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The clinical and multimodal imaging features of IgG4-related dacryoadenitis with coexisting vitiligo: A case report
1Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Rationale:
IgG4-related dacryoadenitis is an ocular manifestation of IgG4-related disease. Reports on its multimodal imaging features, particularly the manifestations on color Doppler ultrasound, are rare.
Patient Concerns:
A 76-year-old woman experienced persistent edema of the bilateral upper eyelids for more than 2 years, with a medical history of vitiligo, allergic dermatitis, and hypertension. Physical examination revealed enlarged lacrimal glands with palpable, firm, and movable nodules, accompanied by swollen eyelids and swollen lymph nodes in front of the ears. Color Doppler ultrasound showed the lacrimal glands were markedly enlarged bilaterally, rich in blood supply. Orbital computed tomography highlighted diffuse enlargement of the lacrimal glands bilaterally, with slightly higher density. Serum IgG4 levels were elevated.
Diagnoses:
IgG4 related dacryoadenitis.
Interventions:
A biopsy of left lacrimal gland was performed and methylprednisolone 20 mg/day was prescribed and then tapered.
Outcomes:
Her symptoms improved significantly 1 week after treatment. Serum IgG4 levels gradually decreased. At the 6-month follow-up, the condition was stable.
Lessons:
IgG4-related dacryoadenitis should be considered in the differential diagnosis of unexplained lacrimal gland enlargement. The association between IgG4-related dacryoadenitis and concurrent vitiligo requires further investigation.
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