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Immunoglobulin G4-related Dacryoadenitis Successfully Treated with Baricitinib
Atsuhiko Suenaga1,2, Naoki Sawa1,3, Yuki Oba1
1Department of Nephrology and Rheumatology, Toranomon Hospital Kajigaya, Japan.
Insights
Immunoglobulin G4-related dacryoadenitis, a rare condition causing lacrimal gland enlargement, was effectively treated with baricitinib when steroids failed. This treatment also improved associated atopic dermatitis.
Area of Science:
- Ophthalmology
- Rheumatology
- Immunology
Background:
- Immunoglobulin G4-related disease (IgG4-RD) is a multisystem fibroinflammatory condition.
- IgG4-related dacryoadenitis, an ocular manifestation of IgG4-RD, presents with lacrimal gland enlargement.
- Steroid therapy is the first-line treatment, but resistance can occur.
Abstract:
A 48-year-old woman visited our hospital because of bilateral lacrimal gland enlargement. Her serum immunoglobulin G4 (IgG4) level was high, and positron emission tomography-computed tomography showed significant positive findings in the bilateral lacrimal gland. A biopsy revealed a considerable increase in IgG4/CD138, leading to a diagnosis of IgG4-related dacryoadenitis. The disease did not respond to steroid therapy, so treatment was started with baricitinib because of exacerbation of the original atopic dermatitis and dacryoadenitis after the second dose of the coronavirus disease 2019 (COVID-19) vaccine. Baricitinib was effective for resolving both dermatitis and dacryoadenitis, and steroids were able to be discontinued. The IgG4 level also improved.
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