IgG4-related Ocular Adnexal Disease Mimicking Thyroid-associated Orbitopathy

Hidefumi Inaba; Takahiro Hayakawa; Waka Miyamoto; Ken Takeshima; Hiroyuki Yamaoka; Yasushi Furukawa; Hiromichi Kawashima; Hiroyuki Ariyasu; Hisao Wakasaki; Hiroto Furuta; Masahiro Nishi; Taisei Nakao; Hideyuki Sasaki; Yuka Okada; Kazuto Matsunaga; Yasushi Nakamura; Takashi Akamizu

doi:10.2169/internalmedicine.52.0902

CASE REPORTS

IgG4-related Ocular Adnexal Disease Mimicking Thyroid-associated Orbitopathy

Hidefumi Inaba, Takahiro Hayakawa, Waka Miyamoto, Ken Takeshima, Hiroyuki Yamaoka, Yasushi Furukawa, Hiromichi Kawashima, Hiroyuki Ariyasu, Hisao Wakasaki, Hiroto Furuta, Masahiro Nishi, Taisei Nakao, Hideyuki Sasaki, Yuka Okada, Kazuto Matsunaga, Yasushi Nakamura, Takashi Akamizu

Author information

Hidefumi Inaba
The First Department of Medicine, Wakayama Medical University, Japan
Takahiro Hayakawa
The First Department of Medicine, Wakayama Medical University, Japan
Waka Miyamoto
The First Department of Medicine, Wakayama Medical University, Japan
Ken Takeshima
The First Department of Medicine, Wakayama Medical University, Japan
Hiroyuki Yamaoka
The First Department of Medicine, Wakayama Medical University, Japan
Yasushi Furukawa
The First Department of Medicine, Wakayama Medical University, Japan
Hiromichi Kawashima
The First Department of Medicine, Wakayama Medical University, Japan
Hiroyuki Ariyasu
The First Department of Medicine, Wakayama Medical University, Japan
Hisao Wakasaki
The First Department of Medicine, Wakayama Medical University, Japan
Hiroto Furuta
The First Department of Medicine, Wakayama Medical University, Japan
Masahiro Nishi
The First Department of Medicine, Wakayama Medical University, Japan
Taisei Nakao
The First Department of Medicine, Wakayama Medical University, Japan
Hideyuki Sasaki
The First Department of Medicine, Wakayama Medical University, Japan
Yuka Okada
Department of Ophthalmology, Wakayama Medical University, Japan
Kazuto Matsunaga
Department of Respiratory Medicine, Wakayama Medical University, Japan
Yasushi Nakamura
Department of Clinical Laboratory Medicine, Wakayama Medical University, Japan
Takashi Akamizu
The First Department of Medicine, Wakayama Medical University, Japan

Keywords: IgG4, ocular adnexal disease, thyroid-associated orbitopathy, Hashimoto's thyroiditis

JOURNAL OPEN ACCESS

2013 Volume 52 Issue 22 Pages 2545-2551

DOI https://doi.org/10.2169/internalmedicine.52.0902

Details

Abstract

A 72-year-old man presented with bilateral eyelid swelling and redness. An orbital CT scan showed bilateral proptosis, extraocular muscle enlargement and swollen lacrimal glands, mimicking thyroid-associated orbitopathy (TAO) with Hashimoto's thyroiditis (HT). During the patient's clinical course, spontaneous remission of lung consolidation (35×26 mm) was seen. A diagnosis of IgG4-related disease (IgG4-RD) was made based on an elevated serum IgG4 level (1,020 mg/dL; normal, 4-108), predominance of IgG4-positive plasma cells (IgG4/IgG: 35/70 in HPF) in the lacrimal glands and typical features of Mikulicz's disease. This report provides a novel description of this unusual disease entity among HT, TAO and IgG4-RD.

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