PMC7492922_01
(a) Patient with orbit inflammation after sugery and multiple rounds of steroids prior to radiation. (b) Follow-up: 3 months after radiation with resolution of inflammation and symptomatic improvement.
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fig1
The 39-year old patient initially presented in 2017 for recurrent episodes of dry, painful, swelling of the right eye (Figure 1(a)). Although he experienced an inflammatory flare during the first week of radiotherapy, he subsequently had an impressive clinical response (Figure 1).
(a) Lacrimal gland obliterated by dense lymphoplasmacytic infiltrate containing reactive lymphoid aggregate (H&E, 200x). (b) IgG4 immunohistochemical stain showing abundant IgG4+ plasma cells (IgG4, 200x).
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fig2
The patient was referred to radiation oncology, where his constellation of findings prompted consideration of the possibility of IgG4-ROD and a request for IgG4 staining of tissue from his 2017 orbitotomy was sent and shown to be 100 per high-powered field (Figure 2).