Patients with orbitary and kidney commitment
Rare differential diagnoses
Abstract
A series of three cases that consulted the rheumatology service due to orbital and renal involvement is reported. One of them presented orbital pseudotumor with proteinuria in the nephrotic range, a biopsy was performed, finding dense lymphoplasmacytic infiltrate and storiform fibrosis with immunohistochemistry: 15 IgG4 positive cells per HPF and IgG/IgG4 ratio ≤40%, concluding diagnosis of IgG4 related disease. The second and third cases presented ocular involvement with raccoon eyes and yellowish lesions on the eyelids, both with proteinuria greater than 500 mg/24 h, with apple-green birefringence of amyloid on congo red staining. Different rare differential diagnoses to take into account in these patients are discussed.References
I. Wallace ZS, Naden RP, Chari S, Choi H, Della-Torre E, Dicaire JF, et al.; American College of Rheumatology/European League Against Rheumatism IgG4-Related Disease Classification Criteria Working Group. The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria for IgG4-Related Disease. Arthritis & Rheumatology 2020;72(1):7-19.
II. Pakrou N, Selva D, Leibovitch I. Wegener’s granulomatosis: ophthalmic manifestations and management. Semin Arthritis Rheum 2006 Apr;35(5):284-92. doi: 10.1016/j.semarthrit.2005.12.003. PMID: 16616151.
III. Siatkowski RM, Capó H, Byrne SF, Gendron EK, Flynn JT, Muñoz M, et al. Clinical and echographic findings in idiopathic orbital myositis. Am J Ophthalmol 1994 Sep 15;118(3):343-50. doi: 10.1016/s0002-9394(14)72959-9. PMID: 8085592.
IV. Sager L, Reibaldi A, Calvo R, Gallo J, Schmid M, et al. El ojo: un rompecabezas diagnóstico. Estudio observacional descriptivo y revisión. Rev Arg Reumatol 2020;31(4):14.
V. Sager L, Reibaldi A, Calvo R, Ortiz A, Roverano S, Paira S. Viejas enfermedades conocidas que afectan la órbita. Presentación de un caso clínico y revisión. Rev Arg Reumatol 2020;31(4):31-34.
VI. Tiegs-Heiden CA, Eckel LJ, Hunt CH, Diehn FE, Schwartz KM, Kallmes DF, et al. Immunoglobulin G4-related disease of the orbit: imaging features in 27 patients. AJNR. American Journal of Neuroradiology 2014;35(7):1393-1397.
VII. Martín-Nares E, Hernández-Molina G, Rodríguez-Ramírez S, Rivera-Fuentes L, Niño-Cruz JA, Núñez-Abreu A, et al. IgG4-related kidney disease: experience from a Mexican cohort. Clin Rheumatol 2020 nov; 39(11):3401-3408. doi: 10.1007/s10067-020-05135-y. Epub 2020 Jun 1. PMID: 32488771.
VIII. Capecchi R, Giannese D, Moriconi D, Bonadio AG, Pratesi F, Croia C, et al. Renal involvement in IgG4-related disease: from sunlight to twilight. Front Med (Lausanne) 2021; 8:635706. doi: 10.3389/fmed.2021.635706.
IX. Reibaldi A, Sager L, Calvo R, Gallo J, Ortiz A, Roverano S, et al. Enfermedad de Erdheim-Chester. Serie de diecinueve casos y un diagnóstico diferencial de relevancia. Rev Arg Reumatol 2020;31(2):31-36.
X. Andron AA, Nair AG, Rocca DD, Rocca RCD, Reddy HS. Concomitant adult onset xanthogranuloma and IgG4 related orbital disease: a rare occurrence. Orbit 2020;26:1-4. doi: 10.1080/01676830.2020.1814353.
XI. Quispetira J, Moisés C, Paredes A, Sánchez G, Pacheco M, Carbajal T. Enfermedad de Rosai-Dorfman cutánea: reporte de caso y revisión de la literatura. Folia Dermatol. Peru 2009; 20 (2):91-94.
XII. Cánovas JM, Crespo MA, Lescano V. Enfermedad de Rosai-Dorfman renal. Presentación de un caso. Revista Española de Patología 2012;45(4):247-251.
XIII. Reibaldi AA, Sager L, Calvo R, Ortiz A, Roverano S, Paira S. Gammapatías monoclonales de significado clínico en reumatología. Revista Cubana de Reumatología. 2020;22(4):e168
XIV. Chen LYC, Mattman A, Seidman MA, Carruthers MN. IgG4-related disease: what a hematologist needs to know. Haematologica 2019;104 (3).
XV. Hawkins PN. Amyloidosis. Blood Reviews 1995;(9):135-142.
Copyright (c) 2021 Intellectual property rights: authors. Reproduction rights: Argentine Society of Rheumatology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
