title: Unilateral eyelid mass as an unusual presentation of ocular adnexal IgG4-related inflammation.
abstract: OBJECTIVE
  IgG4-related sclerosing disease is a new clinicopathologic systemic entity, which can involve ocular adnexal structures, such as lacrimal glands and orbital tissues. However, this entity seems to display a more diffuse, frequently bilateral, pattern in such cases. Conjunctival involvement has not been reported in this disease.
  
  
  METHODS
  We report the case of a 67-year-old woman with left upper palpebral mass for 5 months. A biopsy was performed, and the patient underwent systemic evaluation for IgG4-related disease.
  
  
  RESULTS
  The clinicopathologic study revealed intense lymphoplasmacytic and sclerosing inflammation, with IgG4-positive plasma cells and an IgG4:IgG ratio >40%. The conjunctiva was also involved, which was different from previous studies. The only abnormality was hyperglycemia at 180 mg/dL (reference range, 70-99 mg/dL) and a raised glycosylated hemoglobin at 7.8%. Serum IgG and IgG4 levels were normal.
  
  
  CONCLUSIONS
  Our case presented an unusual framework of ocular adnexal IgG4-related inflammation, with a more benign and restricted palpebral manifestation involving the conjunctiva.
authors.affiliation: Department of Ophthalmology, University of São Paulo School of Medicine Hospital, São Paulo, Brazil.
authors.forename: Fabricio L
authors.initials: FL
authors.lastname: da Fonseca
authors.forename: Renata de Iracema Pulcheri
authors.initials: Rde I
authors.lastname: Ramos
authors.forename: Patricia P
authors.initials: PP
authors.lastname: de Lima
authors.forename: Ariel B
authors.initials: AB
authors.lastname: Nogueira
authors.forename: Suzana
authors.initials: S
authors.lastname: Matayoshi
mesh_terms: D000368:Aged; D003228:Conjunctiva / Q000276:immunology / Q000473:pathology; D005141:Eyelid Diseases / Q000276:immunology* / Q000473:pathology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D012598:Sclerosis / Q000276:immunology / Q000473:pathology
chemical_list: D007074:Immunoglobulin G