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Stuchfield-Denby E, De Sainte Marie B, Hie M, Hatchuel Y, Gerber A, Bencheikh S, Pugnet G, Groh M, Farhat MM, Urbina D, Ebbo M, Schleinitz N. IgG4-related uveitis. A French cohort and literature review. Semin Arthritis Rheum 2024; 64:152278. [PMID: 38000318 DOI: 10.1016/j.semarthrit.2023.152278] [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: 06/12/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION IgG4-related disease (IgG4-RD) is a fibro-inflammatory disorder that can affect almost any organ. IgG4-related ophthalmic disease is a protean condition involving the orbit and ocular adnexa. Although a few cases of uveitis have been reported, the exact pattern of IgG4-related intraocular manifestations remains unclear. Here, we report on a nationwide French multicenter cohort of patients with IgG4-RD and uveitis and conducted a literature review. METHODS Patients with uveitis and a concomitant definite diagnosis of IgG4-RD (Revised Comprehensive Diagnostic criteria, American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-RD, International Consensus Diagnostic Criteria for auto-immune pancreatitis, or diagnostic criteria for IgG4-related hypophysitis), were screened from our national IgG4-RD and systemic fibrosis database. Concomitantly, we conducted a PubMed literature review and selected cases of definite IgG4-RD with uveitis. RESULTS We reported on 16 patients (8 from our database and 8 from the literature) and a total of 30 episodes of uveitis. Uveitis cases represented 3 % of total IgG4-RD patients in the national database on IgG4-RD and systemic fibrosis. Uveitis was inaugural in IgG4-RD in 4/16 cases (25 %) (appearing before any other IgG4-related symptom, at a median of 9 months), occurred concurrently to other IgG4-related symptoms in 9/16 cases (56 %) (at a median of 15 months before IgG4-RD diagnosis), and appeared during follow up in 3/16 patients (19 %) (at a median of 57 months after first IgG4-related symptoms). When uveitis occurred during follow up, it was associated with IgG4-RD manifestations in other organs in 6/9 patients (67 %). Uveitis was bilateral in 8/16 cases (50 %) and granulomatous in 5/10 cases (50 %). It was anterior in 8/13 (62 %), intermediate in 3/13 (23 %), and global (panuveitis) in 4/13 patients (31 %). Median serum IgG4 at diagnosis was 3.2 g/L. Median follow up time was of 6 years, during which 8/16 patients (50 %) experienced at least one relapse of uveitis. Treatment data was available for 29/30 uveitis flares. Steroids were used in 28/29 episodes of uveitis (97 %), leading to remission of uveitis in 16/28 cases (57 %). Methotrexate and rituximab (in combination with systemic steroids) were administered as second- or third-line therapy in 6/29 (21 %) and 5/29 (17 %) episodes of uveitis, respectively, and led to remission of uveitis in 4/6 cases (67 %) and 4/5 cases (80 %), respectively. One third of uveitides required at least two different lines of treatment for remission induction (mainly a combination of both systemic steroids and methotrexate or rituximab). DISCUSSION AND CONCLUSIONS Uveitis may be one of the initial symptoms of IgG4-RD, and IgG4-RD should be considered in the diagnostic workup of uveitis. Its early onset in IgG4-RD may help with early diagnosis and treatment of the disease. Steroid monotherapy may be sufficient to treat IgG4-related uveitis, yet relapses were frequent (50 %) and ultimately a third of patients required at least two lines of treatment. Hence, steroid-sparing agents can be considered at early stages of the disease, particularly for patients with a high risk of relapse or steroid-related complications.
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Affiliation(s)
| | | | - Miguel Hie
- Medecine interne, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Hatchuel
- Pédiatrie, Hôpital Pierre Zobda-Quitman, CHU de Martinique, Fort de France, Martinique
| | - Anne Gerber
- Médecine interne, CHU Nord Félix Guyon, Saint-Denis, La Réunion, France
| | - Saliha Bencheikh
- Médecine interne, Centre Hospitalier de Perpignan, Perpignan, France
| | - Grégory Pugnet
- Service de Médecine Interne et Immunologie Clinique, CHU Rangueil, Toulouse, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Department of Internal Medicine, Foch Hospital, Suresnes, France, Univ. Lille, INSERM U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Meryem-Maud Farhat
- University Lille, Inserm, CHU de Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France
| | - Diego Urbina
- Service de médecine infantile, Hôpital Timone Enfants, Marseille, France
| | - Mikael Ebbo
- Médecine interne, Hôpital de la Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Nicolas Schleinitz
- Médecine interne, Hôpital de la Timone, AP-HM, Aix-Marseille Université, Marseille, France
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Ma J, Xie M, Long K, Deng M, Zhou L, Luo J. IgG4-related ophthalmic disease masquerading as ciliary body tumors and scleritis in both eyes: a case report. BMC Ophthalmol 2023; 23:92. [PMID: 36894878 PMCID: PMC9999535 DOI: 10.1186/s12886-023-02822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND To report a rare case of IgG4-related ophthalmic disease (IgG4-ROD) manifesting as intraocular masses and scleritis in both eyes in a 61-year-old male and to investigate the changes in multimodal imaging features of the lesion sites and helper T-cell type 1 (Th 1)/Th 2/Th 17 cytokine levels in the aqueous humor. CASE PRESENTATION A patient with IgG4-ROD seemingly manifested with an intraocular tumor in the left eye and sequentially, with an inflammatory mass in the ciliary body and scleritis in the right eye. The patient complained of vision loss of 6 months duration in the left eye at his first visit. With a preliminary diagnosis of an intraocular tumor, enucleation of the left eyeball and histopathological examination were performed. Approximately 3 months later, the patient started to experience headache, eye pain, and declining vision in the right eye. Ophthalmic imaging revealed a ciliary mass and scleritis. Th 1/Th 2/Th 17 cytokine levels and multimodal imaging findings were analyzed before and after corticosteroid treatment. Histopathological examination and immunohistochemistry (IHC) of the enucleated left eye demonstrated lymphoplasmacytic infiltration with an IgG4+/IgG+ cell ratio of approximately 40%, pointing to the diagnosis of probable IgG4-ROD. Long-term treatment with corticosteroids led to significant improvement in the signs and symptoms of the left eye. Th 1/Th 2/Th 17 cytokine profile monitoring of the aqueous humor and multimodal imaging of the right eye showed gradual regression of the mass and attenuation of ocular inflammation during treatment. CONCLUSIONS Patients with an atypical presentation of IgG4-ROD, such as intraocular masses and scleritis, are likely to experience a significant delay in diagnosis. This case demonstrates the significance of IgG4-ROD in the differential diagnosis of intraocular tumors and ocular inflammation. IgG4-RD is a newly diagnosed disease with multi-organ involvement and little is known about its pathogenesis, particularly in the eye. The present case will open new challenges in the clinico-pathological diagnosis and research of this disease. Combined investigations of multimodal imaging and cytokine level detection of intraocular fluid provide a new and effective way to monitor disease progression.
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Affiliation(s)
- Jiayue Ma
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Furong District, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Manyun Xie
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Furong District, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Kejun Long
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Furong District, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Mi Deng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Furong District, Changsha, 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Liang Zhou
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Furong District, Changsha, 410011, China. .,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China.
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, No. 139, Renmin Middle Road, Furong District, Changsha, 410011, China. .,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China.
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Ben Salah R, Kammoun S, Mefteh A, Frikha F, Rekik M, Trigui A, Bahloul Z. Orbital inflammatory pseudotumor revealing multi-organ immunoglobulin G4-related disease. Int J Rheum Dis 2023; 26:531-534. [PMID: 36445834 DOI: 10.1111/1756-185x.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
Relatively recently, the concept that immunoglobulin G4 (IgG4)-related disease is a distinct chronic inflammatory disorder rather than a subset of Sjögren's syndrome has been accepted. IgG4-related disease (IgG4-RD) is a fibro-inflammatory systemic immune-mediated condition that can affect the pancreas, salivary glands, and lymph nodes. Almost every organ may be impacted synchronously or metachronously by this illness, which causes the development of sclerotic masses of varying sizes. Numerous other rheumatic diseases can present with characteristics of IgG4-RD, making it difficult to distinguish between them. However, cases of IgG4-RD involving the bilateral orbits, and pancreas with biological abnormalities are rare. We present a case of an 18-year-old female with vitiligo since the age of 3 years who presented with acute pancreatitis and acalculous cholecystitis, bilateral orbital masses, palpebral edema, and eosinophilia. The patient was diagnosed with IgG4-RD in keeping with clinical presentation and the elevated serum IgG4 level and after elimination of other differential diagnoses. The patient's symptoms gradually relieved after glucocorticoid therapy. This case presents an uncommon combination of clinical features infrequently reported in the literature. Multi-organ IgG4-RD is a multisystemic mass, commonly creating diagnostic challenges for clinicians. Furthermore, and more importantly, it highlights the need to keep a differential of IgG4-RD in mind, to aid in the early and correct treatment of the disease.
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Affiliation(s)
- Raida Ben Salah
- Department of Internal Medicine, University of Sfax, Sfax, Tunisia
| | - Sonda Kammoun
- Department of Ophthalmology, University of Sfax, Sfax, Tunisia
| | - Ansar Mefteh
- Department of Internal Medicine, University of Sfax, Sfax, Tunisia
| | - Faten Frikha
- Department of Internal Medicine, University of Sfax, Sfax, Tunisia
| | - Mona Rekik
- Department of Ophthalmology, University of Sfax, Sfax, Tunisia
| | - Amira Trigui
- Department of Ophthalmology, University of Sfax, Sfax, Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine, University of Sfax, Sfax, Tunisia
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Fukushima A, Tabuchi H. A Case of Immunoglobulin G4-Related Scleritis and Pneumonia Initially Diagnosed as Eosinophilic Pneumonia. Cureus 2022; 14:e29725. [DOI: 10.7759/cureus.29725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
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Abstract
PURPOSE To report a case of IgG4-related ophthalmic disease, which presented with papillitis and subretinal deposits. METHODS Observational case report with multimodal imaging. RESULTS A 52-year-old man with a history of persistent lymphadenopathy presented with decreased vision in his left eye. Funduscopic examination demonstrated cuticular drusen in both eyes and florid edema of the left optic nerve, along with scattered circumscribed grey-yellow subretinal deposits that were distinct from the cuticular drusen. Swept-source optical coherence tomography demonstrated a hyper-reflective subretinal material corresponding to the grey-yellow subretinal deposits on clinical examination along with diffuse outer retinal disruption. Fundus autofluorescence revealed scattered hypoautofluorescence corresponding to cuticular drusen and also larger patches of hypoautofluorescence corresponding to the grey-yellow subretinal deposits. Fluorescein angiography demonstrated hypofluorescence corresponding to the large subretinal deposits and leakage at the optic nerve. Lymph node biopsy demonstrated IgG4-positive plasma cells and elevated serum IgG4 levels leading to a diagnosis of IgG4-related ophthalmic disease. The patient was treated with oral prednisone with subsequent resolution of the optic nerve edema. CONCLUSION We describe multimodal imaging of unique retinal and optic nerve findings associated with IgG4-related ophthalmic disease. Our report broadens the spectrum of ocular involvement associated with IgG4-related disease.
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Kim SJ, Lee SU, Kang MS, Ahn JH, Shin J, Park CY, Lee JE. IgG4-related disease presenting as recurrent scleritis combined with optic neuropathy. BMC Ophthalmol 2021; 21:5. [PMID: 33402162 PMCID: PMC7784029 DOI: 10.1186/s12886-020-01774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/16/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND We report a case of atypical presentation of IgG4-related disease (IgG4-RD) with recurrent scleritis and optic nerve involvement. CASE PRESENTATION A 61-year-old male presented with ocular pain and injection in his left eye for 2 months. Ocular examination together with ancillary testing led to the diagnosis of scleritis, which relapsed in spite of several courses of steroid treatment. After cessation of steroid, the patient complained of severe retro-orbital pain and blurred vision. His best corrected vision was count finger, the pupil was mid-dilated and a relative afferent pupillary defect was found. Funduscopic examination demonstrated disc swelling. Magnetic resonance imaging (MRI) showed enhancing soft tissue encasing the left globe, medial rectus muscle and optic nerve. Systemic work-up revealed multiple nodules in right lower lung and a biopsy showed histopathological characteristics of IgG4-RD. Long-term treatment with corticosteroids and a steroid-sparing agent (methotrexate) led to significant improvement in signs and symptoms with no recurrence for 2 years. CONCLUSIONS This case highlights the significance of IgG4-RD in the differential diagnosis of recurrent scleritis. IgG4-RD may cause optic neuropathy resulting in visual loss. Early diagnosis and proper treatment can prevent irreversible organ damage and devastating visual morbidity.
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Affiliation(s)
- Su Jin Kim
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seung Uk Lee
- Department of Ophthalmology, School of Medicine, Kosin University, #34 Amnam-dong, Seo-gu, Busan, 602-702, South Korea
| | - Min Seung Kang
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jung Hyo Ahn
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jonghoon Shin
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University Ilsan Hospital, #27 Dongguk-ro, Ilsandong-gu, Goyang, 10326, South Korea.,Sensory Organ Research Center, Dongguk University, Goyang, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea. .,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
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Image-Guided Intensity-Modulated Radiation Therapy for IgG4-Related Ophthalmic Disease. Case Rep Ophthalmol Med 2020; 2020:8873078. [PMID: 32963860 PMCID: PMC7492922 DOI: 10.1155/2020/8873078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background IgG4-related ophthalmic disease is a rare, newly recognized entity with high failure rates on first-line therapy of systemic corticosteroids and no other proven management options. Case Presentation. Here, we present the clinical course of a patient with IgG4 ophthalmic disease who achieved a favorable response from radiotherapy. Our patient initially presented with a history of recurrent painful flares of orbital inflammation, a pathologic diagnosis follicular lymphoid hyperplasia from a right lacrimal gland biopsy, and MRI imaging noting expansion of the lateral rectus muscle of the right eye. Initial treatment with dacryoadenectomy and multiple courses of corticosteroids failed to keep his symptoms at bay. Further evaluation revealed florid IgG4 staining. In this context, he was evaluated for image-guided intensity-modulated radiotherapy (IG-IMRT) to the orbit to 20 Gy in 10 fractions. His ophthalmic symptoms resolved. Conclusions This treatment experience suggests radiotherapy may be a favorable option for symptom relief in patients with IgG4-related ophthalmic disease not controlled by corticosteroids.
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Dong P, Wang L, Li L. Bilateral orbital involvement of IgG4-related disease detected on 18F-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography: A Clinical Case Report. Medicine (Baltimore) 2019; 98:e18138. [PMID: 31764855 PMCID: PMC6882616 DOI: 10.1097/md.0000000000018138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RATIONALE IgG4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory condition, which could involve multiple structures, including the pancreas, salivary glands, and lymph nodes. However, cases of IgG4-RD involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate are rare. PATIENT CONCERNS A 51-year-old man complaining of bilateral exophthalmos, reduced vision, and weight loss of 15 kg over 2 years presented to our department for evaluation. DIAGNOSES Based on the elevated serum IgG4 level, postoperative pathology, and the features of F-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT), which revealed diffuse increased FDG uptake in many structures, he was diagnosed with IgG4-related disease involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate. INTERVENTIONS Because of the significant bilateral proptosis and exposure keratoconjunctivitis in the right eye, bilateral soft-tissue masses located in the orbits were resected, and the patient was started on oral methylprednisolone with gradual tapering. OUTCOMES The patient's symptoms gradually relieved after the operation and glucocorticoid therapy. Four months later, cranial axial CT revealed remarkable narrowing of soft-tissue masses in the bilateral orbits, and his serum IgG4 level reduced sharply. LESSONS IgG4-RD should be considered in cases of diffuse FDG uptake in the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate on PET/CT.
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Affiliation(s)
| | - Li Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Lin Li
- Department of Nuclear Medicine
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Asproudis I, Kanari M, Ntountas I, Ragos V, Goussia A, Batistatou A, Voulgari PV. Successful treatment with rituximab of IgG4-related disease coexisting with adult-onset asthma and periocular xanthogranuloma. Rheumatol Int 2019; 40:671-677. [PMID: 31392499 DOI: 10.1007/s00296-019-04409-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022]
Abstract
Immunoglobulin G4-related disease (IgG4RD) is a systemic fibro-inflammatory disease of unknown aetiology, which is characterized by tumefactive lymphoplasmatocytic infiltrative lesions, with a predominance of IgG4 positive plasma cells, fibrosis and obliterative phlebitis. Adult-onset asthma and periocular xanthogranuloma (AAPOX) is a rare disease of unknown aetiology characterized by violaceous or yellow cutaneous papules and nodules usually accompanied with adult-onset asthma. We report a case of IgG4RD associated with AAPOX. We also conducted a literature search with keywords including IgG4RD and AAPOX. A 36-year-old woman presented with bilateral exophthalmos and periorbital oedema. Keratoconjunctivitis sicca, painless left parotid gland and submandibular left lymph node enlargement were also noted. Two and half years ago biopsy of yellow plaques of her right lower eyelid confirmed periorbital xanthogranuloma. She underwent parotid gland biopsy which showed IgG4RD. She was treated with steroids and two cycles of rituximab with complete remission. The literature review revealed 8 articles describing 14 cases with IgG4RD and AAPOX, 9 men and 5 women (ratio M:F = 1.8:1) were affected. The age at diagnosis was greater in men compared to women. In the majority of patients, ophthalmic presentation included bilateral upper and lower eyelid swelling while systemic features were asthma, lacrimal and parotid involvement, lymphadenopathy, sclerosing pancreatitis and sclerosing cholangitis. Prednisone and rituximab were effective treatments. It has to be clarified whether the association between IgG4RD and AAPOX represents shared pathophysiology, a common underlying cause or coincidence. Rituximab added to steroids resulted in complete remission of the two entities.
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Affiliation(s)
- Ioannis Asproudis
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
| | - Maria Kanari
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Ntountas
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Ragos
- Department of Oral and Maxillofacial Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - Anna Goussia
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Paraskevi Vasileios Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece.
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Vashi B, Khosroshahi A. IgG4-Related Disease with Emphasis on Its Gastrointestinal Manifestation. Gastroenterol Clin North Am 2019; 48:291-305. [PMID: 31046976 DOI: 10.1016/j.gtc.2019.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IgG4-related disease is an immune-mediated fibroinflammatory condition with a diverse spectrum of organ involvement, commonly in the pancreas and bile ducts among other organs such as salivary and lacrimal glands. Classic histopathologic findings are the gold standard for confirmation of diagnosis, although diagnosis remains challenging, as biomarkers to date are neither sufficient nor necessary. Glucocorticoids are the most effective initial treatment, generally having a dramatic response, although limited clinical evidence exists regarding effective maintenance therapy. This review summarizes key GI manifestations of this condition for the practicing gastroenterologist and addresses the pathology, disease mechanism, and current therapeutic recommendations.
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Affiliation(s)
- Bijal Vashi
- Department of Medicine, Emory University, 200 Whitehead Building, 615 Michael Street, Atlanta, GA 30322, USA
| | - Arezou Khosroshahi
- Department of Medicine, Emory University, 244 Whitehead Building, 615 Michael Street, Atlanta, GA 30322, USA.
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Nagpal SJS, Sharma A, Chari ST. Autoimmune Pancreatitis. Am J Gastroenterol 2018; 113:1301. [PMID: 29910463 DOI: 10.1038/s41395-018-0146-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
Over the course of the last 2 decades our knowledge of autoimmune pancreatitis has increased exponentially. In this review, we summarize the clinical presentation, diagnosis and treatment of AIP, to better allow general gastroenterologists and primary care providers to consider AIP as a as a rare but important cause of painless obstructive jaundice and recurrent acute pancreatitis. While steroids remain the mainstay of first line therapy, a number of patients with type 1 AIP require immunomodulators or rituximab to maintain remission; recommendations on the management of relapses continue to evolve.
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Affiliation(s)
| | - Ayush Sharma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Suresh T Chari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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13
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Infrequent organ involvement of IgG4-related diseases: a literature review. Clin Rheumatol 2018; 37:1153-1159. [PMID: 29502226 DOI: 10.1007/s10067-018-4048-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/30/2018] [Accepted: 02/19/2018] [Indexed: 01/28/2023]
Abstract
IgG4-related disease (IgG4-RD) is a chronic and systemic disease that can involve multiple organs. The most commonly involved organs include the salivary glands, orbital adnexal structures, paranasal sinus, thyroid, lungs, breasts, aorta, pancreas, biliary ducts, kidneys, retroperitoneum, lymph nodes, prostate, pituitary, and endocranium. Due to increased disease research, several new site-specific nuances of IgG4-RD have been described. The authors have reviewed the recent literature and briefly summarize the infrequent organ involvement of IgG4-RD.
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Bielefeld P, Saadoun D, Héron E, Abad S, Devilliers H, Deschasse C, Trad S, Sène D, Kaplanski G, Sève P. [Scleritis and systemic diseases: What should know the internist?]. Rev Med Interne 2018; 39:711-720. [PMID: 29496270 DOI: 10.1016/j.revmed.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/02/2018] [Indexed: 12/27/2022]
Abstract
Scleritis is an inflammatory disease of the sclera; outer tunic of the eye on which the oculomotor muscles are inserted. It can be associated with a systemic disease up to one time out of 3. These associated diseases are mainly rheumatoid arthritis, vasculitis, including granulomatosis with polyangiitis in the first line and spondyloarthropathies. Before mentioning such an etiology, it is necessary to eliminate an infectious cause, mainly herpetic, which is regularly underestimated. The classification of scleritis is clinical. We distinguish between anterior scleritis and posterior scleritis. Anterior scleritis is diffuse or nodular, usually of good prognosis. Anterior necrotizing scleritis with inflammation is often associated with an autoimmune disease, necrotizing scleritis without inflammation usually reflects advanced rheumatoid arthritis. The treatment of these conditions requires close collaboration between internists and ophthalmologists to decide on the use of corticosteroid therapy with or without immunosuppressors or biotherapies.
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Affiliation(s)
- P Bielefeld
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - D Saadoun
- Service de médecine interne, DHU I2B, inflammation, immunopathology, biotherapy, centre national de référence des maladies auto-immunes et systémiques rares, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie-Paris 6, AP-HP, 75013 Paris, France.
| | - E Héron
- Service de médecine interne, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex 12, France.
| | - S Abad
- Service de médecine interne, hôpital Avicenne, AP-HP, université Paris 13, Sorbonne Paris Cité, 93009 Bobigny cedex, France.
| | - H Devilliers
- Service de médecine interne et maladies systémiques, médecine interne 2, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - C Deschasse
- Service d'ophtalmologie, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, université de Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
| | - D Sène
- Service de médecine interne, GH Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisère, AP-HP, université Sorbonne Paris Cité Paris Diderot, 75475 Paris cedex 10, France.
| | - G Kaplanski
- Service de médecine interne et immunologie clinique, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - P Sève
- Service de médecine interne, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Université de Lyon, 69100 Lyon, France.
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Karim F, de Hoog J, Paridaens D, Verdijk R, Schreurs M, Rothova A, van Hagen M, van Laar J. IgG4-related disease as an emerging cause of scleritis. Acta Ophthalmol 2017; 95:e795-e796. [PMID: 28229544 DOI: 10.1111/aos.13376] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Faiz Karim
- Department of Internal Medicine; Section Clinical Immunology; Erasmus MC; Rotterdam The Netherlands
| | - Joeri de Hoog
- Department of Ophthalmology; Erasmus MC; Rotterdam The Netherlands
| | - Dion Paridaens
- Department of Orbital Surgery; The Rotterdam Eye Hospital; Rotterdam The Netherlands
| | - Rob Verdijk
- Department of Pathology; Section Ophthalmic Pathology; Erasmus MC; Rotterdam The Netherlands
| | - Marco Schreurs
- Department of Immunology; Erasmus MC; Rotterdam The Netherlands
| | - Aniki Rothova
- Department of Ophthalmology; Erasmus MC; Rotterdam The Netherlands
| | - Martin van Hagen
- Department of Internal Medicine; Section Clinical Immunology; Erasmus MC; Rotterdam The Netherlands
| | - Jan van Laar
- Department of Internal Medicine; Section Clinical Immunology; Erasmus MC; Rotterdam The Netherlands
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16
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17
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18
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Thompson A, Whyte A. Imaging of IgG4-related disease of the head and neck. Clin Radiol 2017; 73:106-120. [PMID: 28501095 DOI: 10.1016/j.crad.2017.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
IgG4-related disease is a systemic, inflammatory disorder typically involving multiple organ systems. Several eponymous conditions described previously in the clinical and radiology literature are now recognised to be part of the IgG4-related disease spectrum. This includes multiple manifestations in the head and neck region, which are the subject of this review. Imaging can occasionally suggest the specific diagnosis of IgG4 disease. More commonly, it will be included in a limited differential diagnosis that requires clarification with the aid of image-guided biopsy. There are strict histopathological criteria for the diagnosis of IgG4-related disease.
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Affiliation(s)
- A Thompson
- Neurological Intervention and Imaging Service Western Australia, Level 1, G Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Neurological Intervention and Imaging Service Western Australia, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia; Princess Margaret Hospital for Children, Roberts Road, Subiaco, WA 6008, Australia.
| | - A Whyte
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, WA 6008, Australia; School of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; Department of Medicine and Radiology, University of Melbourne, Parkville, VIC 3010, Australia
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19
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Haldar D, Cockwell P, Richter AG, Roberts KJ, Hirschfield GM. An overview of the diagnosis and management of immunoglobulin G4-related disease. CMAJ 2016; 188:953-961. [PMID: 27325130 PMCID: PMC5026513 DOI: 10.1503/cmaj.151402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Debashis Haldar
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Paul Cockwell
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Alex G Richter
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Keith J Roberts
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Gideon M Hirschfield
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
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20
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Goto H, Ueda S. Immunoglobulin G4-Related Ophthalmic Disease Involving the Sclera Misdiagnosed as Intraocular Tumor: Report of One Case. Ocul Oncol Pathol 2016; 2:285-288. [PMID: 27843911 DOI: 10.1159/000447405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/14/2016] [Indexed: 12/24/2022] Open
Abstract
AIMS Immunoglobulin G4 (IgG4)-related disease is known to have diverse clinical manifestations. We report a case of IgG4-related ophthalmic disease misdiagnosed as intraocular tumor. METHODS Case report. RESULTS A 41-year-old man was referred to our department with a diagnosis of intraocular tumor, presumably choroidal melanoma. Although MR imaging was compatible with choroidal melanoma, he had been observed periodically without treatment because fundus findings were not typical of melanoma and visual function was preserved. He was again referred to us 15 years later due to increased tumor size and visual field disturbance. Transscleral biopsy of the intraocular tumor was attempted to make a histopathological diagnosis. During the biopsy procedure, thick placoid tissue adhering to the sclera was found at a location consistent with the site of the elevated intraocular lesion. Histopathological examination of this extraocular material revealed proliferation of dense fibrous tissue with follicular proliferation of lymphocytes and plasmacytes. The plasmacytes were diffusely positive for IgG and IgG4. Serum IgG4 level was slightly elevated and no extraocular lesion was detected. Despite administration of systemic corticosteroids after biopsy, the intraocular mass was not reduced. Visual acuity of 20/20 has been maintained as of the last follow-up. CONCLUSION IgG4-related disease should be included in the differential diagnosis of intraocular elevated lesion.
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Affiliation(s)
- Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Shunichiro Ueda
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
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21
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Koenigstein D, Neudorfer M, Goldenberg D, Habot-Wilner Z. CHOROIDAL EFFUSION AS AN OCULAR MANIFESTATION OF IMMUNOGLOBULIN G4-RELATED DISEASE. Retin Cases Brief Rep 2016; 10:197-200. [PMID: 26484804 DOI: 10.1097/icb.0000000000000223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To report a unique ocular manifestation of immunoglobulin G4-related disease (IgG4-RD) as choroidal effusion. METHODS Case report. RESULTS An 81-year-old man presented with clinical manifestations of choroidal effusion, confirmed by fluorescein angiography, ophthalmic ultrasound (posterior segment), high-frequency ultrasound biomicroscopy, Heidelberg Spectralis spectral domain optical coherence tomography, and enhanced depth imaging spectral domain optical coherence tomography. Systemic multi-organ findings included chronic pancreatitis, irregularity of the intrahepatic bile ducts, lymphadenopathy, aortitis, fibrotic changes of the lungs, hypophysitis, and sialadenitis. Extensive workup revealed elevated IgG4 serum levels, and lymph nodes biopsy showed reactive pattern with polyclonal IgG4 positive plasma cells. These findings were compatible with IgG4-related disease. Treatment with oral corticosteroids resulted in complete resolution of the choroidal effusion. CONCLUSION Choroidal effusion may be an ocular manifestation of IgG4-related disease. Oral corticosteroids is an effective treatment. Ophthalmologists should be aware of this possible finding.
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Affiliation(s)
- Dvir Koenigstein
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Wu A, Andrew NH, McNab AA, Selva D. IgG4-Related Ophthalmic Disease: Pooling of Published Cases and Literature Review. Curr Allergy Asthma Rep 2015; 15:27. [PMID: 26141575 DOI: 10.1007/s11882-015-0530-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In recent years, IgG4-related ophthalmic disease (IgG4-ROD) has emerged as a common cause of orbital inflammation, accounting for a substantial proportion of idiopathic orbital inflammation and lymphoid hyperplasia. The last pooled analysis of published cases was conducted in 2012, but a large number of new cases have been added to the literature since then. In this review, we present the demographic, clinical, histological, and treatment data for 172 published cases of biopsy-confirmed IgG4-ROD. Results are accompanied by a review of the relevant literature.
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Affiliation(s)
- Albert Wu
- South Australian Institute of Ophthalmology, University of Adelaide, Level 8, East Wing, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia,
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23
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Ghably JG, Borthwick T, O'Neil TJ, Youngberg GA, Datta AA, Krishnaswamy G. IgG4-related disease: a primer on diagnosis and management. Ann Allergy Asthma Immunol 2015; 114:447-54. [DOI: 10.1016/j.anai.2015.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/07/2015] [Accepted: 04/13/2015] [Indexed: 01/06/2023]
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Lee CS, Harocopos GJ, Kraus CL, Lee AY, Van Stavern GP, Couch SM, Rao PK. IgG4-associated orbital and ocular inflammation. J Ophthalmic Inflamm Infect 2015; 5:15. [PMID: 26034515 PMCID: PMC4446498 DOI: 10.1186/s12348-015-0047-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/12/2015] [Indexed: 02/08/2023] Open
Abstract
Background IgG4-associated orbital and ocular inflammation is a relatively unknown entity characterized by sclerosing inflammation with infiltration of IgG4-positive plasma cells. Some so-called idiopathic inflammation syndromes are being re-classified as IgG4-associated inflammation with histopathologic evaluation. Findings We report three cases with differing manifestations of IgG4-associated ocular and orbital inflammation: a case of recurrent, treatment-refractory sclero-uveitis that was diagnosed as granulomatosis with polyangiitis with an IgG4-related component, a case of pachymeningitis with optic neuritis that resulted in permanent visual loss, and a case of orbital inflammatory pseudotumor. All three would have been incompletely diagnosed without thorough histopathologic evaluation (including immunohistochemistry). Conclusions IgG4-associated disease is an idiopathic, multi-organ inflammatory state that can manifest as chronic, relapsing, sclerosing inflammation in virtually any organ system. There is a wide range of presentations in ocular and orbital inflammation. Ophthalmologists should keep IgG4-associated inflammation in mind when examining chronic, sclerofibrosing inflammation with multi-system involvement. The histology of biopsy specimens is crucial in making the correct diagnosis. Timely assessment may lead to fewer diagnostic tests and more targeted therapy.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, CB 8096, 660 S. Euclid, St. Louis, MO 63110 USA ; Department of Ophthalmology, University of Washington, Seattle, WA USA
| | - George J Harocopos
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, CB 8096, 660 S. Euclid, St. Louis, MO 63110 USA ; Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO USA
| | - Courtney L Kraus
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, CB 8096, 660 S. Euclid, St. Louis, MO 63110 USA ; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD USA
| | - Aaron Y Lee
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, CB 8096, 660 S. Euclid, St. Louis, MO 63110 USA ; Department of Ophthalmology, University of British Columbia, Vancouver, BC Canada
| | - Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, CB 8096, 660 S. Euclid, St. Louis, MO 63110 USA
| | - Steven M Couch
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, CB 8096, 660 S. Euclid, St. Louis, MO 63110 USA
| | - P Kumar Rao
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, CB 8096, 660 S. Euclid, St. Louis, MO 63110 USA
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Abstract
IgG4-related disease is a protean condition that mimics many malignant, infectious, and inflammatory disorders. This multi-organ immune-mediated condition links many disorders previously regarded as isolated, single-organ diseases without any known underlying systemic condition. It was recognised as a unified entity only 10 years ago. Histopathology is the key to diagnosis. The three central pathology features of IgG4-related disease are lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis. The extent of fibrosis is an important determinant of responsiveness to immunosuppressive therapies. IgG4-related disease generally responds to glucocorticoids in its inflammatory stage, but recurrent or refractory cases are common. Important mechanistic insights have been derived from studies of patients treated by B-cell depletion. Greater awareness of this disease is needed to ensure earlier diagnoses, which can prevent severe organ damage, disabling tissue fibrosis, and even death. Identification of specific antigens and T-cell clones that drive the disease will be the first steps to elucidate the pathogenesis of IgG4-related disease.
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Affiliation(s)
- Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Yoh Zen
- Department of Pathology, Kobe University, Kobe, Japan
| | - Shiv Pillai
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Choi YJ, Lee MJ, Kim N, Choung HK, Khwarg SI, Kim JE. Inflammatory pseudotumor of eyelid: a probable IgG4-related sclerosing disease clinically mimicking eyelid pilomatrixoma. BMC Ophthalmol 2015; 15:23. [PMID: 25880568 PMCID: PMC4359763 DOI: 10.1186/s12886-015-0004-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 02/06/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ocular adnexal IgG4-related sclerosing disease (IgG4-SD) has been categorized as a novel disease entity. It is characterized by stromal sclerosis and an infiltration of mass-forming lymphoplasmic cells containing many IgG4-positive plasma cells. Although ocular adnexal tissue involvement has been increasingly reported, a focal nodular sub-brow mass is not typical in an IgG4-SD presentation. We report a rare case of probable ocular adnexal IgG4-SD that clinically mimicked eyelid pilomatrixoma. CASE PRESENTATION A 42-year-old woman presented with a nodular mass in her left sub-brow area. The initial clinical impression of her lesion was eyelid pilomatrixoma. However, the final pathologic diagnosis was IgG4-SD, but extranodal marginal zone B-cell lymphoma could not be excluded. The patient underwent testing to determine tumor malignancy and systemic IgG4-SD involvement. Laboratory testing showed normal IgG and IgG4 serum levels and imaging revealed no remarkable findings. Oral prednisolone was administered and slowly tapered to manage the possible remnant lesion and to prevent disease recurrence. Two years after initiating therapy, there was no evidence of relapse. The patient is under close surveillance for signs of recurrence, systemic involvement, and potential malignant transformation. CONCLUSIONS We found an unusual case of probable ocular adnexal IgG4-SD, which presented as a unilateral restricted mass involving the sub-brow area. Although the mass was surgically removed, systemic steroid treatment and long-term surveillance were initiated due to the possibility of recurrence, the potential association with systemic disease, and the potential development of extranodal mucosa-associated lymphoid tissue (MALT) lymphoma.
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Affiliation(s)
- Youn Joo Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
| | - Min Joung Lee
- Department of Ophthalmology, Hallym Sacred Heart Hospital, Anyang, Korea.
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea. .,Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
| | - Ho-Kyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 39, Boramae-gil, Dongjak-gu, Seoul, 156-707, Korea. .,Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. .,Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
| | - Ji Eun Kim
- Department of Pathology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
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Heidari P, Verdijk RM, van den Bosch WA, Paridaens D. Biopsy-proven recurrence of unilateral IgG4-related orbital inflammation after 20 years. Orbit 2014; 33:388-91. [PMID: 24911364 DOI: 10.3109/01676830.2014.904380] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 38-year-old female patient presented with a painful swelling in the lateral part of the upper eyelid, a diffuse scleritis and slight hypoglobus of the right eye. An orbital biopsy showed a fibrotic idiopathic orbital inflammation (IOI) with, on immunohistochemical staining, an increased number of IgG4-positive plasma cells scored as >200 per high-power field, with IgG4/IgG ratio >0.50, indicating orbital IgG4 related autoimmune disease. On treatment with oral prednisone and azathioprine the symptoms resolved within 6 months. Twenty years prior, the patient had been diagnosed with an IOI of at the same side, for which at that time a biopsy had been taken similarly. Reclassification of the previous biopsy specimen with immunohistological staining also showed evidence of orbital IgG4 related disease. To our knowledge this is the first report of a biopsy-proven unilateral IgG4-related orbitopathy that recurred after 20 years.
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Affiliation(s)
- Pegah Heidari
- The Rotterdam Eye Hospital, Oculoplastic & Orbital Service , Rotterdam , the Netherlands
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30
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Sogabe Y, Ohshima KI, Azumi A, Takahira M, Kase S, Tsuji H, Yoshikawa H, Nakamura T. Location and frequency of lesions in patients with IgG4-related ophthalmic diseases. Graefes Arch Clin Exp Ophthalmol 2014; 252:531-8. [PMID: 24384801 DOI: 10.1007/s00417-013-2548-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 10/16/2013] [Accepted: 12/05/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is well-known that the lacrimal gland (LG) may be affected in IgG4-related ophthalmic disease (IgG4ROD). Recently, IgG4-related ophthalmic lesions other than those of the lacrimal gland have been reported. However, no study to date has revealed the details of these lesions. This study was conducted to evaluate the location and frequency of lesions found in conjunction with IgG4ROD using radiological imaging. METHODS Radiological images and clinical records of 65 patients collected from seven institutions in Japan were reviewed retrospectively. All patients had been pathologically diagnosed with IgG4ROD. Patients of mucosa-associated lymphoid tissue lymphoma associated with IgG4-related lesions were excluded. Orbital magnetic resonance imaging or computed tomography findings were evaluated. RESULTS Of the 65 patients, 31 (47.7 %) had lesions involving the LG alone, whereas 34 (52.3 %) had lesions involving the areas other than LG, including eight patients who had lesions without any LG involvement. IgG4-related ophthalmic lesions included LG enlargement in 57 patients (87.7 %), trigeminal nerve branch enlargement in 25 (38.5 %), extraocular muscle enlargement in 16 (24.6 %), diffuse orbital fat lesions in 15 (23.1 %), orbital mass lesions in 11 (16.9 %), eyelid lesions in eight (12.3 %), and nasolacrimal duct lesion in one (1.5 %). Six patients (9.2 %) presented with visual disturbance due to optic nerve disturbance, eight (12.3 %) with a restriction of ocular movement, and 19 (29.2 %) with exophthalmos. CONCLUSIONS Thirty-four (52.3 %) of the 65 IgG4ROD patients had lesions in areas other than LG. Lesions were found in the trigeminal nerve branch including pterygopalatine fossa, extraocular muscles, orbital fat, eyelid, and nasolacrimal duct.
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Affiliation(s)
- Yuka Sogabe
- Department of Ophthalmology, Mitoyo General Hospital, 708, Himehama, Toyohama-cho, Kanonji, Kagawa, 7691695, Japan,
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