A Case Report of IgG4-related Diseases Involving Mammary Gland, Parotid Gland and Orbit

Ruixia Yang^{1, 2}, Weijuan Song^{1, 2}, Ting Cui^{1, 2}, Qiuxia Ge^{1, 2}, Li Jiang^{1, 2,} and Lujiang Yi^{1, 2,}

¹Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, P. R. China

²National Key Clinical Department of Laboratory Medicine, Nanjing, P. R. China.

Cite this paper

Ruixia Yang, Weijuan Song, Ting Cui, Qiuxia Ge, Li Jiang and Lujiang Yi. A Case Report of IgG4-related Diseases Involving Mammary Gland, Parotid Gland and Orbit. American Journal of Medical Case Reports. 2019; 7(4):71-73. doi: 10.12691/AJMCR-7-4-5

Abstract

Immunoglobulin G4-related disease (IgG4-RD) is a chronic progressive autoimmune disease. Mammary gland, parotid gland and orbit involvement in IgG4-RD is extremely rare. Herein, we report a case of IgG4-RD presenting with pain in breasts, parotid masses and bilateral exophthalmos. A 52-year-old woman came to our breast disease clinic for treatment, because of pain in her breasts. After examination, eliminated the possibility of breast cancer. Physical examination indicated bilateral parotid hypertrophy and a small amount of clear liquid flowed out while pressed lightly, space-occupying lesions in the upper and outer orbits of the both eyes, this condition had been existing for 6 years. The results of immunohistochemical staining indicated IgG4-positive plasma cells in parotid masses and laboratory tests revealed elevated serum IgG4 (1480 mg/dL, normal range: 3-201 mg/dL), a diagnosis of IgG4-RD of the mammary gland, parotid gland and orbit was formulated.

Keywords

IgG4-realted disease, breast pain, orbital neoplasm, parotid masses, immunohistochemistry, case report

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Fong CW, Lio LI, Pon M, Mok TM, Hou N. IgG4-Related Aortitis. Eur J Case Rep Intern Med. 2018; 27; 5(9): 000881.
[2]	Wallace ZS, Zhang Y, Perugino CA, Naden R, Choi HK, Stone JH; ACR/EULAR IgG4-RD Classification Criteria Committee. Clinical phenotypes of IgG4-related disease: an analysis of two international cross-sectional cohorts. Ann Rheum Dis. 2019; 78(3): 406-412.
[3]	Slim D, Gunawardena H, Calvert JM, Daly RS, Plummeridge MJ, Medford AR. IgG4-related pulmonary disease: the protean impersonator? J R Coll Physicians Edinb. 2018; 48(2): 130-133.
[4]	Fernandes B, Anacleto R, Carvalho L. IGG4 Disease And Slerosing Aortitis. Rev Port Cir Cardiotorac Vasc. 2017;24(3-4): 162.
[5]	Umehara H, Okazaki K, Masaki Y, Kawano M, Yamamoto M, Saeki T, Matsui S, Yoshino T, Nakamura S, Kawa S, Hamano H, Kamisawa T, Shimosegawa T, Shimatsu A, Nakamura S, Ito T, Notohara K, Sumida T, Tanaka Y, Mimori T, Chiba T, Mishima M, Hibi T, Tsubouchi H, Inui K and Ohara H. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol 2012; 22: 21-30.
[6]	Inoue D, Yoshida K, Yoneda N, Ozaki K, Matsubara T, Nagai K, Okumura K, Toshima F, Toyama J, Minami T, Matsui O, Gabata T, Zen Y. IgG4-related disease: dataset of 235 consecutive patients. Medicine (Baltimore). 2015; 94(15): e680.
[7]	Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, Fukushima M, Nikaido T, Nakayama K, Usuda N, Kiyosawa K. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001 8; 344(10):732-8.
[8]	Chen JH, Deshpande V. IgG4-related Disease and the Liver. Gastroenterol Clin North Am. 2017 Jun;46(2):195-216.
[9]	Meridor K, Levy Y. Immunoglobulin G4-Related Disease Presenting with Clinical Similarity to Churg-Strauss Syndrome. Isr Med Assoc J. 2019; 21(2): 124-125.
[10]	Kadowaki H, Amiya E, Hoshino Y, Tamura M, Uehara M, Nakayama A, Nawata K, Domoto Y, Saeki T, Ono M, Komuro I. Enormous Aneurysm in Coronary Artery Fistula With Immunoglobulin G4-Related Disease. Can J Cardiol. 2019; 35(2): 230. e1-230. e3.
[11]	Zhou Y, Shao L, Ruan W, Jin J, Xu H, Ying K, Wu X. Pulmonary vascular involvement of IgG4-related disease: Case series with a PRISMA-compliant systemic review. Medicine (Baltimore). 2019; 98(6): e14437.
[12]	Tabata T, Kamisawa T, Takuma K, Egawa N, Setoguchi K, Tsuruta K, Obayashi T and Sasaki T. Serial changes of elevated serum IgG4 levels in IgG4-related systemic disease. Intern Med 2011; 50: 69-75.
[13]	Kawa S, Skold M, Ramsden DB, Parker A, Harding SJ. Serum IgG4 Concentration in IgG4-Related Disease. Clin Lab. 2017 Sep 1; 63(9): 1323-1337.
[14]	Carruthers MN, Khosroshahi A, Augustin T, Deshpande V and Stone JH. The diagnostic utility of serum IgG4 concentrations in IgG4related disease. Ann Rheum Dis 2015; 74: 1418.
[15]	Rzepecka A, Babińska A, Sworczak K. IgG4-related disease in endocrine practice. Arch Med Sci. 2019 Jan; 15(1): 55-64.
[16]	Mimori T. IgG4-related disease - A new disease entity developed in the twenty-first century. Mod Rheumatol. 2019; 29(2): 213.