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Cardoso O, Hamade M, Saigal K, Wang R, Saigal G. Left-Sided Sensorineural Hearing Loss and Facial Weakness in a 35-Year-Old Patient: A Diagnostic Challenge and Case Report. Cureus 2023; 15:e41606. [PMID: 37559836 PMCID: PMC10409533 DOI: 10.7759/cureus.41606] [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] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
We present the case of a 35-year-old patient who presented with a three-month history of left-sided sensorineural hearing loss and left-sided facial weakness. Initial imaging suggested a schwannoma, and the patient underwent ten treatments of intra-tympanic steroid injections and antibiotics, and was scheduled for surgery. However, the planned schwannoma removal surgery with gamma-knife was aborted due to the absence of the previously identified mass on the pre-procedure MRI. Subsequent imaging revealed continued enhancement of the left internal auditory canal (IAC), leading to considerations of lymphoma, sarcoidosis, IgG4 disease, or other inflammatory condition. The patient's symptoms have significantly improved since and are currently being conservatively managed and monitored. However, the patient continues to show persistent findings on MRI. This case highlights the diagnostic challenges faced in identifying the underlying etiology of this patient and emphasizes the need for further investigations and multidisciplinary management in patients with similar presentations.
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Affiliation(s)
- Osmay Cardoso
- Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Mohamad Hamade
- Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Khushi Saigal
- Radiology, University of Florida College of Medicine, Gainesville, USA
| | - Richard Wang
- Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
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Polianskis M, Ivaška J, Dadonienė J, Lengvenis G, Besusparis J, Rauba D, Morozas A, Ivaškienė T, Lesinskas E. Immunoglobulin G4-Related Disease Presenting as Temporal Bone Lesion with Facial Nerve Palsy. ORL J Otorhinolaryngol Relat Spec 2022; 84:473-479. [PMID: 35671746 DOI: 10.1159/000522612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/30/2022] [Indexed: 12/24/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic condition which could present as local infiltration of skull base structures. We report a case of IgG4-RD with infiltration of the temporal bone and surrounding structures in a patient with systemic vasculitis on systemic steroids. A 31-year-old woman presented with right-sided facial weakness, headache, and right ear hearing loss. On examination, redness and retraction of the right tympanic membrane and facial paresis (House-Brackman IV) were noted. Computed tomography imaging showed mastoiditis, temporal lobe stroke, and brain abscess. Magnetic resonance imaging (MRI) showed infiltration in the infratemporal fossa, nasopharynx, spreading along the Eustachian tube and perineurally along the branches of CN V and CN VII intracranially, forming a dural based mass in the middle cranial fossa. Intracranial mass compressed the temporal lobe of the brain, causing perifocal brain edema. Endoscopic biopsy of the nasopharynx was chosen as the least invasive method. It showed marked fibrosis of the tissue, dense lymphoplasmacytic infiltrates, and an increased number of IGG4-positive plasma cells. Serum IgG4 levels were below the diagnostic criteria of IgG4-RD, but histological characteristics of IgG4-RD were met. The patient was treated with high-dose oral prednisolone. Resolution of symptoms, including facial nerve paresis, was observed and infiltration in the nasopharynx, infratemporal fossa decreased on subsequent MRI tests. No recurrence was noted on the follow-up of 16 months. The case presented itself as a diagnostic challenge for a multidisciplinary team to differentiate pathology caused by either IgG4-RD, systemic vasculitis, or atypic mastoiditis. MRI and histological reports were essential to establish a correct diagnosis.
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Affiliation(s)
- Marius Polianskis
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justinas Ivaška
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Dadonienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Givi Lengvenis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justinas Besusparis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Darius Rauba
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arnoldas Morozas
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tatjana Ivaškienė
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Clinic of Ear, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Mallany HP, Anagnos V, Hwa T, Chao T, Montone K, Eliades S. Isolated Otologic Involvement of IgG4 Related Disease: A Case Report and Review of Literature. Cureus 2022; 14:e23787. [PMID: 35530834 PMCID: PMC9067345 DOI: 10.7759/cureus.23787] [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] [Accepted: 04/03/2022] [Indexed: 11/05/2022] Open
Abstract
Immunoglobulin G4 related disease (IgG4-RD) is a systemic autoimmune disease process that classically presents with multi-organ involvement; however isolated involvement of various structures within the body has also been described. Histopathologic examination is considered the gold standard for diagnosis. Glucocorticoids are well established as first-line treatment, but relapses are common, and consultation with rheumatology, immunology, and/or oncology teams is almost always warranted for proper medical management and disease maintenance. Given the relative infancy of IgG4-RD as an accepted diagnosis and the overall rarity of the disease, much still needs to be learned about this variable disease process. We present this case of isolated otologic and lateral skull base involvement of IgG4-RD to contribute to the understanding of this exceedingly rare clinical entity.
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Phenotypes of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1505-1511. [PMID: 32389275 DOI: 10.1016/j.jaip.2019.12.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
Chronic rhinosinusitis (CRS) is a complex heterogeneous disease with different phenotypes and endotypes. Recent advances in our understanding of the pathogenetic mechanisms of CRS endotypes have led to the introduction of effective biologic agents for CRS management. Traditionally, CRS phenotypes have been divided into with or without nasal polyps depending on the presence of polyps. Although this classification does not reflect the various endotypes that are recently emerging, it is simple and easily recognized by clinicians. Other phenotypes of CRS are fungal rhinosinusitis (including invasive and noninvasive subtypes), infectious rhinosinusitis, aspirin-exacerbated respiratory disease, cystic fibrosis, pediatric CRS, and CRS associated with systemic diseases. This article reviews the diagnostic approaches and up-to-date treatment strategies for each CRS phenotype with the hope that a better understanding of endotypes will result in a more scientific understanding of phenotypes and precise, personalized treatments.
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Ren Q, Su J, Zhang D, Ding X. Otological IgG4-Related Disease With Inner Ear Involvement: A Case Report and Review of Literature. EAR, NOSE & THROAT JOURNAL 2020; 101:NP441-NP444. [PMID: 33325728 DOI: 10.1177/0145561320976411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory disease involving multiple organs. Some studies have reported otological manifestations of IgG4-RD, although most studies describe involvement of the middle ear, and reports on inner ear manifestations are limited. Here, we describe a case of a 30-year-old man with IgG4-RD involving the inner ear. This case demonstrated that IgG4-RD affected the inner ear and caused cochlear ossification. Cochlear implants may be considered for milder cases, and hormone and immunosuppressive therapy may control disease progression.
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Affiliation(s)
- Qinzhan Ren
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinfei Su
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Daoxing Zhang
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiuyong Ding
- Department of Otolaryngology-Head and Neck Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
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Immunoglobulin G4-Related Disease Presented as Recurrent Otitis Media and Mixed Hearing Loss Treated With Cyclophosphamide and Rituximab: A Case Report. Arch Rheumatol 2018; 34:233-237. [PMID: 31497772 DOI: 10.5606/archrheumatol.2019.7178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/10/2018] [Indexed: 01/13/2023] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic autoimmune disease; however, it rarely presents as recurrent otitis media and mixed hearing loss. In this article, we present a 43-year-old male patient who presented with recurrent otitis media and mixed hearing loss that is the 12th case of IgG4-RD with middle and inner ear involvement. We also report the clinical response of cyclophosphamide and rituximab therapy in IgG4- RD. These two drugs have never been used to treat otologic symptoms, but were used to treat other organs affected by IgG4-RD. One year later, the patient underwent mastoidectomy of the right ear and the pathological reports revealed IgG4-related disease. A rheumatologist administered immunosuppressive therapy comprising cyclophosphamide and rituximab. After therapy, patient's right-sided mixed hearing loss partially improved. We recorded all pure tone audiometry data to evaluate the clinical course and treatment effect. Finally, we concluded that pathological confirmation and further immunosuppressive therapy should be considered in a timely manner to prevent hearing impairment. We recommend cyclophosphamide and rituximab for the treatment of diseases involving the middle and inner ear.
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