Clinical diagnosis and treatment for 3 cases of IgG4-related sinusitis

Objective To summarize the clinical characteristics, treatment regimens, and outcomes of IgG4-related sinusitis in order to improve clinicians' knowledge of the disease. Methods A retrospective descriptive study was conducted on 3 cases of IgG4-related sinusitis admitted to our hospital from January 2019 to January 2023. Their clinical manifestation, results of laboratory tests, radiological findings, surgical methods, postoperative pathologic results, treatment and managements, and outcomes during follow-up were analyzed, and relevant literature was also reviewed. Results Among the 3 patients, there were 1 male and 2 females, at an average age of 63 (53 to 71) years, with a course of disease for 1~5 years. The main symptoms included nasal congestion, ear fullness, eyelid lumps, cervical lymphadenopathy and enlarged submandibular gland. Serum IgG4 level was elevated to 3.2~4.7 g/L. Sinus CT scans confirmed sinusitis with nasal polyps. No involvement of organs other than the head and neck was observed in radiological examination. All 3 cases underwent functional endoscopic sinus surgery and polypectomy. Post-surgical pathology confirmed IgG4-related sinusitis. Other treatments included nasal steroids and nasal lavage conventionally. Recurrence of the disease was noted 3~10 months postoperatively, then 30~40 mg/d prednisone acetate was given orally as induction therapy for 1 month, which effectively controlled the conditions in all cases. The dose of prednisone acetate was gradually reduced to 5 mg/day for long-term maintenance. One patient took oral immunosuppressant mycophenolate mofetil in combination. All 3 patients were followed up for 14~32 months, and no further recurrence was observed. Conclusion IgG4-related sinusitis shows similar clinical characteristics as chronic sinusitis, and pathologic observation is essential for its diagnosis. Its preferred treatment is steroid therapy, particularly low-dose long-term as maintenance, is key to preventing recurrence. Combined steroid and immunosuppressant therapy can more effectively control the condition of disease.