A Case of Submandibular Lymphadenopathy with IgG4-related Disease

Abstract

IgG4-related disease is a recently proposed pathological entity characterized by tumor-like enlargement of one or more organs, IgG4 positive plasma cell accumulation and raised serum IgG4 levels. We present a case of submandibular lymphadenopathy with IgG4-related disease. The patient was a 49-year-old man, who had been receiving periodontal treatment in our department. We investigated swelling of the right submandibular region that had been identified previously. An excisional biopsy revealed enlarged lymph nodes. IgG4 positive plasma cells were found in interfollicular areas (IgG4/IgG ratio: 89.5%). Thus, IgG4-related disease was suspected. The serum IgG4 level was high on blood testing, and so we consulted the department of rheumatology. At present, he is asymptomatic except for the head and neck lesions without medication. The patient is on regular follow-up with hematological and radiological examination.