Case Series and Brief Reports
Immunoglobulin G4-Related Ophthalmic Disease Involving the Sclera Misdiagnosed as Intraocular Tumor: Report of One CaseGoto H. · Ueda S.
Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
Hiroshi Goto, MD
Department of Ophthalmology, Tokyo Medical University
6-7-1 Nishi-shinjuku, Shinjuku-ku
Tokyo 160-0023 (Japan)
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Aims: Immunoglobulin G4 (IgG4)-related disease is known to have diverse clinical manifestations. We report a case of IgG4-related ophthalmic disease misdiagnosed as intraocular tumor. Methods: Case report. Results: A 41-year-old man was referred to our department with a diagnosis of intraocular tumor, presumably choroidal melanoma. Although MR imaging was compatible with choroidal melanoma, he had been observed periodically without treatment because fundus findings were not typical of melanoma and visual function was preserved. He was again referred to us 15 years later due to increased tumor size and visual field disturbance. Transscleral biopsy of the intraocular tumor was attempted to make a histopathological diagnosis. During the biopsy procedure, thick placoid tissue adhering to the sclera was found at a location consistent with the site of the elevated intraocular lesion. Histopathological examination of this extraocular material revealed proliferation of dense fibrous tissue with follicular proliferation of lymphocytes and plasmacytes. The plasmacytes were diffusely positive for IgG and IgG4. Serum IgG4 level was slightly elevated and no extraocular lesion was detected. Despite administration of systemic corticosteroids after biopsy, the intraocular mass was not reduced. Visual acuity of 20/20 has been maintained as of the last follow-up. Conclusion: IgG4-related disease should be included in the differential diagnosis of intraocular elevated lesion.
© 2016 S. Karger AG, Basel
- Yamamoto M, Ohara M, Suzuki C, Naishiro Y, Yamamoto H, Takahashi H, et al: Elevated IgG4 concentrations in serum of patients with Mikulicz's disease. Scand J Rheum 2004;33:432-433.
- Japanese study group of IgG4-related ophthalmic disease: A prevalence study of IgG4-related ophthalmic disease in Japan. Jpn J Ophthalmol 2013;57:573-579.
- Umehara H, Okazaki K, Masaki Y, Masaki Y, Kawano M, Yamamoto M, et al: Comprehensive diagnostic criteria for IgG4-related disease (IgG4RD), 2011. Mod Rheumatol 2012;22:21-30.
- Goto H, Takahira M, Azumi A, et al: Diagnostic criteria for IgG4-related ophthalmic disease. Jpn J Ophthalmol 2015;59:1-7.
- Goto H, Usui M, Ishii I: Efficacy of (123)N-isopropyl-p-[(123)I]-iodoamphetamine single photon emission computed tomography for the diagnosis of uveal malignant melanoma. Am J Ophthalmol 2001;132:937-939.
- Sogabe Y, Ohshima K, Azumi A, Takahira M, Kase S, Tsuji H, et al: Location and frequency of lesions in patients with IgG4-related ophthalmic diseases. Graefes Arch Clin Exp Ophthalmol 2014;52:531-538.
- Ohno K, Sato Y, Ohshima K, et al: IgG4-related disease involving the sclera. Mod Rheumatol 2014;24:195-198.
- Philippakis E, Cassoux N, Charlotte F, et al: IgG4-related disease masquerading as recurrent scleritis and chronic conjunctivitis. Ocul Immunol Inflamm 2015;23:168-172.
- Khosroshahi A, Wallace ZS, Crowel JL, et al: International consensus guidance statement on the management and treatment of IgG4-related disease. Arthritis Rheumatol 2015;67:1688-1699.
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