title: Probable Immunoglobulin Subtype-G4-Related Disease in the Head and Neck from Foreign Body Injection: A Case Report.
abstract: Introduction Immunoglobulin subtype G4-related disease (IgG4-RD) is a fibroinflammatory disease of unknown etiology, with manifestations involving nearly every organ system. Its association with foreign bodies is not established. Here, we present a novel case of IgG4-RD in response to foreign body injection. Case Description A 58-year-old woman presented with history of persistent left facial pain, xerophthalmia, blurred vision, and trismus. The patient's medical history was significant for left-sided temporomandibular joint (TMJ) reconstruction with silicone injection into the joint. Magnetic resonance imaging revealed a lesion in the left skull base. Biopsies demonstrated the cardinal histopathological features of IgG4-RD. The patient was treated with a tapering dose of prednisolone followed by rituximab, resulting in tumor shrinkage and resolution of her symptoms. Discussion This is the first reported case of IgG4-RD potentially precipitated by a foreign body, in this case injected silicone into the TMJ. The pathogenesis and etiology of IgG4-RD is still not fully elucidated, but allergic and reactive inflammatory reactions have been implicated in the disease process. This case report should raise the idea of reactive foreign bodies as a causative agent for IgG4-RD.
authors.affiliation: Hofstra North Shore, LIJ School of Medicine, Hempstead, New York, United States.
authors.forename: Mallory Jayne
authors.initials: MJ
authors.lastname: Highstein
authors.affiliation: Hofstra North Shore, LIJ School of Medicine, Hempstead, New York, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mallen
authors.affiliation: New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States.
authors.forename: Tristan
authors.initials: T
authors.lastname: Tham
authors.affiliation: New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States.
authors.forename: Tara
authors.initials: T
authors.lastname: Brennan
authors.affiliation: New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Boubour
authors.affiliation: Lenox Hill Hospital, Department of Pathology, North Shore, LIJ Healthy System, New York, New York, United States.
authors.forename: Elena
authors.initials: E
authors.lastname: Opher
authors.affiliation: Lenox Hill Hospital, Department of Pathology, North Shore, LIJ Healthy System, New York, New York, United States.
authors.forename: Vira
authors.initials: V
authors.lastname: Wolf
authors.affiliation: New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States.
authors.forename: Prabhjyot
authors.initials: P
authors.lastname: Singh
authors.affiliation: New York Head and Neck Institute, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Costantino
keywords: G4-related disease; foreign body injection; head and neck; immunoglobulin subtype