PMC6332970_01
Clinical examination and computed tomography (CT). (a) Color photo and (b) scanning laser ophthalmoscope image showing papillary of right upper eyelid. (c) Orbital CT showing mild swelling of bilateral lacrimal glands. (d) Orbital CT showing hypertrophy of soft tissue in left pterygopalatine fossa (red circle: left pterygopalatine fossa).
CRII2018-3763084.001.jpg
PMC6332970_01_CRII2018-3763084.001.jpg
fig1
On August 2013, the patient presented the discomfort of bilateral eyelids and papillary swelling of upper eyelids was observed (Figures 1(a) and 1(b)). The computed tomography (CT) image showed bilateral lacrimal gland swellings and hypertrophy of soft tissue in left pterygopalatine fossa (Figures 1(c) and 1(d)).
Histopathologic and immunohistochemical findings of right upper eyelid. (a) Histopathologic findings of right upper eyelid included lymphoplasmic infiltration with lymphoid follicles formation consistent with sclerosing inflammation (H & E, x100). (b) Immunostaining identified IgG-positive plasma cells in lymphoid follicle (immunostaining, x200). (c) Immunostaining identified numerous IgG4-positive plasma cells, accounting for 50% of IgG-positive plasma cells (immunostaining, x200).
CRII2018-3763084.002.jpg
PMC6332970_01_CRII2018-3763084.002.jpg
fig2
In immunostaining for IgG and IgG4 plasma cell, the ratio of IgG4 to IgG was 50% (Figure 2).
The relationship between clinical symptoms of EGPA and serum level of IgG4 or the ratio of IgG4 to IgG levels.
CRII2018-3763084.003.jpg
PMC6332970_01_CRII2018-3763084.003.jpg
fig3
In this case, serum IgG and IgG4 levels were measured from the first visit (Figure 3).