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Temporal bone involvement of IgG4-related disease: a rare condition misleading to petrous apicitis causing lateral rectus palsy
  1. Sanathorn Chowsilpa1,
  2. Sayanan Chowsilpa2,
  3. Tanyathorn Teeranoraseth1 and
  4. Kannika Roongrotwattanasiri1
  1. 1 Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  2. 2 Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  1. Correspondence to Dr Sanathorn Chowsilpa, sanathorn{at}


IgG4-related disease (IgG4-RD) of temporal bone is rare and clinical manifestation mimics infection. A 19-year-old female presented with progressive left earache and intermittent left nasal obstruction. Then, she rapidly developed left lateral rectus palsy. The physical examination revealed mild redness of left tympanic membrane and a small nasal polyp from the left middle meatus. CT scan showed left petrous apicitis and enhancing sinonasal mucosa. Therefore, Gradenigo’s syndrome was first considered. The empirical intravenous antibiotic was immediately prescribed and surgery was performed. The intraoperative pale soft tissue mass in middle ear and polyp in the left nasal cavity were sent for pathological examination and found positive immunohistochemical stains for IgG4 in plasma cells. Systemic corticosteroid, the first-line treatment, was started and her symptoms were finally recovery.

  • ear, nose and throat/otolaryngology
  • otitis
  • rheumatology
  • otolaryngology/ent
  • haematology (incl blood transfusion)
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  • Contributors SC has responsibilities on overall manuscript writing, literature review and data preparation. SayC has responsibilities on pathological part of manuscript writing. TT has responsibilities on case presentation part of manuscript. KR has responsibilities on case presentation part of manuscript. All authors contributed to refinement of the study protocol and approved the final manuscript.

  • 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.

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

  • Patient consent for publication Not required.

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