A case of igg4-related pharyngolaryngitis

Narihisa Suzuki, Masato Fujioka, Yasutomo Araki, Hiroyuki Ozawa, Mitsuhiro Kawaura

Research output: Contribution to journalArticle

Abstract

IgG4-related inflammatory diseases, including autoimmune pancreatitis and Mikulicz syndrome, have become known to physicians as new clinical entities, especially over the past few years. We would like to present a case of IgG4-related oropharyngolaryngitis. We encountered a case with a severe and intractable inflammation distributed exclusively in the hypopharynx and laryngeal surface of the epiglottis. The patient did not spontaneously recover and the disease was resistant to antibiotics and NSAIDs that were administered for 4 weeks. Frequent fiberscope inspections and punch biopsies failed to provide a diagnosis, and were followed by a detailed examination under laryngomicrosurgery, with multiple tissue samplings under general anesthesia. The samples revealed proliferative, non-malignant inflammatory lesions and the pathology showed IgG4-related symptoms; indicated by all of the criteria including blood and local IgG4 elevation being met. Symptoms were quickly suppressed by a week of steroid infusion drips, followed by a gradual tapering of oral steroids in accordance with a regimen for autoimmune pancreatitis. For many years, ENT physicians have often used corticosteroids empirically for atypical pharyngitis, but usage of steroids on conditions with uncertain criteria has always been criticized. This is, as far as we know, the first report of oropharyngolaryngitis to be associated with IgG4-related symptoms. The case is thought-provoking in that some of those recurrent atypical oropharyngolaryngitis cases might be explained in accordance with this information. Moreover, the results suggest that the serum IgG4 level might be a predictive marker for the requirement of corticosteroids administration.

Original languageEnglish
Pages (from-to)227-233
Number of pages7
JournalPractica Oto-Rhino-Laryngologica
Volume107
Issue number3
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Immunoglobulin G
Steroids
Pancreatitis
Adrenal Cortex Hormones
Epiglottis
Physicians
Hypopharynx
Pharyngitis
Non-Steroidal Anti-Inflammatory Agents
Intravenous Infusions
General Anesthesia
Autoimmune Diseases
Pathology
Anti-Bacterial Agents
Inflammation
Biopsy
Serum

Keywords

  • Autoimmune disease
  • IgG4-related diseases
  • Pharyngolaryngitis

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

A case of igg4-related pharyngolaryngitis. / Suzuki, Narihisa; Fujioka, Masato; Araki, Yasutomo; Ozawa, Hiroyuki; Kawaura, Mitsuhiro.

In: Practica Oto-Rhino-Laryngologica, Vol. 107, No. 3, 2014, p. 227-233.

Research output: Contribution to journalArticle

Suzuki, Narihisa ; Fujioka, Masato ; Araki, Yasutomo ; Ozawa, Hiroyuki ; Kawaura, Mitsuhiro. / A case of igg4-related pharyngolaryngitis. In: Practica Oto-Rhino-Laryngologica. 2014 ; Vol. 107, No. 3. pp. 227-233.
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