title: Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Positive Otitis Media and Rhinosinusitis With Pathological Features of Immunoglobulin G4-Related Disease: A Case Report.
abstract: BACKGROUND
  Immunoglobulin G4-related disease (IgG4-RD) and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have different clinical and pathological features. However, differentiation between these 2 disorders is sometimes difficult.
  
  
  OBJECTIVE
  To report a case involving a patient with characteristics of both IgG4-RD and AAV.
  
  
  METHODS
  Case report with literature review.
  
  
  RESULTS
  We report a case of myeloperoxidase-ANCA-positive otitis media and rhinosinusitis with pathological features of IgG4-RD in a 73-year-old man. The patient was first clinically suspected to have granulomatosis with polyangiitis. All of the main characteristic pathological features of IgG4-RD were present: dense lymphoplasmacytic infiltration, increased numbers of IgG4-positive plasma cells, storiform-type fibrosis, and obliterative phlebitis.
  
  
  CONCLUSIONS
  The simultaneous presence of the characteristics of both IgG4-RD and AAV makes diagnosis and treatment difficult.
authors.affiliation: Department of Otorhinolaryngology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan Department of Otolaryngology, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan takoto@tmd.ac.jp.
authors.forename: Keiko
authors.initials: K
authors.lastname: Ohno
authors.affiliation: Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Tokyo, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Arai
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Tokyo, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Sugihara
authors.affiliation: Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Tokyo, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Iga
authors.affiliation: Department of Otorhinolaryngology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan Department of Otolaryngology, School of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan.
authors.forename: Yurika
authors.initials: Y
authors.lastname: Kimura
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D001301:Audiometry, Pure-Tone; D001323:Autoantibodies / Q000276:immunology; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D015432:Glomerulonephritis, Membranoproliferative / Q000276:immunology / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D061270:Nasal Septal Perforation / Q000000981:diagnostic imaging / Q000276:immunology; D010033:Otitis Media / Q000276:immunology* / Q000503:physiopathology; D009195:Peroxidase / Q000276:immunology*; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000276:immunology* / Q000473:pathology; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000276:immunology*; D014057:Tomography, X-Ray Computed
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D007074:Immunoglobulin G; D009195:Peroxidase
keywords: ANCA; ANCA-associated vasculitis; IgG4; IgG4-related disease; fibrosis; nasal manifestation