IgG4-Related Disease of Bilateral Temporal Bones.

Published

Journal Article

OBJECTIVE: IgG4-related disease (IgG4-RD) is an idiopathic inflammatory condition that causes pseudotumor formation in single or multiple organs, including those of the head and neck. Temporal bone involvement is rare, with only 3 cases of unilateral temporal bone IgG4-RD described in the literature. We report the first known case of IgG4-RD of bilateral temporal bones and describe its clinical presentation, diagnosis, and treatment. METHODS: The patient was a 52-year-old man with latent tuberculosis (TB) who presented with a 10-year history of bilateral profound hearing loss and vestibular dysfunction. Computed tomography and magnetic resonance imaging demonstrated bilateral labyrinthine destruction with invasion of the posterior fossa. RESULTS: Immunoglobulin level testing showed elevated total serum IgG levels with normal IgG4 levels. Bilateral mastoidectomies were performed, with biopsy samples demonstrating IgG4 staining with IgG4-positive plasma cells up to 40/HPF (high power field) on the right and 20/HPF on the left, consistent with bilateral IgG4-RD. CONCLUSION: IgG4-RD of bilateral temporal bones presents with chronic and progressive bilateral hearing loss and vestibular dysfunction. Clinical presentation and radiologic findings are nonspecific, and definitive diagnosis must be made with histopathology and immunostaining. Corticosteroids are therapeutic, but surgical resection may be necessary for temporal bone IgG4-RD to improve long-term remission.

Full Text

Duke Authors

Cited Authors

  • Li, L; Ward, B; Cocks, M; Kheradmand, A; Francis, HW

Published Date

  • March 2017

Published In

Volume / Issue

  • 126 / 3

Start / End Page

  • 236 - 240

PubMed ID

  • 27729479

Pubmed Central ID

  • 27729479

Electronic International Standard Serial Number (EISSN)

  • 1943-572X

Digital Object Identifier (DOI)

  • 10.1177/0003489416672476

Language

  • eng

Conference Location

  • United States