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Olgu Romatoloji Pratiğinde IgG4 ilişkili Orbital Hastalı

Yıl 2024, Cilt: 46 Sayı: 5, 807 - 812, 12.09.2024
https://doi.org/10.20515/otd.1488512

Öz

İmmünoglobulin G4 ile ilişkili hastalık (IgG4-RD), IgG4 ile ilişkili sistemik hastalık, hiper-IgG4 hastalığı, IgG4 ile ilişkili otoimmün hastalık olarak da bilinir. Etiyolojisi bilinmeyen ve karakteristik histopatolojik özelliklere sahip tümefaktif lezyonlarla karakterize, birden fazla organ tutulumu ile seyredebilen, fibroinflamatuar bir durumdur. Lakrimal bezler ve göz dışı kaslar da dahil olmak üzere tüm orbita dokularını etkileyebilir. 52 yaşında kadın hasta, sağ gözünün üstünde şişlik şikayetiyle başvurdu. Kontrastlı MR çektirdikten sonra biyopsi yapıldı. Sonuç olarak patolojik bulguların IgG4'e bağlı sklerozan hastalık ile uyumlu olduğu bildirildi. Hastaya başlangıçta kortikosteroid tedavisi verildi, ardından metotreksat ve azatiyoprin tedavisi uygulandı ve bu tedavi, durumunu başarılı bir şekilde stabilize etti. Klinik pratikte bu hastalık neredeyse tüm organ ve sistemleri etkileyebildiğinden, klinisyenlerin erken tanı konusunda bilgi sahibi olması ve hasta yönetiminde multidisipliner bir yaklaşım benimsemesi büyük önem taşımaktadır.

Kaynakça

  • 1. Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366(6):539-51.
  • 2. Kamisawa T, Funata N, Hayashi Y, Eishi Y, Koike M, Tsuruta K, et al. A new clinicopathological entity of IgG4-related autoimmune disease. J Gastroenterol. 2003;38(10):982-4.
  • 3. Wang N, Zhu P, Xiang Y, Tao L, Huang T, Feng Z. IgG4-related autoimmune pancreatitis and sclerosing cholangitis: A case report and literature review. Medicine (Baltimore). 2024;103(17):e37922.
  • 4. Wallace ZS, Naden RP, Chari S, Choi H, Della-Torre E, Dicaire JF, et al. The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria for IgG4-Related Disease. Arthritis Rheumatol. 2020;72(1):7-19.
  • 5. McNab AA, McKelvie P. IgG4-Related Ophthalmic Disease. Part II: Clinical Aspects. Ophthalmic Plast Reconstr Surg. 2015;31(3):167-78.
  • 6. Wallace ZS, Deshpande V, Stone JH. Ophthalmic manifestations of IgG4-related disease: single-center experience and literature review. Semin Arthritis Rheum. 2014;43(6):806-17.
  • 7. Takuma K, Kamisawa T, Anjiki H, Egawa N, Igarashi Y. Metachronous extrapancreatic lesions in autoimmune pancreatitis. Intern Med. 2010;49(6):529-33.
  • 8. Hamano H, Arakura N, Muraki T, Ozaki Y, Kiyosawa K, Kawa S. Prevalence and distribution of extrapancreatic lesions complicating autoimmune pancreatitis. J Gastroenterol. 2006;41(12):1197-205.
  • 9. Ebbo M, Patient M, Grados A, Groh M, Desblaches J, Hachulla E, et al. Ophthalmic manifestations in IgG4-related disease: Clinical presentation and response to treatment in a French case-series. Medicine (Baltimore). 2017;96(10):e6205.
  • 10. Kutzscher AE, Silkiss RZ. IgG4-related disease presenting with profound bilateral orbital and adnexal inflammation. American Journal of Ophthalmology Case Reports. 2023;29:101782.
  • 11. Rajak SN, Eldredge TA, Rashid F, Brittain GP. IgG4-related orbital disease mass lesion. Can J Ophthalmol. 2016;51(2):e70-2.
  • 12. Farooq TA, Mudhar H, Sandramouli S. A case of non-lacrimal immunoglobulin G4 (IgG4)-related orbital disease with mastitis. Orbit. 2016;35(1):16-9.
  • 13. Umehara H, Okazaki K, Kawa S, Takahashi H, Goto H, Matsui S, et al. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021;31(3):529-33.
  • 14. Andrew N, Kearney D, Selva D. IgG4-related orbital disease: a meta-analysis and review. Acta Ophthalmol. 2013;91(8):694-700.
  • 15. Ohshima K-i, Sogabe Y, Sato Y. The usefulness of infraorbital nerve enlargement on MRI imaging in clinical diagnosis of IgG4-related orbital disease. Japanese journal of ophthalmology. 2012;56:380-2.
  • 16. Soussan JB, Deschamps R, Sadik J, Savatovsky J, Deschamps L, Puttermann M, et al. Infraorbital nerve involvement on magnetic resonance imaging in European patients with IgG4-related ophthalmic disease: a specific sign. European radiology. 2017;27:1335-43.
  • 17. Ren J, Yuan Y, Wu Y, Tao X. Differentiation of orbital lymphoma and idiopathic orbital inflammatory pseudotumor: combined diagnostic value of conventional MRI and histogram analysis of ADC maps. BMC Medical Imaging. 2018;18:1-8.
  • 18. Masaki Y, Matsui S, Saeki T, Tsuboi H, Hirata S, Izumi Y, et al. A multicenter phase II prospective clinical trial of glucocorticoid for patients with untreated IgG4-related disease. Mod Rheumatol. 2017;27(5):849-54.
  • 19. Detiger SE, Karim AF, Verdijk RM, van Hagen PM, van Laar JAM, Paridaens D. The treatment outcomes in IgG4-related orbital disease: a systematic review of the literature. Acta Ophthalmol. 2019;97(5):451-9.
  • 20. Khosroshahi A, Wallace ZS, Crowe JL, Akamizu T, Azumi A, Carruthers MN, et al. International Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease. Arthritis Rheumatol. 2015;67(7):1688-99.
  • 21. Wu A, Andrew NH, McNab AA, Selva D. Bilateral IgG4-related ophthalmic disease: a strong indication for systemic imaging. Br J Ophthalmol. 2016;100(10):1409-11.
  • 22. Ohno K, Sato Y, Ohshima K-i, Takata K, Miyata-Takata T, Takeuchi M, et al. A subset of ocular adnexal marginal zone lymphomas may arise in association with IgG4-related disease. Scientific Reports. 2015;5(1):13539.
  • 23. Sato Y, Ohshima K, Ichimura K, Sato M, Yamadori I, Tanaka T, et al. Ocular adnexal IgG4-related disease has uniform clinicopathology. Pathol Int. 2008;58(8):465-70.

Understanding Igg4 Related Orbital Disease: A Rheumatologist's Perspective

Yıl 2024, Cilt: 46 Sayı: 5, 807 - 812, 12.09.2024
https://doi.org/10.20515/otd.1488512

Öz

Immunoglobulin G4-related disease (IgG4-RD) is also known as IgG4-related systemic disease, hyper-IgG4 disease, IgG4-related autoimmune disease. It is a multi-organ, fibro-inflammatory condition with tumefactive lesions of unknown etiology and characteristic histopathological features. It can affect all orbital tissues, including the lacrimal glands and extraocular muscles. A 52-year-old female patient, presented with complaints of swelling above her right eye. After undergoing a contrast-enhanced MRI, she had a biopsy. Consequently, the pathological findings were reported as consistent with IgG4-related sclerosing disease. The patient was initially prescribed corticosteroid therapy, followed by methotrexate and azathioprine treatment, which successfully stabilized her condition. Since the disease can affect almost all organs and systems, it is crucial for clinicians to have knowledge about early diagnosis and employ a multidisciplinary approach in patient management.

Kaynakça

  • 1. Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366(6):539-51.
  • 2. Kamisawa T, Funata N, Hayashi Y, Eishi Y, Koike M, Tsuruta K, et al. A new clinicopathological entity of IgG4-related autoimmune disease. J Gastroenterol. 2003;38(10):982-4.
  • 3. Wang N, Zhu P, Xiang Y, Tao L, Huang T, Feng Z. IgG4-related autoimmune pancreatitis and sclerosing cholangitis: A case report and literature review. Medicine (Baltimore). 2024;103(17):e37922.
  • 4. Wallace ZS, Naden RP, Chari S, Choi H, Della-Torre E, Dicaire JF, et al. The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria for IgG4-Related Disease. Arthritis Rheumatol. 2020;72(1):7-19.
  • 5. McNab AA, McKelvie P. IgG4-Related Ophthalmic Disease. Part II: Clinical Aspects. Ophthalmic Plast Reconstr Surg. 2015;31(3):167-78.
  • 6. Wallace ZS, Deshpande V, Stone JH. Ophthalmic manifestations of IgG4-related disease: single-center experience and literature review. Semin Arthritis Rheum. 2014;43(6):806-17.
  • 7. Takuma K, Kamisawa T, Anjiki H, Egawa N, Igarashi Y. Metachronous extrapancreatic lesions in autoimmune pancreatitis. Intern Med. 2010;49(6):529-33.
  • 8. Hamano H, Arakura N, Muraki T, Ozaki Y, Kiyosawa K, Kawa S. Prevalence and distribution of extrapancreatic lesions complicating autoimmune pancreatitis. J Gastroenterol. 2006;41(12):1197-205.
  • 9. Ebbo M, Patient M, Grados A, Groh M, Desblaches J, Hachulla E, et al. Ophthalmic manifestations in IgG4-related disease: Clinical presentation and response to treatment in a French case-series. Medicine (Baltimore). 2017;96(10):e6205.
  • 10. Kutzscher AE, Silkiss RZ. IgG4-related disease presenting with profound bilateral orbital and adnexal inflammation. American Journal of Ophthalmology Case Reports. 2023;29:101782.
  • 11. Rajak SN, Eldredge TA, Rashid F, Brittain GP. IgG4-related orbital disease mass lesion. Can J Ophthalmol. 2016;51(2):e70-2.
  • 12. Farooq TA, Mudhar H, Sandramouli S. A case of non-lacrimal immunoglobulin G4 (IgG4)-related orbital disease with mastitis. Orbit. 2016;35(1):16-9.
  • 13. Umehara H, Okazaki K, Kawa S, Takahashi H, Goto H, Matsui S, et al. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021;31(3):529-33.
  • 14. Andrew N, Kearney D, Selva D. IgG4-related orbital disease: a meta-analysis and review. Acta Ophthalmol. 2013;91(8):694-700.
  • 15. Ohshima K-i, Sogabe Y, Sato Y. The usefulness of infraorbital nerve enlargement on MRI imaging in clinical diagnosis of IgG4-related orbital disease. Japanese journal of ophthalmology. 2012;56:380-2.
  • 16. Soussan JB, Deschamps R, Sadik J, Savatovsky J, Deschamps L, Puttermann M, et al. Infraorbital nerve involvement on magnetic resonance imaging in European patients with IgG4-related ophthalmic disease: a specific sign. European radiology. 2017;27:1335-43.
  • 17. Ren J, Yuan Y, Wu Y, Tao X. Differentiation of orbital lymphoma and idiopathic orbital inflammatory pseudotumor: combined diagnostic value of conventional MRI and histogram analysis of ADC maps. BMC Medical Imaging. 2018;18:1-8.
  • 18. Masaki Y, Matsui S, Saeki T, Tsuboi H, Hirata S, Izumi Y, et al. A multicenter phase II prospective clinical trial of glucocorticoid for patients with untreated IgG4-related disease. Mod Rheumatol. 2017;27(5):849-54.
  • 19. Detiger SE, Karim AF, Verdijk RM, van Hagen PM, van Laar JAM, Paridaens D. The treatment outcomes in IgG4-related orbital disease: a systematic review of the literature. Acta Ophthalmol. 2019;97(5):451-9.
  • 20. Khosroshahi A, Wallace ZS, Crowe JL, Akamizu T, Azumi A, Carruthers MN, et al. International Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease. Arthritis Rheumatol. 2015;67(7):1688-99.
  • 21. Wu A, Andrew NH, McNab AA, Selva D. Bilateral IgG4-related ophthalmic disease: a strong indication for systemic imaging. Br J Ophthalmol. 2016;100(10):1409-11.
  • 22. Ohno K, Sato Y, Ohshima K-i, Takata K, Miyata-Takata T, Takeuchi M, et al. A subset of ocular adnexal marginal zone lymphomas may arise in association with IgG4-related disease. Scientific Reports. 2015;5(1):13539.
  • 23. Sato Y, Ohshima K, Ichimura K, Sato M, Yamadori I, Tanaka T, et al. Ocular adnexal IgG4-related disease has uniform clinicopathology. Pathol Int. 2008;58(8):465-70.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Romatoloji ve Artrit
Bölüm OLGU SUNUMLARI / CASE REPORTS
Yazarlar

Dilara Bulut Gökten 0000-0002-9226-7532

Rıdvan Mercan 0000-0003-1537-2192

Yayımlanma Tarihi 12 Eylül 2024
Gönderilme Tarihi 22 Mayıs 2024
Kabul Tarihi 2 Temmuz 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 46 Sayı: 5

Kaynak Göster

Vancouver Bulut Gökten D, Mercan R. Understanding Igg4 Related Orbital Disease: A Rheumatologist’s Perspective. Osmangazi Tıp Dergisi. 2024;46(5):807-12.


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