Vol.19 No.1

Case Report

A case of immunoglobulin G4-related chronic sclerosing sialadenitis and dacryoadenitis associated with tuberculosis

Authors

Mitsuhiro Kawano1 , Kazunori Yamada1 , Yasushi Kakuchi1 , Kiyoaki Ito1 , Ryoko Hamano1 , Hiroshi Fujii1 , Ryo Inoue1 , Masami Matsumura1 , Masayuki Takahira2 , Yoh Zen3 , Akihiro Yachie4 , Akikatsu Nakashima5, Masakazu Yamagishi1

  • Division of Rheumatology, Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
  • Department of Ophthalmology, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
  • Department of Human Pathology, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
  • Department of Pediatrics, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
  • Department of Internal Medicine, Saiseikai Kanazawa Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
Received:

9 May 2008

Accepted:

August 2008

Published online:

15 October 2008

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Abstract

We describe a 64-year-old woman with chronic sclerosing sialadenitis and dacryoadenitis, which developed during treatment for cervical lymph node tuberculosis. Anti-tuberculosis treatment did not improve the swelling in the lacrimal and submandibular glands, and a biopsy specimen of the lacrimal gland showed inflammation, with abundant lymphoid follicles with fibrosis and granuloma without caseous necrosis. Immunohistological examination of a repeat biopsy specimen showed abundant immunoglobulin (Ig) G4-positive plasma cell infiltration. Corticosteroid therapy improved the salivary gland swelling without reactivation of the tuberculosis. This case suggests that an abnormal immunological reaction to tuberculosis may be one of the etiological candidates for IgG4-related disease.

Key words

Immunoglobulin G4 (IgG4) - Mikulicz’s syndrome - Sclerosing dacryoadenitis - Sclerosing sialadenitis - Tuberculosis