IgG4-Related Ophthalmic Disease Presenting as Meningitis and Panuveitis
Purpose. We report an uncommon case of immunoglobulin gamma 4-related ophthalmic disease (IgG4-ROD) presenting as meningitis and panuveitis. Observations. A 35-year-old male with no prior ophthalmic history presented with headaches, altered mental status, and fever of unknown origin. A lumbar punctu...
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| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Ophthalmological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2019/5653282 |
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| author | Maria A. Mavrommatis Sarah A. Avila Richard France |
| author_facet | Maria A. Mavrommatis Sarah A. Avila Richard France |
| author_sort | Maria A. Mavrommatis |
| collection | DOAJ |
| description | Purpose. We report an uncommon case of immunoglobulin gamma 4-related ophthalmic disease (IgG4-ROD) presenting as meningitis and panuveitis. Observations. A 35-year-old male with no prior ophthalmic history presented with headaches, altered mental status, and fever of unknown origin. A lumbar puncture (LP) revealed an elevated white count with lymphocytic predominance, confirming a suspected meningitis. After an extensive work-up, he was discharged on oral acyclovir to cover for presumed aseptic meningitis. The patient initially improved, however, bilateral eye pain, redness, and photophobia 2 weeks after discharge prompted his first visit to the ophthalmology clinic. Exam at that time was consistent with bilateral anterior uveitis for which he was given topical prednisolone and cyclopentolate. In addition to the preceding work-up, quantitative immunoglobulin serology including IgG4 levels was added. At follow-up, he was found to have increased ocular inflammation with vitreitis, nerve head edema, and subclinical macular thickening. Visual acuity (VA) had decreased in both eyes. Serology titers for IgG had resulted in a significant elevation in IgG subclass 4 (IgG4). Optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) confirmed posterior retinal involvement. The patient was diagnosed with presumed bilateral panuveitis secondary to IgG4-ROD. Conclusions and Importance. IgG4-RD can be a serious condition that requires careful consideration and intuition to diagnose. This report serves to encourage ophthalmologists to consider IgG4-ROD in cases of idiopathic systemic inflammation with ophthalmic involvement. |
| format | Article |
| id | doaj-art-dd45acefaa2e43219b5e253d38f24cfb |
| institution | Kabale University |
| issn | 2090-6722 2090-6730 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Ophthalmological Medicine |
| spelling | doaj-art-dd45acefaa2e43219b5e253d38f24cfb2025-02-03T01:30:14ZengWileyCase Reports in Ophthalmological Medicine2090-67222090-67302019-01-01201910.1155/2019/56532825653282IgG4-Related Ophthalmic Disease Presenting as Meningitis and PanuveitisMaria A. Mavrommatis0Sarah A. Avila1Richard France2Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USADepartment of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USADepartment of Ophthalmology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USAPurpose. We report an uncommon case of immunoglobulin gamma 4-related ophthalmic disease (IgG4-ROD) presenting as meningitis and panuveitis. Observations. A 35-year-old male with no prior ophthalmic history presented with headaches, altered mental status, and fever of unknown origin. A lumbar puncture (LP) revealed an elevated white count with lymphocytic predominance, confirming a suspected meningitis. After an extensive work-up, he was discharged on oral acyclovir to cover for presumed aseptic meningitis. The patient initially improved, however, bilateral eye pain, redness, and photophobia 2 weeks after discharge prompted his first visit to the ophthalmology clinic. Exam at that time was consistent with bilateral anterior uveitis for which he was given topical prednisolone and cyclopentolate. In addition to the preceding work-up, quantitative immunoglobulin serology including IgG4 levels was added. At follow-up, he was found to have increased ocular inflammation with vitreitis, nerve head edema, and subclinical macular thickening. Visual acuity (VA) had decreased in both eyes. Serology titers for IgG had resulted in a significant elevation in IgG subclass 4 (IgG4). Optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) confirmed posterior retinal involvement. The patient was diagnosed with presumed bilateral panuveitis secondary to IgG4-ROD. Conclusions and Importance. IgG4-RD can be a serious condition that requires careful consideration and intuition to diagnose. This report serves to encourage ophthalmologists to consider IgG4-ROD in cases of idiopathic systemic inflammation with ophthalmic involvement.http://dx.doi.org/10.1155/2019/5653282 |
| spellingShingle | Maria A. Mavrommatis Sarah A. Avila Richard France IgG4-Related Ophthalmic Disease Presenting as Meningitis and Panuveitis Case Reports in Ophthalmological Medicine |
| title | IgG4-Related Ophthalmic Disease Presenting as Meningitis and Panuveitis |
| title_full | IgG4-Related Ophthalmic Disease Presenting as Meningitis and Panuveitis |
| title_fullStr | IgG4-Related Ophthalmic Disease Presenting as Meningitis and Panuveitis |
| title_full_unstemmed | IgG4-Related Ophthalmic Disease Presenting as Meningitis and Panuveitis |
| title_short | IgG4-Related Ophthalmic Disease Presenting as Meningitis and Panuveitis |
| title_sort | igg4 related ophthalmic disease presenting as meningitis and panuveitis |
| url | http://dx.doi.org/10.1155/2019/5653282 |
| work_keys_str_mv | AT mariaamavrommatis igg4relatedophthalmicdiseasepresentingasmeningitisandpanuveitis AT sarahaavila igg4relatedophthalmicdiseasepresentingasmeningitisandpanuveitis AT richardfrance igg4relatedophthalmicdiseasepresentingasmeningitisandpanuveitis |