ANCA-associated vasculitis and IgG4-related disease overlap syndrome: a case report and literature review

Faz-Muñoz, David; Hinojosa‐Azaola, Andrea; Mejía-Vilet, Juan M.; Uribe, Norma; Rull-Gabayet, Marina; Muñoz-Castañeda, Wallace Rafael A; Vargas-Parra, Nancy; Martín‐Nares, Eduardo

doi:10.1007/s12026-022-09279-8

Cited by 13 publications

(3 citation statements)

References 55 publications

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“…On the contrary, treatment of IgG4-RD should be started with glucocorticoids, without immunosuppressive treatment in the first line [ 2 , 41 ]. Recent reports suggest that rituximab, anty-CD20 therapy or cyclophosphamide could be used in ANCA-associated vasculitis/IgG4-RD overlap syndrome [ 26 , 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Supraglottic Localization of IgG4-Related Disease—Rare and Challenging Equity

Barańska

Makowska

Wągrowska-Danilewicz

et al. 2022

JPM

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Supraglottic stenosis is a rare symptom, particularly in fibroinflammatory multifocal diseases, such as IgG4-related disease (IgG4-RD). There is still an inconsistency in the diagnosis of less-common locations of IgG4-RD, which causes a delay in the diagnosis and treatment. Our paper aims to analyze different aspects of IgG4-RD presenting as supraglottic stenosis, including the possible overlap with ANCA-associated vasculitis. We compare the usefulness of the recently revised ACR/EULAR and Comprehensive criteria and discuss treatment options. The review was performed according to PRISMA guidelines using the MEDLINE Pubmed and Scopus databases. The analysis includes nine papers describing supraglottic laryngeal stenosis in 13 patients. Furthermore, we present a case of a woman with ongoing supraglottic stenosis presenting with cough, temporary dyspnea and stridor as the symptoms of localized IgG4-RD. At the time of writing, the patient remains in remission while receiving treatment with cyclophosphamide and methylprednisolone. The symptoms of supraglottic localization of IgG4-RD may be severe; however, at that point, clinicians should suspect autoimmune etiology and attempt to modulate the autoimmune response instead of performing dilatation surgery—the effects of which may not result in extended intervals between interventions. The ACR/EULAR criteria show great specificity; however, when IgG4-RD is presumed, the specific treatment should be implemented.

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Section: Discussionmentioning

confidence: 99%

Supraglottic Localization of IgG4-Related Disease—Rare and Challenging Equity

Barańska

Makowska

Wągrowska-Danilewicz

et al. 2022

JPM

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“…Ocular manifestations in the course of the disease were seen in ca 26–50% of patients with GPA [ 15 , 16 , 17 ]. In 15.6–19.3% of cases, ocular symptoms constituted the first sign of the disease [ 15 , 18 , 19 , 20 , 21 ]. Thus, an ophthalmologist should consider the diagnosis of GPA, especially in cases where other features of the disease, such as pulmonary or renal disease, are absent.…”

Section: Discussionmentioning

confidence: 99%

Ocular Involvement of Granulomatosis with Polyangiitis

Byszewska

Skrzypiec

Rymarz

et al. 2023

JCM

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Granulomatosis with polyangiitis (GPA), formerly referred to as Wegener’s disease, is a form of ANCA-associated vasculitis. It manifests mainly in the kidneys and the upper respiratory tract, but ocular involvement is not uncommon. In this article, four cases with ocular manifestations are presented with comprehensive photographic documentation. We describe the way to proper diagnosis, which may be long, the possible treatment, and the final outcomes. Our patients had the following ocular manifestations of GPA: retinal vasculitis, anterior necrotizing scleritis, medial orbital wall and orbital floor erosion with middle face deformation, compressive optic neuropathy due to retrobulbar inflammatory mass, and the abscess of the eyelids, inflammatory intraorbital mass causing exophthalmos and diplopia. This manuscript includes the description of severe forms of GPA, the initial signs and symptoms, relapses, and difficulties in achieving remission. The extraocular involvement is described with diagnostic modalities and laboratory findings. One of the reported cases was diagnosed by an ophthalmologist on the basis of ocular symptoms in the early stages of the disease. Our outcomes are compared with those discussed in the literature.

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“…On the other hand, overdiagnosis has become a more prominent problem in recent years because IgG4‐RD is one of the greatest mimickers by other diseases, rendering accurate diagnosis profoundly challenging. These include but are not limited to, tumors (eg, lymphoma, solid tumors, and inflammatory myofibroblastic tumor 5 ), connective tissue diseases (eg, anti‐neutrophilic cytoplasmic antibody [ANCA]‐associated vasculitis 6 and Sjögren's syndrome 7 ), hematological diseases (eg, Castleman's disease, 8 Rosai‐Dorfman disease, 9 and Kimura's disease 10 ), sarcoidosis, Erdheim‐Chester disease 11 and chronic infections (eg, chronic fungal infection 12 ).…”

Section: Figurementioning

confidence: 99%

Confusions and challenges in the diagnosis of IgG4‐related disease

Zhang,

Zhang

2023

Int J of Rheum Dis

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ANCA-associated vasculitis and IgG4-related disease overlap syndrome: a case report and literature review

Cited by 13 publications

References 55 publications

Supraglottic Localization of IgG4-Related Disease—Rare and Challenging Equity

Supraglottic Localization of IgG4-Related Disease—Rare and Challenging Equity

Ocular Involvement of Granulomatosis with Polyangiitis

Confusions and challenges in the diagnosis of IgG4‐related disease

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