IgG4-Related Dacryoadenitis in Egyptian Patients: A Retrospective Study

Omar Hassan Salama,1 Ezzat Nabil Abbas Ibrahim,1 Mostafa Osman Hussein,1 Ahmed Mohammed Madinah Alkady,1 Mohammed Eid Abd El-Salam,1 Saad Ghanem2 1Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 2Rheumatology and Rehabilitation Department, Faculty of Medicine, Al-Azhar University, Cairo, EgyptCorrespondence: Omar Hassan Salama, Lecturer of Ophthalmology, Faculty of Medicine, Al Azhar University, El Hussain University Hospital, Gawhar Al Qaed Street, Al Darrasah, Cairo, 11561, Egypt, Tel +201146316323, Email omar.salama@azhar.edu.egPurpose: To report clinical, serological, and histopathological findings in Egyptian patients with dacryoadenitis associated with ImmunoglobulinG4-related disease (IgG4-RD).Methods: We retrospectively revised medical records of patients presented to Al-Azhar University Hospitals with lacrimal gland (LG) swelling between June 2016 and February 2022. We included patients with definite IgG4-related disease (IgG4-RD) diagnosis and excluded those with possible, probable, or unlikely IgG4-RD based on The Japanese Ministry of Health, Labour, and Welfare’s 2011 guidelines.Results: Sixteen cases were included in the study (Fourteen females and two males, mean age 39.2± 12.2 years); Seven cases met the criteria of Mikulicz disease, and nine cases met full clinical, serological, and histopathological criteria. Mean reported serum IgG was 1792.5 ± 313.7 (range 1063– 2134) mg/dl, mean serum IgG4 was 576.25± 215.3 (range 112– 841) mg/dl, and mean Serum IgG4/IgG ratio was 31.9 ± 12.4%. The mean number of IgG4+ plasma cells/HPF was 74 ± 21.2, and the mean IgG4+ plasma cell percentage was 55 ± 9.7%. Serum IgG4 level showed a positive correlation to tissue IgG4+plasma cell percentage, while serum IgG4/IgG ratio positively correlated to both percentage and number of IgG4+plasma cells. Steroids had a good initial response, but recurrences were common.Conclusion: A considerable proportion of patients with lacrimal gland swelling fall within the range of IgG4-RD. Proper diagnosis requires clinical, serological, and histopathologic correlation. Patients require long follow-up periods.Keywords: IgG4-RD, IgG4-ROD, IgG4-related dacryoadenitis, Mikulicz disease