Dr.Harsha Chandran

Dr.Modini Pandharpurkar

Abstract

Purpose: Reporting a case of proptosis in IgG4-related disease in a known case of hypothyroidism.
Method: A 40-year-old female with complaints of diffuse swelling and outward protrusion of BE for last 2 years; gradually progressive, painless. Known hypothyroid on medication. On general examination; b/l parotids, submandibular and sublingual gland enlargement noted. Anterior segment examination showed B/L proptosis. Hertel showed 24mm in RE, 23 mm in LE. MRI brain showed thickened EOM with b/l proptosis. Lab investigations show IgG4-1753 mg/dl (700-1600 mg/dl). PET-CT showed metabolically active foci.
Result: Based on systemic evaluation and investigations, a diagnosis of IgG4-related diseases was made. Patient started on glucocorticoids.
Conclusion: Clinching a diagnosis of IgG4-related ophthalmic diseases is often challenging due to its subtle ophthalmological presentations with other systemic findings that are likely to be missed if not looked for.