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New disease
CASE REPORT
Immunoglobulin G4-related disease of the paranasal sinuses
  1. Anthony Bashyam1,
  2. Sidhartha Nagala1,
  3. Fawzia Tahir2,
  4. Showkat Mirza1
  1. 1ENT Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
  2. 2Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
  1. Correspondence to Mr Anthony Bashyam, abashyam{at}doctors.org.uk

Summary

Immunoglobulin G4-related disease (IgG4-RD) is becoming increasingly documented. It was first described in relation to autoimmune pancreatitis. Features of the disease include tissue infiltration by IgG4 plasma cells with associated fibrosis and the growth of pseudotumours. A 71-year-old woman presented with increasing right cheek swelling and mild proptosis. Ten years earlier, she had a similar presentation and was diagnosed with an inflammatory pseudotumour. Examination revealed a lesion in the right nasal cavity. CT and MRI confirmed a mass within the right maxillary antrum extending into the nasal cavity. Endoscopic biopsies showed florid plasma cell infiltrate with marked increase in IgG+ plasma cells. Immunostaining expressed IgG4 (70%). She was started on a course of prednisolone and her symptoms resolved. IgG4-RD is becoming an emerging disease entity. Its involvement in the paranasal sinuses can mimic nasal tumours. Major surgical resection should be avoided as patients can often be treated medically.

  • ear, nose and throat/otolaryngology
  • ear, nose and throat
  • immunology
  • pathology

https://doi.org/10.1136/bcr-2018-224472

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    Footnotes

    • Contributors AB was responsible for the literature search, design/write up and final editing of the article. SN is involved in the conception, literature search and design/write up. FT was responsible for the patient management/diagnosis, preparation of slides and histopathology write up and review. SM was responsible for the conception, patient management/diagnosis, revisions and final editing of article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.