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A. Faiz Karim, Rob M. Verdijk, A. Paul Nagtegaal, Rakesh Bansie, Dion Paridaens, P. Martin van Hagen, Jan A. M. van Laar, To distinguish IgG4-related disease from seronegative granulomatosis with polyangiitis, Rheumatology, Volume 56, Issue 12, December 2017, Pages 2245–2247, https://doi.org/10.1093/rheumatology/kex335
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!!...!! Sir, IgG4-related disease (IgG4-RD) is a fibro-inflammatory disease that can affect almost every organ [1]. Indeed, previous unexplained conditions have now been reclassified as primarily IgG4-RD and may imitate many inflammatory, infectious and malignant disorders often leading to a delay in diagnosis or incorrect diagnosis. Nasal manifestation of IgG4-RD, mostly of the paranasal sinuses, has previously been described in case reports, but it can also manifest as a primary or secondary nasal disease such as chronic sinusitis and paranasal sinusitis with dacryoadenitis [2]. Since IgG4-RD localized in the nasal or orbital region remarkably resembles limited granulomatosis with polyangiitis (GPA) [3], IgG4-RD could be an alternative diagnosis in ANCA negative limited GPA. After revising the diagnosis to IgG4-RD in patient 1, we re-evaluated two other ANCA negative patients from a funded database with similar clinical features and could alter the diagnosis into IgG4-RD (Table 1). The histomorphological features matching IgG4-RD and absence of evident features of GPA were the reasons for immunohistochemical analysis in these cases leading to the diagnosis of IgG4-RD. !!...!!
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