Johal Kirti, Welch Kevin, Peters Anju
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Am J Rhinol Allergy. 2017 Sep 1;31(5):302-304. doi: 10.2500/ajra.2017.31.4455.
Immunoglobulin G4 (IgG4) related disease is a systemic inflammatory disease characterized by tumor-like tissue infiltration with IgG4 positive (IgG4+) plasma cells. Aspirin-exacerbated respiratory disease (AERD) is defined as asthma, chronic rhinosinusitis with nasal polyposis, and hypersensitivity to cyclooxygenase-1 inhibitors.
We described a case of a non-smoking 61-year-old male with prior NSAID sensitivity who presented with a 1-year history of left eye proptosis associated with chronic nasal symptoms, ultimately identified as concurrent AERD and IgG4 sinusitis.
The patient was evaluated in the clinic and diagnosed by using clinical, radiographic, and surgical biopsy findings.
Although initial concern was greatest for malignancy, a biopsy specimen confirmed the presence of a dense lymphoplasmacytic infiltrate and storiform fibrosis, associated with increased IgG4+ plasma cells. Therefore, IgG4-related disease (RD) was identified in this patient with AERD.
Shared type II inflammation may be responsible for the coexistence of IgG4-RD and AERD as observed in our patient. Health care workers must be cognizant of the simultaneous presentation of both IgG4-RD and AERD.
免疫球蛋白G4（IgG4）相关疾病是一种全身性炎症性疾病，其特征为IgG4阳性（IgG4+）浆细胞浸润形成肿瘤样组织。阿司匹林加重性呼吸道疾病（AERD）的定义为哮喘、伴有鼻息肉的慢性鼻-鼻窦炎以及对环氧化酶-1抑制剂过敏。
我们描述了一例61岁不吸烟男性病例，该患者既往对非甾体抗炎药敏感，出现左眼突出伴慢性鼻部症状1年，最终确诊为AERD与IgG4鼻窦炎并存。
对患者进行门诊评估，并通过临床、影像学及手术活检结果进行诊断。
尽管最初最担心的是恶性肿瘤，但活检标本证实存在密集的淋巴浆细胞浸润和席纹状纤维化，伴有IgG4+浆细胞增多。因此，该AERD患者被确诊为IgG4相关疾病（RD）。
如我们的患者所示，共同的II型炎症可能是IgG4-RD和AERD并存的原因。医护人员必须认识到IgG4-RD和AERD可能同时出现。
