treatment with methylprednisolone and leflunomide, follow-up imaging showed near-complete resolution of the lung and liver nodules. Literatures were searched in China National Knowledge Infrastructure (CNKI), Wanfang, and PubMed databases (up to September 2023), and no case of IgG₄-RD complicated with both liver involvement and infection was found. A total of 26 cases of IgG₄-RD involving the liver have been reported so far, predominantly in males (92.3%), with an average age of 51 years. Most patients presented with abnormal liver function as the initial symptom, with normal blood inflammatory markers. Imaging typically shows a single nodule in 88.5% of cases, with clear boundaries and uniform enhancement, as well as ring enhancement. Concurrent involvement of the pancreas and biliary tract is common. Pathology is the gold standard for confirming the disease. Conclusions This case reports coexistence of IgG₄-related HIPT and infection within multiple hepatic nodules. In the diagnosis and treatment of patients with IgG₄-RD presenting with multiple hepatic nodules, if the imaging characteristics of the nodules are inconsistent, it is necessary to consider the possibility of the underlying disease coexisting with other conditions, which can be easily misdiagnosed. Actively obtaining pathological tissue is crucial for aiding in the definitive diagnosis.