A case of immunoglobulin G4-related chronic sclerosing sialadenitis and dacryoadenitis associated with tuberculosis

Abstract

We describe a 64-year-old woman with chronic sclerosing sialadenitis and dacryoadenitis, which developed during treatment for cervical lymph node tuberculosis. Anti-tuberculosis treatment did not improve the swelling in the lacrimal and submandibular glands, and a biopsy specimen of the lacrimal gland showed inflammation, with abundant lymphoid follicles with fibrosis and granuloma without caseous necrosis. Immunohistological examination of a repeat biopsy specimen showed abundant immunoglobulin (Ig) G4-positive plasma cell infiltration. Corticosteroid therapy improved the salivary gland swelling without reactivation of the tuberculosis. This case suggests that an abnormal immunological reaction to tuberculosis may be one of the etiological candidates for IgG4-related disease.

Sclerosing Orbital Inflammation and Systemic Disease

“…16,21,22,31,32,[34][35][36] Cheuk et al 21 reported 6 cases, 4 women and 2 men with an average age of 45.5 years (SD 18.3, range 24-67). Five of the 6 cases had bilateral disease, and 50% had salivary gland involvement.…”

IgG4-related disease and its pathogenesis—cross-talk between innate and acquired immunity

“…IgG4-RD occurs comparatively more in the older persons (median age, 58 years), slowly progresses and shows relatively weak inflammation signs such as low titer of CRP ( 1 ). Infections with various species of pathogens such as Helicobacter pylori ( 46 , 47 ), Gram-negative bacteria ( 48 ) and Mycobacterium tuberculosis ( 49 ) have been reported in IgG4-RD. In addition, stimulation with toll-like receptor (TLR) ligands induces production of both IgG4 and IL-10 from PBMCs ( 50 ).…”

Pancreatic Tuberculosis or Autoimmune Pancreatitis

“…Kawano et al reported a case of IgG4 related chronic sialadenitis and dacryoadenitis in a patient who had been treated for cervical lymph node tuberculosis [29]. Imai et al reported a case of IgG4 related tubulointerstitial nephritis after remission of urinary tract tuberculosis [30].…”