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Cler SJ, Ogden MA, Farrell NF, Roland LT, Diffie CE, Schneider JS. When inflammation is not just inflammation-A review of systemic diseases of the nose and sinuses part 1: IgG4-related disease and sarcoidosis. Am J Otolaryngol 2024; 45:104213. [PMID: 38237467 DOI: 10.1016/j.amjoto.2023.104213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND Chronic rhinosinusitis is a very common condition. IgG4-related disease (IgG4-RD) and sarcoidosis are systemic diseases which can contribute to the development of chronic rhinosinusitis in select patients. OBJECTIVE Characterize the presenting features, diagnostic criteria, workup, and management of sinonasal IgG4-RD and sarcoidosis as they are encountered in otolaryngology clinics. METHODS Full length manuscripts published 2000 or later were reviewed. A separate search was conducted for each disease. Pertinent clinical features related to sinonasal manifestations of IgG4-RD and sarcoidosis were collected and reported in this review. RESULTS 404 references were discovered during literature review process. In total, 42 references for IgG4-RD and 34 references for sarcoidosis were included in this review. CONCLUSION IgG4-RD and sarcoidosis are autoimmune inflammatory conditions that can affect many systems of the body. For both disease entities, sinonasal disease is a less common presentation which can lead to delayed diagnosis. Sinonasal IgG4-RD commonly presents in the setting of multisystem disease. All with other clinical features, biopsy plays a key role in the diagnosis for both diseases. Treatment for IgG4-RD consists primarily of steroids and rituximab which can lead to excellent and durable remission. A variety of immunosuppressive agents are used in the management of sarcoidosis. Surgery for IgG4-RD is primarily utilized for tissue biopsy, although resection or debulking may be considered. For sarcoidosis, surgery can be used for tissue biopsy and functional sinus surgery can offer symptomatic relief in many patients.
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Affiliation(s)
- Samuel J Cler
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America.
| | - M Allison Ogden
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
| | - Nyssa Fox Farrell
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
| | - Lauren T Roland
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
| | - Colin E Diffie
- Washington University in St. Louis School of Medicine, Department of Medicine, Division of Rheumatology, United States of America
| | - John S Schneider
- Washington University in St. Louis School of Medicine, Department of Otolaryngology, United States of America
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Cao C, Liang Q, Feng C, Guo S. IgG4-Related Disease Involving the Paranasal Sinus Orbit: A Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231193559. [PMID: 37596946 DOI: 10.1177/01455613231193559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a rare and complicated clinical disease entity newly identified in recent years. It is a chronic inflammatory disease mediated by the immune system that can affect various organs throughout the body, such as the pancreas, salivary gland (submandibular gland, parotid gland, and sublingual gland), lacrimal gland, and thyroid gland. In rare cases, it involves sinuses and orbits. We describe a 44-year-old patient who was hospitalized with distension and pain in her right eye. The lesions included the nasal sinus and orbit. IgG4-RD was diagnosed after surgery and the patient was treated without complications. This case report helps to provide clinicians with additional information to assist in the diagnosis of the disease.
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Affiliation(s)
- Changxing Cao
- Department of Otolaryngology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Qiulin Liang
- Department of Otolaryngology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Department of Otolaryngology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chao Feng
- Department of Otolaryngology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Shasha Guo
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
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Khoo V, Khoo HSJ, Goh LC. Nasolacrimal Duct Malignancy or IgG4- Related Disease? A Curious Case Report of a Nasal Vestibular Mass and Review of the Literature. Medeni Med J 2021; 36:281-286. [PMID: 34915688 PMCID: PMC8565585 DOI: 10.5222/mmj.2021.80445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition associated with tumefactive lesions at multiple sites. IgG4-RD was initially recognized in 2001 in a case of autoimmune pancreatitis. However, the disease was not limited to the pancreas but involved other organs such as the bile ducts, lacrimal glands, lymph nodes and salivary glands. IgG4-RD is rarely seen with an estimated incidence of 0.2 to 1/100.000 as reported in Japan, but with minimal to no incidence data have been published in Western countries. We hereby report a case of an IgG4-related mass arising from the nasolacrimal duct, masquerading as a sinonasal mass.
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Affiliation(s)
- Veejie Khoo
- Hospital Sultanah Aminah, Department of Otorhinolaryngology, Johor Bahru, Malaysia
| | | | - Liang Chye Goh
- Hospital Sultanah Aminah, Department of Otorhinolaryngology, Johor Bahru, Malaysia
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Wilson CP, Brownlee BP, El Rassi ET, McKinney KA. Sinonasal immunoglobin G4-related disease: case report and review. Clin Case Rep 2021; 9:e05095. [PMID: 34917361 PMCID: PMC8643486 DOI: 10.1002/ccr3.5095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/12/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
Immunoglobin G4-related disease (IgG4-RD) is a chronic fibro-inflammatory condition that presents as a single or multiple tumefactive lesions affecting virtually any organ system. Here we report a case of recurrent sinonasal IgG4-RD and review the literature of this evolving entity.
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Affiliation(s)
- Caleb P. Wilson
- Department of OtolaryngologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Benjamin P. Brownlee
- Department of OtolaryngologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Edward T. El Rassi
- Department of OtolaryngologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Kibwei A. McKinney
- Department of OtolaryngologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
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Sokol EV, Vasilyev VI, Palshina SG, Kokosadze NV, Probatova NA, Kovrigina AM, Safonova TN, Rodionova EB, Gaiduk IV, Selifanova EI. [Clinical and laboratory characteristics of IgG4-realated disease and its diagnostic algorithm]. TERAPEVT ARKH 2019; 91:40-48. [PMID: 32598675 DOI: 10.26442/00403660.2019.05.000236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 12/24/2022]
Abstract
AIM to propose diagnostic algorithm of IgG4-related disease (IgG4-RD). MATERIALS AND METHODS One center retrospective research. 52 pts with IgG4-RD were included. The diagnosis was proved histologically and immunohistochemically. 48 out of 52 pts received treatment. Treatment included one of the following schemes (along with low oral glucocorticoids): rituximab monotherapy, cyclophosphamide monotherapy or their combination. RESULTS The mean age was 47.4±5.9 years, the mean age of the disease onset was 43.9±16.0 years. Median time before the diagnosis was 24 months. The most often sites of IgG4-RD were lacrimal (63.5%), salivary (46.2%) glands, lungs (48%), lymph nodes (34.6%) and retroperitoneum (17.3%). In clinical picture the leading complain was organ enlargement, but not its dysfunction. Pain was characteristic for retroperitoneum localization. In 56.8% of pts with IgG4-related syalo - and/or dacryoadenitis there was association with ear - nose - throat organs affection. In 4 pts (7.7%) IgG4-RD was combined with some malignant disease, including MALT-lymphoma of lacrimal glands. Irreversible organ damage as an IgG4-RD outcome had 15.4% of pts. The main laboratory markers of IgG4-RD were ESR elevation (38.5%), blood eosinophilia (9.6%), immunological disturbances (serum total IgG and IgG4 elevation, IgE elevation, antinuclear antibodies, rheumatoid factor detection, hypocomplementemia). Serum IgG4 level >1.35 g/l was elevated in 88% of pts and correlated with the number of affected organs (Spearman correlation coefficient 0.39, Student's test, р=0.0056). Monoclonal serum secretion and B-cell clonality in the tissue was detected in 4 (23.5%) out of 17 pts, but not all of them had both signs. CONCLUSION Based on the analysis of clinical and laboratory characteristics of IgG4-RD a diagnostic algorithm was proposed that enhances the detection and examination of the patients with suspected IgG4-RD.
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Affiliation(s)
- E V Sokol
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - V I Vasilyev
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - S G Palshina
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - N V Kokosadze
- N.N. Blokhin National Medical Research Centre of Oncology" of the Health Ministry of Russia
| | - N A Probatova
- N.N. Blokhin National Medical Research Centre of Oncology" of the Health Ministry of Russia
| | | | | | - E B Rodionova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - I V Gaiduk
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - E I Selifanova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
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Singh AD, Soneja M, Memon SS, Vyas S. Interesting case of base of skull mass infiltrating cavernous sinuses. BMJ Case Rep 2016; 2016:bcr2016217669. [PMID: 27852681 PMCID: PMC5129029 DOI: 10.1136/bcr-2016-217669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 01/13/2023] Open
Abstract
A man aged 35 years presented with chronic headache and earache of 1-year duration. He had progressive vision loss and diplopia since last 9 months. He also had pain over the face and episodic profuse epistaxis. On examination, perception of light was absent in the right eye and hand movements were detected at 4 m distance in the left eye. Imaging revealed a lobulated mass in the nasopharynx extending into the bilateral cavernous sinuses and sphenoid sinus with bony erosions. Biopsy of the nasopharyngeal mass revealed pathological features which are characteristic of IgG4 disease. His serum IgG4 levels and acute inflammatory markers were also elevated. The patient was started on oral corticosteroid therapy. Fever, headache and earache resolved early and there was gradual improvement in the vision of the left eye. After 6 months, visual acuity in the left eye was 6/9, but right eye visual acuity had no change. Follow-up imaging revealed a significant reduction in the size of the mass.
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Affiliation(s)
- Achintya Dinesh Singh
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- All India Institute of Medical Sciences, New Delhi, India
| | - Saba Samad Memon
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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7
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Vandjelovic ND, Humphreys IM. Immunoglobulin G4-related sclerosing disease of the paranasal sinuses: A case report and literature review. ALLERGY & RHINOLOGY 2016; 7:85-9. [PMID: 27658185 PMCID: PMC5010438 DOI: 10.2500/ar.2016.7.0154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Immunoglobulin G4 (IgG4) related sclerosing disease (RSD) of the paranasal sinuses is a rare lesion of dense lymphoplasmacytic tissue, with a high proportion of IgG4+ plasma cells. We presented a rare case of IgG4-RSD with isolated involvement of the paranasal sinuses in the absence of multiorgan involvement. Methods: A case report and comprehensive literature review. Results: To our knowledge, only 11 cases of IgG4-RSD with paranasal sinus involvement have been reported. Patients with IgG4-RSD commonly present with epistaxis and symptoms that mimic chronic rhinosinusitis, e.g., rhinorrhea, nasal obstruction, and facial pressure. On imaging, an expansive and erosive process is described. Surgery provides tissue for immunohistologic evaluation; however, there is a paucity of evidence about the direct extent of surgical resection or medical therapies. Postoperative steroids were typically started, although the regimen was not standardized. Conclusion: Few cases of paranasal sinus IgG4-RSD have been reported in the literature. Evidence-based recommendations regarding treatment and surveillance of paranasal sinus IgG4-RSD are lacking; however, most reports describe systemic steroids as the mainstay of treatment. This single subject analysis, with a review of previously reported cases adds to the expanding body of data related to this rare disorder.
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Affiliation(s)
- Nathan D Vandjelovic
- 1Department of Otolaryngology-Head and Neck Surgery, Michigan State University, Detroit Medical Center, Detroit, Michigan, USA
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Song BH, Baiyee D, Liang J. A rare and emerging entity: Sinonasal IgG4-related sclerosing disease. ALLERGY & RHINOLOGY 2015; 6:151-7. [PMID: 26686205 PMCID: PMC5391482 DOI: 10.2500/ar.2015.6.0136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immunoglobulin G4 (IgG4) related sclerosing disease (rSD) is a new disease entity, first described in 2001, that involves autoimmune pancreatitis. Considered a systemic disease with lesions described in multiple organ systems, IgG4-rSD that affects the sinonasal region is rare. Our goal was to highlight the sinonasal presentation of this unique disease and to review previously reported adult cases from 2003 to 2014. METHODS Case report (a 72-year-old man who presented with left exophthalmos, periorbital pain, and epiphora) and review of the literature. RESULTS Radiographic workup with computed tomography and magnetic resonance imaging demonstrated a left sinonasal mass that involved the left maxillary and ethmoid sinuses, with surrounding bony destruction and orbital invasion. Nasal endoscopy demonstrated a fibrous lesion emanating in the middle meatus, with surrounding mucosal inflammation. The patient underwent an endoscopic biopsy, medial maxillectomy, and ethmoidectomy with tumor debulking. Pathology demonstrated inflamed respiratory mucosa with dense lymphoplasmacytic infiltrate and fibrosis; flow cytometry demonstrated no malignant cell populations; immunophenotyping demonstrated multiple foci of IgG4 cells. Plasma IgG4 was elevated in the setting of normal total IgG. The patient was treated with postoperative systemic and topical corticosteroids. Surveillance imaging studies and nasal endoscopy demonstrated disease resolution without recurrence. CONCLUSIONS Sinonasal IgG4-rSD is a rare disease that can present with bony and soft-tissue invasion. This was an exceptional case, with osseous involvement and orbital invasion. Immunohistologic workup is essential for diagnosis. It is important to differentiate this disease from sinonasal tumors. Treatment includes corticosteroids and surgical debulking. Sinonasal IgG4-rSD represents an emerging disease that may present challenges for future rhinologists.
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Affiliation(s)
- Brian H Song
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
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9
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Highstein MJ, Mallen J, Tham T, Brennan T, Boubour A, Opher E, Wolf V, Singh P, Costantino P. Probable Immunoglobulin Subtype-G4-Related Disease in the Head and Neck from Foreign Body Injection: A Case Report. J Neurol Surg Rep 2015; 76:e265-9. [PMID: 26623239 PMCID: PMC4648737 DOI: 10.1055/s-0035-1564602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/10/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Immunoglobulin subtype G4-related disease (IgG4-RD) is a fibroinflammatory disease of unknown etiology, with manifestations involving nearly every organ system. Its association with foreign bodies is not established. Here, we present a novel case of IgG4-RD in response to foreign body injection. Case Description A 58-year-old woman presented with history of persistent left facial pain, xerophthalmia, blurred vision, and trismus. The patient's medical history was significant for left-sided temporomandibular joint (TMJ) reconstruction with silicone injection into the joint. Magnetic resonance imaging revealed a lesion in the left skull base. Biopsies demonstrated the cardinal histopathological features of IgG4-RD. The patient was treated with a tapering dose of prednisolone followed by rituximab, resulting in tumor shrinkage and resolution of her symptoms. Discussion This is the first reported case of IgG4-RD potentially precipitated by a foreign body, in this case injected silicone into the TMJ. The pathogenesis and etiology of IgG4-RD is still not fully elucidated, but allergic and reactive inflammatory reactions have been implicated in the disease process. This case report should raise the idea of reactive foreign bodies as a causative agent for IgG4-RD.
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Affiliation(s)
| | - Jonathan Mallen
- Hofstra North Shore, LIJ School of Medicine, Hempstead, New York, United States
| | - Tristan Tham
- New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States
| | - Tara Brennan
- New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States
| | - Alexandra Boubour
- New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States
| | - Elena Opher
- Lenox Hill Hospital, Department of Pathology, North Shore, LIJ Healthy System, New York, New York, United States
| | - Vira Wolf
- Lenox Hill Hospital, Department of Pathology, North Shore, LIJ Healthy System, New York, New York, United States
| | - Prabhjyot Singh
- New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States
| | - Peter Costantino
- New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States
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Kurien R, Babu TR, Rupa V. Unusual cause of maxillary sinus mass with proptosis. BMJ Case Rep 2015; 2015:bcr-2015-210627. [PMID: 26392443 DOI: 10.1136/bcr-2015-210627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We report a case of a 21-year-old Indian man with an 8-month history of left-sided headache, maxillary sinus mass, proptosis and swelling of the left temple, whose contrast-enhanced CT scans of the paranasal sinuses showed an enhancing, destructive soft tissue mass involving the left maxillary sinus, orbit, infratemporal fossa and anterior cranial fossa, suggestive of a malignancy or chronic granulomatous disease. Histopathological examination of the sinus mass, which was debulked and partially excised via an endoscopic approach, suggested a diagnosis of immunoglobulin G4-related sclerosing disease of the maxillary sinus. Subsequent immunohistochemical staining and biochemical tests confirmed the diagnosis. We highlight the importance of considering this increasingly recognised but rare entity that can mimic a malignant lesion with its clinical and radiological features but which, unlike the latter, has a very good prognosis with appropriate treatment.
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Affiliation(s)
- Regi Kurien
- Department of ENT-3, Christian Medical College, Vellore, Tamil Nadu, India
| | - Telugu Ramesh Babu
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vedantam Rupa
- Department of ENT-3, Christian Medical College, Vellore, Tamil Nadu, India
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11
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Guo Y, Ansdell D, Brouha S, Yen A. Coronary periarteritis in a patient with multi-organ IgG4-related disease. J Radiol Case Rep 2015; 9:1-17. [PMID: 25926916 DOI: 10.3941/jrcr.v9i1.1967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Immunoglobulin G4-related disease is a recently described systemic clinicopathological entity characterized by immunoglobulin G4-producing plasmacytic infiltration of tissue and frequently by elevated serum immunoglobulin G4 concentration. Manifestations of this disease have been documented in nearly all organs and locations, but coronary artery involvement is not widely recognized. We report the coronary findings of a patient with multi-organ immunoglobulin G4-related disease. Non-electrocardiogram-gated computed tomography of the chest demonstrated nodular and rind-like periarterial soft tissue thickening along the proximal coronary artery segments with improvement following steroid therapy.
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Affiliation(s)
- Yueyang Guo
- School of Medicine, UC San Diego, San Diego, CA, USA
| | - David Ansdell
- Department of Radiology, UC San Diego Health System, San Diego, CA, USA
| | - Sharon Brouha
- Department of Radiology, UC San Diego Health System, San Diego, CA, USA
| | - Andrew Yen
- Department of Radiology, UC San Diego Health System, San Diego, CA, USA
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12
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Laco J, Kamarádová K, Mottl R, Mottlová A, Doležalová H, Tuček L, Žatečková K, Slezák R, Ryška A. Plasma cell granuloma of the oral cavity: a mucosal manifestation of immunoglobulin G4-related disease or a mimic? Virchows Arch 2014; 466:255-63. [PMID: 25522952 DOI: 10.1007/s00428-014-1711-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/23/2014] [Accepted: 12/09/2014] [Indexed: 12/23/2022]
Abstract
The aim of the study was to test the hypothesis that oral plasma cell granuloma may represent a mucosal manifestation of immunoglobulin (Ig)G4-related disease (IgG4-RD) in the oral cavity. The study sample comprised two males and four females, aged 54-79 years (median 62 years). The lesions were localized on gingival/alveolar mucosa (four cases), hard palate, and floor of the mouth, measuring 17-40 mm (median 31 mm). The duration of the lesions ranged from 3 months to several years. Information on IgG4 serum levels was available for two patients, and these were increased to 1.85 and 1.65 g/L, respectively. The follow-up period ranged 11-30 months (median 13 months). None of the lesions recurred, and none of the patients developed any manifestation of IgG4-RD. Microscopically, all cases presented as nodular lesions composed of numerous polyclonal plasma cells admixed with lymphocytes, histiocytes, mast cells, and eosinophils, set within collagenized stroma in variable proportions. Obliterative phlebitis was observed in two cases. The number of IgG4-positive plasma cells ranged between 51 and 142 per HPF (median 114), while the IgG4/IgG ratio values ranged between 0.16 and 0.72 (median 0.44) and were above 0.40 in three cases. Based on international criteria, two cases were diagnosed as definite and one as probable IgG4-RD. Oral plasma cell granuloma is a heterogeneous group of lesions, and a subset may represent a mucosal manifestation of IgG4-RD in the oral cavity.
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Affiliation(s)
- Jan Laco
- The Fingerland Department of Pathology, Charles University in Prague-Faculty of Medicine and University Hospital in Hradec Kralove, Sokolska 581, 500 05, Hradec Kralove, Czech Republic,
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13
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Wu A, Andrew NH, Tsirbas A, Tan P, Gajdatsy A, Selva D. Rituximab for the treatment of IgG4-related orbital disease: experience from five cases. Eye (Lond) 2014; 29:122-8. [PMID: 25341435 DOI: 10.1038/eye.2014.251] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/22/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To review the clinical efficacy and safety of rituximab for treatment of IgG4-related orbital disease (IgG4-ROD). DESIGN Retrospective multicentre interventional case series. METHODS Chart review for five cases of biopsy-confirmed IgG4-ROD (IgG4+>10/HPF, ratio of IgG4+/IgG+>40%) treated with rituximab. Information retrieved included the dosing schedule, adverse events and the magnitude, temporality, and duration of the clinical response. RESULTS All cases of IgG4-ROD were either steroid dependent or steroid resistant. Rituximab doses for induction therapy included two doses of 1000 mg at 2-weekly intervals, and four doses at 375 mg/m(2) at weekly intervals. Two months after starting rituximab, three cases achieved complete clinical resolution and two cases achieved partial clinical resolution. Complete radiological resolution occurred in one case, and partial radiological resolution in three cases. Three cases received rituximab maintenance therapy and one case was commenced on mycophenolate. No relapse occurred during a mean follow-up of 33 months (range: 7-65 months). One disease relapse occurred when the dosing interval of rituximab maintenance therapy was extended to 6-monthly intervals; remission was swiftly achieved with rituximab reinduction therapy. The only adverse effects reported were one episode of fatigue lasting 1 week and two episodes of orbital discomfort. CONCLUSION Rituximab may be an effective treatment option for IgG4-ROD that is steroid dependent or steroid intolerant. Rituximab therapy resulted in swift clinical and radiological improvement, many months free of relapse, and few side effects.
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Affiliation(s)
- A Wu
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - N H Andrew
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - A Tsirbas
- Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - P Tan
- Lions Eye Institute, Perth, Western Australia, Australia
| | - A Gajdatsy
- Lions Eye Institute, Perth, Western Australia, Australia
| | - D Selva
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
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14
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Prabhu SM, Yadav V, Irodi A, Mani S, Varghese AM. IgG4-related disease with sinonasal involvement: A case series. Indian J Radiol Imaging 2014; 24:117-20. [PMID: 25024517 PMCID: PMC4094959 DOI: 10.4103/0971-3026.134384] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the imaging findings in two cases of IgG4-related disease involving the sinonasal region in the pediatric age group. Imaging findings in IgG4-related disease affecting the nasal cavity and paranasal sinuses have been rarely reported in literature. The diagnosis is made by a combination of clinical, imaging, and histopathologic findings. Radiologists should be aware of the imaging findings of this condition to ensure early diagnosis and treatment.
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Affiliation(s)
- Shailesh M Prabhu
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vikas Yadav
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajoy Mathew Varghese
- Department of Oto-Rhino-Laryngology, Christian Medical College, Vellore, Tamil Nadu, India
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Mathew V, Ashish G, Tyagi AK, Job AK, Chandrasekharan R. Isolated IgG4-related Disease of Sphenoid Sinus Manifesting as Blindness. ACTA ACUST UNITED AC 2014. [DOI: 10.5005/aijoc-6-3-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Introduction
IgG4 related disease is a rare entity which can affect almost all parts of the body. The available literature of this entity related to paranasal sinuses is very limited.
Presentation of case
We present a case of isolated sphenoid sinus affliction by IgG4 related sclerosing disease manifesting as blindness, which recovered fully with pulsed steroid therapy.
Discussion
We present this case in view of developing insights toward diagnosis and management of IgG4 related sclerosing disease in paranasal sinuses, specifically the sphenoid sinus.
Conclusion
IgG4 disease involving paranasal sinuses (PNS) is rare entity and is managed with pulse methylprednisolone and immunomodulator drugs. Considering the limit of understanding of etiopathogenesis of this disease, surgeon needs to keep this differential diagnosis in mind. It may present atypically like isolated sinus involvement and optic neuritis.
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Hu EK, Parrish C, Wrobel B, Deshpande V, Stone JH. Immunoglobulin G4-related disease presenting as an ethmoid and maxillary mass. Ann Allergy Asthma Immunol 2013; 111:75-7. [PMID: 23806471 DOI: 10.1016/j.anai.2013.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/07/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
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