A CASE REPORT OF IgG4-RELATED RHINOSINUSITIS

Abstract

　We report a patient who was diagnosed as having IgG4-related disease after a surgery for chronic sinusitis.

　A 66-year-old male patient presented to our hospital with nasal obstruction, left facial pain, and hyposmia. We found swelling of the nasal mucosa, purulent nasal discharge, and easy bleeding; based on these and the findings of CT, we diagnosed the patient as having chronic sinusitis. No improvement was observed with conservative management, therefore, we performed an operation. Very easy bleeding and significant swelling of the mucosa were seen. After surgery, much erosion and crusting were observed. During the follow-up, a plain x-ray of the chest revealed an abnormal opacity. Further investigations revealed a high serum level of IgG4 and taking these results into consideration with the findings of histopathological examination of the nasal mucosa, the patient was diagnosed as having IgG4-related disease. As the patient complained of ocular and oral dryness, he was started on treatment with oral prednisolone at the dose of 30mg/day, which has now been tapered to 15mg/day. Until now, about 20 months after the operation, the patient has shown no evidence of relapse.