FOUR CASES OF IgG4-RELATED DISEASE WITH CHRONIC RHINOSINUSITIS

• Published in: JIBI INKOKA TEMBO Vol. 63; no. 5; pp. 206 - 213
• Main Authors: Shimamura, Yosuke, Tsurumoto, Yuka, Ishii, Masanori, Tsukidate, Toshiharu
• Format: Journal Article
• Language: Japanese
• Published: Society of Oto-rhino-laryngology Tokyo 15.10.2020
• Subjects: IgG4; metachronous occurrence; rhinosinusitis
• ISSN: 0386-9687; 1883-6429
• DOI: 10.11453/orltokyo.63.5_206

IgG4-related disease is a systemic chronic inflammatory disease characterized by elevated serum levels of IgG4, massive infiltration of tissues by IgG4-positive plasma cells, and tissue fibrosis. Mikulicz's disease, Küttner's tumor and Riedel's thyroiditis are considered to be examples of IgG4-related disease involving the head and neck region. In recent years, reports of nasal manifestations associated with IgG4-related diseases have been increasing. We report four cases of IgG4-related disease who presented with chronic rhinosinusitis. Case 1 (47-year-old man) and Case 2 (49-year-old man) had undergone surgery for chronic sinusitis, but presented with other organ symptoms several years later. IgG4-positive plasma cell infiltration was observed in the nasal biopsy specimens. Case 3 (64-year-old male) and Case 4 (65-year-old male) visited us with the chief complaint of nasal symptoms, accompanied by symptoms pertaining to other organ systems. All four cases had rhinosinusitis accompanied by symptoms pertaining to several other organ systems and were definitively diagnosed as cases of IgG4-related disease by nasal biopsy. Biopsy of nasal polyps is relatively easy to perform as compared to biopsy of other organs, such as the pancreas or pituitary gland. Therefore, otorhinolaryngologists can play an important role in diagnosis of IgG4-related diseases. In patients with rhinosinusitis who present with symptoms pertaining to other organ symptoms, IgG4-related disease must be considered in the differential diagnosis.