J Rhinol.  2024 Nov;31(3):179-183. 10.18787/jr.2024.00025.

A Rare Presentation of IgG4-Related Sinusitis With Chronic Nasal Obstruction and Headache: A Case Report and Literature Review

• Jung DW
• Choi JY

• KMID: 2561502
• DOI: http://doi.org/10.18787/jr.2024.00025

Abstract

IgG4-related disease (IgG4-RD) is a systemic inflammatory condition characterized by tissue infiltration with IgG4-positive plasma cells and a tendency to form mass-like lesions in various organs. IgG4-related sinusitis, although a relatively rare manifestation of IgG4- RD, significantly impacts the paranasal sinuses. A 52-year-old man presented with persistent rhinorrhea, nasal obstruction, and headaches. He was diagnosed with IgG4-RD involving the bilateral nasal cavity, paranasal sinuses, submandibular glands, lacrimal glands, and parotid glands. We recently managed a case of IgG4-related sinusitis, which was successfully diagnosed and treated. This condition represents a distinct subset of chronic rhinosinusitis, with unique pathophysiological and clinical features. Accurate diagnosis and effective management of IgG4-related sinusitis require a high index of suspicion and a multidisciplinary approach.

Keyword

IgG4-related disease; Sinusitis; Headache

Figure

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  Fig. 1. Preoperative endoscopic findings show generalized mucosal swelling with thick mucoid rhinorrhea. A: Right. B: Left.

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  Fig. 2. Preoperative computed tomography findings demonstrate right frontal, ethmoid, and sphenoid sinusitis, as well as left ethmoid sinusitis. There is mucosal thickening of the bilateral maxillary sinuses. A: Coronal. B: Axial.

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  Fig. 3. Histopathologic findings of IgG4-related sinusitis. A and B: Infiltration by inflammatory cells, consisting of lymphocytes and plasma cells (hematoxylin and eosin stain). C and D: Prominently increased IgG4 plasma cells with inflammation (IgG4 special stain).

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