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Takahira M, Goto H, Azumi A. The 2023 revised diagnostic criteria for IgG4-related ophthalmic disease. Jpn J Ophthalmol 2024:10.1007/s10384-024-01072-4. [PMID: 39037515 DOI: 10.1007/s10384-024-01072-4] [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: 12/11/2023] [Accepted: 04/12/2024] [Indexed: 07/23/2024]
Abstract
Immunoglobulin G4 (IgG4)-related disease is a clinical entity characterized by elevated serum IgG4 concentrations and infiltration of IgG4-immunopositive plasmacytes in various organs, including ophthalmic lesions. Diagnostic criteria for IgG4-related ophthalmic disease (IgG4-ROD) were established in 2014 and describe the most affected ocular adnexal tissues such as lacrimal glands, trigeminal nerves and extraocular muscles, but do not mention optic neuropathy, the most severe indication of ophthalmic lesions. We reviewed published case reports of optic neuropathy in IgG4-related disease (n = 44), and in many cases, decreased visual acuities recovered well following treatment such as systemic corticosteroids, rituximab, and orbital surgery. However, some patients did not recover, especially when pretreatment visual acuities were as low as light perception or less. Herein, we propose a 2023 revised diagnostic criteria for IgG4-ROD, which include a reminder not to overlook optic neuropathy. The 2014 diagnostic criteria specify mucosa-associated lymphoid tissue (MALT) lymphoma as an important differential diagnosis for the relationship between IgG4-ROD and orbital lymphoma. The 2023 revision directs physicians' attention toward lymphomas other than MALT lymphoma, considering that the 2014 criteria might have placed too much emphasis on MALT lymphoma.
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Affiliation(s)
- Masayuki Takahira
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Azumi
- Department of Ophthalmology, Kobe Kaisei Hospital, Hyogo, Japan
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2
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Yang J, Liang Q, Han L, Wang Y, Guo Y. Primary intraorbital inflammatory lumpy lesion: A rare case report. Medicine (Baltimore) 2024; 103:e37869. [PMID: 38640264 PMCID: PMC11029932 DOI: 10.1097/md.0000000000037869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/03/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Eosinophilic angiocentric fibrosis (EAF) is considered to be a kind of benign IgG4-related disease, and it is more often found in the nasal cavity. We present a pretty rare case of orbital EAF that is unlike any other reported case for this case is an IgG4 negative orbital EAF and successfully treated by the fronto orbitozygomatic approach surgery. PATIENT CONCERNS This is a 68-year-old man from a rural area of Inner Mongolia Autonomous Region, went to our hospital for a 2-month history of vision loss with a local hospital orbital computer tomography which showed that there was a lesion in his left orbit. The inspection of the patient revealed that the patient left eye was protruding outward and the left eyelid unable to complete open or close. And his left eyeball movement had difficulty in all directions. Postoperative pathology diagnosed that this was a case of IgG4-negative EAF case. DIAGNOSES Orbital EAF. INTERVENTIONS Surgical radical resection and postoperative glucocorticoid therapy. OUTCOMES After surgery, the left eye vision of this patient increased to 0.6 tested in the standard logarithmic visual acuity chart. And his left eyeball movement dysfunction and eyeball outward protruding get a partially relief. LESSONS EAF occurring in the orbit is a very rare disease and immunohistochemical results of EAF can be IgG4 negative.
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Affiliation(s)
- Jinxin Yang
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China
| | - Qianlei Liang
- Department of Neurosurgery, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Liang Han
- Department of Pathology, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Wang
- Department of Pathology, Chian-Japan Union Hospital of Jilin University, Changchun, China
| | - Yongchuan Guo
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China
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3
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Lin LY, Stone JH, Liou VD, Stagner AM, Lee NG. Eosinophilic Angiocentric Fibrosis of the Orbit: A Clinicopathologic Review of 6 Novel Cases With Review of the Literature. Am J Ophthalmol 2023; 256:9-19. [PMID: 37495006 DOI: 10.1016/j.ajo.2023.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To describe 6 cases and review the current state of knowledge of eosinophilic angiocentric fibrosis (EAF) involving the orbit. DESIGN Retrospective clinicopathologic case series and review of the current literature METHODS: Clinical records and histopathologic data of orbit-involving EAF were gathered between 2004 and 2022 from a single academic institution. The patients' presenting clinical symptoms and signs, laboratory data, radiographic studies, and management documentation were collected. RESULTS Retrospective review identified 6 novel cases, totaling 31 cases of EAF involving the orbit described as of this writing. Fourteen patients were male, and the average age of presentation was 49.8 years (range 25-78 years). Eighteen patients had concurrent sinonasal involvement, whereas 13 had primary orbital involvement. The median duration of symptoms prior to evaluation was 24 months, with nasal symptoms, proptosis, periorbital swelling, and pain being the most common presenting symptoms. The majority of patients underwent surgical debulking, as well as treatment with glucocorticoids and steroid-sparing agents, such as rituximab, with varied results. CONCLUSION EAF involving the orbit is uncommon. The histopathologic findings include a perivascular, eosinophil-rich infiltrate and a pauci-inflammatory storiform type of fibrosis concentrated around small vessels. Orbital involvement usually results from local extension from adjacent sinuses, but primary orbital involvement has been described. Surgical debulking and immunosuppressive agents such as rituximab have been shown to stabilize disease.
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Affiliation(s)
- Lisa Y Lin
- From the Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School (L.Y.L., V.D.L., N.G.L.)
| | - John H Stone
- Department of Rheumatology, Massachusetts General Hospital (J.H.S.)
| | - Victor D Liou
- From the Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School (L.Y.L., V.D.L., N.G.L.)
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School (A.M.S.), Boston, Massachusetts, USA
| | - N Grace Lee
- From the Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School (L.Y.L., V.D.L., N.G.L.).
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Liu R, Li J, Ren T, Zhang H, Ma J. A rare lumpy inflammatory lesion of the orbit: a unique case report. Diagn Pathol 2023; 18:30. [PMID: 36823652 PMCID: PMC9948480 DOI: 10.1186/s13000-023-01316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory lesion, especially in orbit. EAF is believed to be related to IgG4-related disease (IgG4-RD), but the clinical manifestations of systemic involvement are relatively rare and easy to be confused with tumors or other inflammatory diseases. Histopathological examination is the most important way of its diagnosis and differentiation. CASE PRESENTATION We presented a 55-year-old female patient presented with recurrent swelling of the right lower eyelid for more than 2 months. The pathological diagnosis was EAF. Positive immunostaining for IgG, CD34, κ, and λ, while negative immunostaining for IgG4. CONCLUSIONS Complete surgical resection is the preferred treatment, histopathological examination is the main diagnostic standard.
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Affiliation(s)
- Rui Liu
- grid.414373.60000 0004 1758 1243Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Jing Li
- grid.414373.60000 0004 1758 1243Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Tingting Ren
- grid.414373.60000 0004 1758 1243Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Hong Zhang
- grid.24696.3f0000 0004 0369 153XPathology Department, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Jianmin Ma
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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5
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Javadirad E, Roozbahani NE, Sadafi S. Eosinophilic angiocentric fibrosis of the sinonasal tract: a case report and review of the literature. J Int Med Res 2022; 50:3000605221126039. [PMID: 36172997 PMCID: PMC9528026 DOI: 10.1177/03000605221126039] [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: 11/16/2022] Open
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare chronic benign disorder of unknown etiology and is characterized by submucosal thickening and fibrosis in the upper respiratory tract. In this report, we describe a case of EAF in the nasal cavity of a woman who underwent elective surgery for division of adhesions and has had no recurrence during 2 years of postoperative follow-up. A review of the literature on the clinical manifestations of EAF, sites of lesions, management, and outcomes identified 48 articles that included 72 cases. A summary of these reports is presented, including our present case. The most common anatomic site involved was the nose (77.8%), the most common manifestation was nasal obstruction (66.7%), and the most common treatment modality was surgical resection (83.3%). After surgery, 36% of patients remained free of EAF. The most common pharmacologic agent used was a corticosteroid (38.9%).
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Affiliation(s)
- Etrat Javadirad
- Department of Pathology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Narges Eskandari Roozbahani
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepehr Sadafi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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6
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Farina J, Broggi G, Federico C, Zanelli M, Palicelli A, Caltabiano R. Eosinophilic Angiocentric Fibrosis of the Nasal Cavities: A Report of an Uncommon Lesion with Emphasis on the Etiology and Differential Diagnosis. Medicina (B Aires) 2022; 58:medicina58070865. [PMID: 35888584 PMCID: PMC9319830 DOI: 10.3390/medicina58070865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023] Open
Abstract
Background and Objectives: Eosinophilic angiocentric fibrosis (EAF) is an indolent but sometimes locally destructive lesion with a predilection for the sinonasal tract. Although it was first described in 1983, its etiology remains unknown. Some authors initially attributed EAF to trauma, hypersensitivity, and/or surgical manipulation, while it has been recently suggested to include EAF within the spectrum of IgG4-related systemic diseases. Materials and Methods: We report an uncommon case of idiopathic EAF in a 76-year-old male who developed two bilateral tumefactive masses in the nasal cavities. Results: As the histological examination showed a subepithelial proliferation of fibroblasts along with sclero-hyaline fibrosis around small-sized vessels (an “onion skin-like” pattern) and an eosinophils-rich inflammatory infiltrate, a diagnosis of EAF was rendered. The differential diagnosis included granuloma faciale, Wegener’s granulomatosis, and Churg–Strauss syndrome. Conclusions: Pathologists should be aware of the possibility that this lesion can be part of the wide spectrum of IgG4-related systemic diseases by performing IgG4 investigations to assess adherence to IgG4-related systemic disease criteria.
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Affiliation(s)
- Jessica Farina
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (J.F.); (R.C.)
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (J.F.); (R.C.)
- Correspondence:
| | - Carmelo Federico
- Otorhinolaryngology Unit, Casa di Cura Gibiino, 95128 Catania, Italy;
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, 95123 Catania, Italy; (J.F.); (R.C.)
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7
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Chew EJC, Lee MHH, Chung HW, Tang PY. Eosinophilic angiocentric fibrosis and IgG4-related disease revisited. Histopathology 2022; 81:149-158. [PMID: 35312191 DOI: 10.1111/his.14646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Eosinophilic angiocentric fibrosis (EAF) has been postulated to lie on the spectrum of IgG4-related disease (IgG4-RD) in a study reported in 2011. However, the aetiology of EAF remains controversial despite increasing literature reporting IgG4-RD targeted investigations in those studies. This review aims to formally evaluate the relationship between EAF and IgG4-RD using the latest 2019 ACR/EULAR classification scheme for IgG4-RD. METHODS A literature search was performed on the PubMed database for all studies describing patients diagnosed with EAF. Additionally, two EAF cases were retrospectively identified from our institution and presented. The demographics, clinical presentation, histological and serological data of each patient were analysed. RESULTS A total of twenty cases were evaluated, including eighteen patients from fourteen articles in the English literature and two cases from our institution. Six out of twenty (30%) patients with EAF met the criteria for IgG4-RD with the 2019 ACR/EULAR classification scheme. CONCLUSION This represents the first attempt at formally evaluating the relationship between EAF and IgG4-RD using a validated set of classification criteria. Using the currently available data, a small proportion of patients with EAF met the criteria for IgG4-RD. However, various limitations of this study suggest that further efforts at disease characterization of EAF may be required.
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Affiliation(s)
- Edwin Jun Chen Chew
- Department of Anatomical Pathology, Singapore General Hospital, Outram Rd, Singapore 169608
| | - Ming-Han Hugo Lee
- Department of Ophthalmology, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
| | - His Wei Chung
- Department of Ophthalmology, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
| | - Po Yin Tang
- Department of Anatomical Pathology, Singapore General Hospital, Outram Rd, Singapore 169608.,Duke-NUS Medical School, 8 College Rd, Singapore 169857
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8
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Mansfield Smith SC, Clare G, Jones RB. Pregnancy following rituximab for orbital eosinophilic angiocentric fibrosis. Rheumatology (Oxford) 2021; 60:iii57-iii59. [PMID: 34137878 DOI: 10.1093/rheumatology/keab034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/08/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sonja C Mansfield Smith
- Department of Ophthamology, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
| | - Gerry Clare
- Department of Ophthamology, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
| | - Rachel B Jones
- Vasculitis and Lupus Unit, Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
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9
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Jurkov M, Olze H, Klauschen F, Bertelmann E, Schneider U, Arens P. [IgG4-Related Orbitopathy as an Important Differential Diagnosis of Advanced Silent Sinus Syndrome. German version]. HNO 2020; 68:864-868. [PMID: 32060570 PMCID: PMC7653796 DOI: 10.1007/s00106-019-00798-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hintergrund Mit Immunglobulin (Ig)G4 assoziierte Erkrankungen werden als immunvermittelte Erkrankungen klassifiziert. Die Ätiologie dieser Krankheiten ist bisher noch nicht geklärt. Sie manifestieren sich auf verschiedene Weise, und die gleichzeitige Beteiligung mehrerer Organe ist nicht ungewöhnlich. Kasuistik Es wird der Fall eines Patienten vorgestellt, der in die Klinik der Autoren überwiesen wurde, nachdem mehrere erfolglose Nasennebenhöhlenoperationen bei ihm durchgeführt worden waren; bei Vorliegen eines Enophthalmus und einer resultierenden Durchwanderungskeratitis bestand die Verdachtsdiagnose eines Silent-Sinus-Syndroms. Der Erhalt der Orbita war nicht mehr möglich. Nach 5 Jahren ohne definitive Diagnose wurde nun die Diagnose einer IgG4-assoziierten Erkrankung gesichert. Diskussion IgG4-assoziierte Erkrankungen stellen einen wichtigen Baustein bei der Differenzialdiagnose chronischer fortgeschrittener Erkrankungen der Orbita und der Nasennebenhöhlen dar. Bei unklaren Krankheitszeichen sollte diese Diagnose in Erwägung gezogen werden. Zu den typischen histologischen Befunden gehören ein storiformes Muster der Fibrose, Vaskulopathie und Gewebeinfiltration durch IgG4-Plasmazellen.
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Affiliation(s)
- M Jurkov
- HNO Klinik, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - H Olze
- HNO Klinik, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - F Klauschen
- Institut für Pathologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - E Bertelmann
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - U Schneider
- Klinik für Rheumatologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - P Arens
- HNO Klinik, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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10
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Okuyama S, Yazu H, Ito Y, Minato H, Fujishima H. Eosinophilic Angiocentric Fibrosis in Bilateral Upper Eyelid Conjunctivas: A First Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924042. [PMID: 32366815 PMCID: PMC7227441 DOI: 10.12659/ajcr.924042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patient: Female, 55-year-old Final Diagnosis: Eosinophilic angiocentric fibrosis Symptoms: Lid swelling Medication: Topical eye drops Clinical Procedure: Resection of conjunctivas Specialty: Ophthalmology
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Affiliation(s)
- Sho Okuyama
- Department of Ophthalmology, Keio University Hospital School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Tsurumi University School of Dental Medicine, Yokohama, Kanagawa, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University Hospital School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Tsurumi University School of Dental Medicine, Yokohama, Kanagawa, Japan.,Keio Allergy Center, Keio University Hospital, Tokyo, Japan
| | - Yumi Ito
- Division of Diagnostic Pathology, Tsurumi University Dental Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroshi Fujishima
- Department of Ophthalmology, Keio University Hospital School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Tsurumi University School of Dental Medicine, Yokohama, Kanagawa, Japan.,Keio Allergy Center, Keio University Hospital, Tokyo, Japan
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11
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Jurkov M, Olze H, Klauschen F, Bertelmann E, Schneider U, Arens P. IgG4-related orbitopathy as an important differential diagnosis of advanced silent sinus syndrome. HNO 2020; 68:65-68. [PMID: 31915884 DOI: 10.1007/s00106-019-00799-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immunoglobulin (Ig)G4-related disease is classified as an immune-mediated disease. The etiology of this condition has not been explained to date. Manifestations of the disease are diverse, and simultaneous involvement of multiple organs is not unusual. CASE REPORT We report the case of a patient referred to us after multiple unsuccessful paranasal sinus operations who presented with enophthalmos and a resultant migratory keratitis with a suspected diagnosis of silent sinus syndrome. Preservation of the orbit was no longer feasible. After five years without a definitive diagnosis, we ascertained that this was a case of IgG4-related disease. DISCUSSION IgG4-related disease represents an important element in the differential diagnosis of chronic advanced diseases of the orbit and paranasal sinuses. The diagnosis should be considered in the case of unclear disease presentations. Typical histological findings include a storiform pattern of fibrosis, vasculopathy, and tissue infiltration by IgG4 plasma cells.
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Affiliation(s)
- M Jurkov
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - H Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - F Klauschen
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - E Bertelmann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - U Schneider
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - P Arens
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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