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Narotam Jeena H, Afrogheh A, West J, van der Colff F, Brey N. A unique presentation of IgG4 disease with ocular, neurologic and mastoid involvement. BMJ Case Rep 2022; 15:e251736. [PMID: 36375856 PMCID: PMC9664293 DOI: 10.1136/bcr-2022-251736] [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] [Indexed: 11/16/2022] Open
Abstract
A man in his 20s presented with headache and acute deterioration in visual acuity. He was found to have panuveitis and raised intracranial pressure with papilloedema. MRI and F-fluorodeoxyglucose positron emission tomography confirmed a subclinical, but active, inflammatory mastoid process. Histology of the mastoid showed immunoglobulin G4 (IgG4) cells, plasma cells and storiform fibrosis.This presentation of IgG4 disease has not been previously described.Treatment with high-dose steroids was initiated, followed by long-term immunosuppressive therapy. The patient's symptoms improved, although he remains dependent on azathioprine and low dose oral steroids for symptom control. To date, there has been no progression of the disease.
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Affiliation(s)
- Heena Narotam Jeena
- Division of Neurology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- Neurology, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Amir Afrogheh
- Anatomical Pathology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- NHLS, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Joshua West
- Otorhinolaryngology, Tygerberg Hospital, Cape Town, Western Cape, South Africa
- Otorhinolaryngology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Freddie van der Colff
- Ophthalmology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- Ophthalmology, Tygerberg Hospital, Cape Town, Western Cape, South Africa
| | - Naeem Brey
- Division of Neurology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- Neurology, Tygerberg Hospital, Cape Town, Western Cape, South Africa
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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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Somani SN, Schneider AL, Welch KC, Alexiev BA, Matsuoka AJ. Probable neurosarcoidosis presenting as acute on chronic otorrhoea: a difficult diagnosis. BMJ Case Rep 2020; 13:13/11/e237676. [PMID: 33139371 DOI: 10.1136/bcr-2020-237676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An elderly African American woman presented to our clinic following 9 months of right-sided unilateral headache, otorrhoea and progressive hearing loss. Despite treatment with topical and oral antibiotics, her clinical condition worsened, and imaging showed mastoid coalescence with an associated subgaleal abscess. She underwent right mastoidectomy and was discharged 3 days later on broad-spectrum intravenous antibiotics despite negative operative cultures. Six weeks later, she was hospitalised with diplopia secondary to a right lateral rectus palsy. Imaging showed abscess resolution but progressive bony remodelling and enhancement of the lateral extending into anterior skull base. Chest CT demonstrated upper lobe predominant pulmonary micronodules, and mastoid biopsy on revision surgery was notable for non-caseating granulomas. Further extensive work-up could not identify an alternative cause, and a presumptive diagnosis of neurosarcoidosis was made. The patient was initiated on intravenous steroids, experienced symptomatic improvement and was thereafter transitioned to oral steroid taper on discharge.
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Affiliation(s)
- Shaan N Somani
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander L Schneider
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Borislav A Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akihiro J Matsuoka
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA .,Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA.,The Hugh Knowles Center for Clinical and Basic Science in Hearing and Its Disorders, Evanston, Illinois, USA
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Bishop JL, Bryan LJ, Savage NM, Byrd JK. Tumefactive fibroinflammatory lesion successfully treated with Rituximab. Intractable Rare Dis Res 2019; 8:138-141. [PMID: 31218165 PMCID: PMC6557232 DOI: 10.5582/irdr.2019.01061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Skull base pseudotumors, or tumefactive fibroinflammatory lesions (TFIL), are tumors characterized by local destruction with benign histopathology. Treatment includes surgery and steroids with varying degrees of symptom relief. A 45-year-old female presented with right otorrhea and middle ear effusion, which progressed to CN V3 pain/numbness, trismus, headache, and autophony. MRI showed a diffuse infiltrating mass in the right infratemporal region involving the trigeminal ganglion. Biopsy revealed benign fibromuscular and adipose tissue with lymphoplasmacytic infiltrate, giving a diagnosis of TFIL. Resection would be very difficult given tumor location. Initial treatment included an extended course of steroids without response, and interval disease progression. Two courses of rituximab 375 mg/m2 weekly × 4 given 3 months apart were then completed with excellent tolerance. With sixteen months following induction, the patient reports minimal symptoms with radiographic findings confirming continued disease regression. Rituximab is a potential treatment option for patients with TFIL without response to steroids.
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Affiliation(s)
- Jessica L Bishop
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Locke J. Bryan
- Department of Medicine, Division of Hematology/Oncology, Georgia Cancer Center at Augusta University, Augusta, GA, USA
- Address correspondence to:Dr. Locke J. Bryan, Department of Medicine, Division of Hematology/Oncology, Georgia Cancer Center at Augusta University, 1120 15th Street, Augusta, GA 30912, USA. E-mail:
| | - Natasha M. Savage
- Department of Pathology, Division of Hematopathology/Hematology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - J. Kenneth Byrd
- Department of Otolaryngology, Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Wuesthoff C, Allende A, Patel N. IgG4 disease of the ear: Report and review. SAGE Open Med Case Rep 2018; 6:2050313X18791428. [PMID: 30116527 PMCID: PMC6088471 DOI: 10.1177/2050313x18791428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 07/05/2018] [Indexed: 12/24/2022] Open
Abstract
In recent years, an immune-mediated disorder involving IgG4 has been described, which targets multiple organs and explains a number of disorders previously regarded as “idiopathic” or of unknown origin. Furthermore, the discovery of IgG4-related disease (IgG4-RD) has placed a number of pathologies within its spectrum, linking symptoms and conditions formerly considered isolated. Reports of the manifestations of IgG4-RD in the head and neck are scarce. Otological manifestations have been reported, but only a handful of cases are available in the literature. This is the first report of recalcitrant serous otitis media secondary to IgG4-RD, confirmed by immunohistopathology. A case of IgG4-RD of the middle ear is presented, manifesting itself as recalcitrant serous otitis media. The case is presented from an otolaryngological and histopathological perspective and briefly reviews this rare disorder. The importance of the awareness of IgG4-RD resides mainly in the fact that it is a treatable condition. This can potentially improve the quality of life of a number of patients, some of whom may not have had a clear diagnosis. A favorable response to glucocorticoids has been reported. In cases of persistent symptoms, immunosuppressive therapy has been used with success.
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Affiliation(s)
- Carolina Wuesthoff
- Deafness Research, Kolling Institute of Medical Research and Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Alexandra Allende
- Department of Histopathology, Douglass Hanly Moir Pathology, Sydney, NSW, Australia.,Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Nirmal Patel
- Deafness Research, Kolling Institute of Medical Research and Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of ORL-Head and Neck Surgery, Macquarie University, Sydney, NSW, Australia
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Soloperto D, Fabbris C, Di Maro F, Marchioni D. IgG4-related pseudotumor affecting ethmoid, orbit and anterior skull base. J Neurosurg Sci 2017. [PMID: 28643505 DOI: 10.23736/s0390-5616.17.04079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Davide Soloperto
- Department of Otolaryngology, Verona University Hospital, Verona, Italy
| | | | - Flavia Di Maro
- Department of Otolaryngology, Verona University Hospital, Verona, Italy -
| | - Daniele Marchioni
- Department of Otolaryngology, Verona University Hospital, Verona, Italy
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