Clinical features of IgG4-related dacryoadenitis.

Abstract

BACKGROUND:

To elucidate the clinical characteristics of IgG4-related dacryoadenitis.

METHODS:

Clinical features, laboratory findings, radiological findings, associated diseases, treatment, and prognosis were prospectively examined in 12 patients (seven men, five women; mean age, 60.9 ± 15.1 years) with IgG4-related dacryoadenitis.

RESULTS:

In addition to eyelid swelling, other ophthalmologic symptoms were observed in seven patients, including diplopia (n = 4), ptosis (n = 2), visual field disturbance (n = 2), eye pain (n = 2), decrease of visual acuity (n = 2), eye-movement disturbance (n = 1), dry eye (n = 1), corneal ulcer (n = 1), and epiphora (n = 1). Swelling of the lacrimal glands was bilateral in half of the patients. Other IgG4-related diseases were present in nine patients, including sialadenitis (n = 5), autoimmune pancreatitis (n = 4), retroperitoneal fibrosis (n = 2), and lymphadenopathy (n = 8). Serum IgG4 levels were significantly higher in patients with other IgG4-related disease (1070 ± 813 mg/dl) than in those without (197 ± 59 mg/dl, p = 0.017). Allergic histories and elevated serum IgE levels were each detected in six patients. Eight patients showed inflammatory extension beyond the lacrimal gland, such as thickened rectus muscle (n = 6), inflammation of the optic nerve (n = 2), and retrobulbar inflammation (n = 3). Steroid therapy was effective in seven patients, but dacryoadenitis relapsed in two patients with markedly higher serum IgG4 levels and autoimmune pancreatitis.

CONCLUSIONS:

IgG4-related dacryoadenitis showed various ophthalmologic symptoms due to extensive inflammation beyond the lacrimal gland, frequent association with other IgG4-related disease or allergic phenomena, and steroid responsiveness.

• Authors: Satomi Koizumi, Terumi Kamisawa, Sawako Kuruma, Taku Tabata, Susumu Iwasaki, Kazuro Chiba, Keigo Setoguchi, Shinichiro Horiguchi, Noriko Ozaki
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 252 Issue 3 Pg. 491-7 (Mar 2014) ISSN: 1435-702X [Electronic] Germany
• PMID: 24318531 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids
• Immunoglobulin G

Topics

• Adult
• Aged
• Autoimmune Diseases (diagnosis, immunology)
• Corneal Diseases (diagnosis, immunology)
• Dacryocystitis (diagnosis, drug therapy, immunology)
• Diplopia (diagnosis, immunology)
• Eye Diseases (diagnosis, drug therapy, immunology)
• Eyelid Diseases (diagnosis, immunology)
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Immunoglobulin G (blood)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Ocular Motility Disorders (diagnosis, immunology)
• Oculomotor Muscles (pathology)
• Optic Neuritis (diagnosis, immunology)
• Prospective Studies
• Sialadenitis (diagnosis, drug therapy, immunology)
• Tomography, X-Ray Computed
• Vision Disorders (diagnosis, immunology)