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A case of compressive optic neuropathy putatively caused by IgG4-related idiopathic orbital inflammation.

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Title: A case of compressive optic neuropathy putatively caused by IgG4-related idiopathic orbital inflammation.
Authors: Haraguchi, Ai / Ando, Takao / Ueki, Ikuko / Horie, Ichiro / Imaizumi, Misa / Usa, Toshiro / Yamasaki, Satoshi / Origuchi, Tomoki / Kawakami, Atsushi
Issue Date: Apr-2012
Publisher: Nagasaki University School of Medicine / 長崎大学医学部
Citation: Acta Medica Nagasakiensia, 57(1), pp.29-32; 2012
Abstract: We report the case of a 58-year-old male presenting with an impairment of the left-sided visual acuity caused by compressive optic neuropathy, and marked bilateral proptosis. Blood test showed markedly elevated IgG4 (1830 mg/dl) and positive TSH receptor-stimulating antibodies (200%), but the thyroid function test were normal. Orbital MRI revealed abnormal soft tissue proliferation around the optic nerve and fusiform enlargement of the extraocular muscles. Systemic CT analysis detected multiple lymph node swelling, pseudotumor in the lung, retroperitoneal fibrosis, and kidney lesions. We considered that the eye manifestation was most likely caused by IgG4-related idiopathic orbital inflammation. Systemic administration of a moderate dose of prednisolone dramatically improved the compression of the optic nerve, as shown by the improvement of the visual acuity and the MRI findings. The clinical course made thyroid-associated ophthalmopathy unlikely. In conclusion, an overall consideration of the clinical picture and extensive work-up of any possible differential diagnosis including measurement of the serum levels of IgG4 was highly useful in making the diagnosis of the patient.
Keywords: compressive optic neuropathy / proptosis / IgG4
URI: http://hdl.handle.net/10069/28550
ISSN: 00016055
Type: Departmental Bulletin Paper
Text Version: publisher
Appears in Collections:Volume 57, No. 1

Citable URI : http://hdl.handle.net/10069/28550

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