title: IgG4-Related Disease of Bilateral Temporal Bones.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA.|2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Lilun
authors.initials: L
authors.lastname: Li
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Ward
authors.affiliation: 3 Department of Pathology, Johns Hopkins Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Cocks
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.|4 Department of Neurology, Johns Hopkins Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Kheradmand
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Howard W
authors.initials: HW
authors.lastname: Francis
mesh_terms: D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D001847:Bone Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006312:Hearing Loss, Bilateral / Q000209:etiology*; D006801:Humans; D007074:Immunoglobulin G; D008297:Male; D008875:Middle Aged; D013701:Temporal Bone
chemical_list: D007074:Immunoglobulin G
keywords: IgG4; immune-mediated; temporal bone