Images in Clinical Rheumatology
IgG4-related orbital pseudotumor
Pseudotumor orbitario relacionado con IgG4
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class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Eva María" "apellidos" => "Fonseca Aizpuru" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Carolina" "apellidos" => "Estrada Menéndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Loreto" "apellidos" => "Buznego Suárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Salud de Contrueces, Gijón, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudotumor orbitario relacionado con IgG4" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 586 "Ancho" => 950 "Tamanyo" => 63144 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MR imaging with pseudotumour.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 47 year-old woman with a background of total thyroidectomy from goitre with benign thyroid nodules presented with exophthalmos of several weeks onset (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no involvement of the ENT sphere, and no pulmonary, polyneuropathy, dry syndrome, arthralgias, photosensitivity or cutaneous lesions. Magnetic resonance (MR) imaging revealed a solid retrobulbar mass which surrounded the optic nerve and was of fusiform morphology measuring 24<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We considered the need for biopsy but desisted, due to the high risk of complications. The ANAS, ANCAS, anti-DNA analysis, complement activity, proteinuria and ACE tested negative and the raising of immunoglobulin G4 860<span class="elsevierStyleHsp" style=""></span>mg/dl was remarkable (normal: 10–140). The patient was diagnosed with a possible IgG4-related inflammatory orbital disease in keeping with clinical and serological criteria. Treatment with high doses of steroids and azatiorpine was initiated but suspended due to intolerance. The patient is currently being treated with mycophenolate mofetil and is responding favourably with no inflammatory activity. IgG4-related disease is a new entity which comprises several fibroinflammatory diseases which have not been previously linked to one another.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> Clinical features are highly varied and presentation is usually subacute.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> Ocular-orbital symptoms include: idiopathic orbital inflammation, pachymeningitis and sclerouveitis.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a> Orbital pseudotumour is an uncommon presentation of IgG4 diseases.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> It is important to recognize this new disease to diagnoses it, since specific treatment may prevent complications.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-11-30" "fechaAceptado" => "2018-02-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández Regueiro R, Fonseca Aizpuru EM, Estrada Menéndez C, Buznego Suárez L. Pseudotumor orbitario relacionado con IgG4. Reumatol Clin. 2020;16:245–246.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 973 "Ancho" => 950 "Tamanyo" => 124142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Exophthalmos.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 586 "Ancho" => 950 "Tamanyo" => 63144 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MR imaging with pseudotumour.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IgG4-related disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.H. 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Dolman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamaophthalmol.2017.1581" "Revista" => array:6 [ "tituloSerie" => "JAMA Ophthalmol" "fecha" => "2017" "volumen" => "135" "paginaInicial" => "769" "paginaFinal" => "776" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28570731" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ophthalmic manifestations of IgG4-related disease: single-center experience and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Z.S. Wallace" 1 => "V. Deshpande" 2 => "J.H. 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Couch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12348-015-0047-y" "Revista" => array:5 [ "tituloSerie" => "J Ophthalmic Inflamm Infect" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26034515" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001600000003/v1_202006131316/S2173574319300759/v1_202006131316/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001600000003/v1_202006131316/S2173574319300759/v1_202006131316/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300759?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 1 | 8 |
| 2024 October | 78 | 31 | 109 |
| 2024 September | 63 | 14 | 77 |
| 2024 August | 71 | 27 | 98 |
| 2024 July | 48 | 34 | 82 |
| 2024 June | 43 | 32 | 75 |
| 2024 May | 50 | 36 | 86 |
| 2024 April | 43 | 29 | 72 |
| 2024 March | 53 | 24 | 77 |
| 2024 February | 49 | 31 | 80 |
| 2024 January | 58 | 20 | 78 |
| 2023 December | 65 | 17 | 82 |
| 2023 November | 65 | 45 | 110 |
| 2023 October | 53 | 31 | 84 |
| 2023 September | 108 | 33 | 141 |
| 2023 August | 61 | 16 | 77 |
| 2023 July | 70 | 21 | 91 |
| 2023 June | 52 | 23 | 75 |
| 2023 May | 83 | 20 | 103 |
| 2023 April | 55 | 11 | 66 |
| 2023 March | 76 | 26 | 102 |
| 2023 February | 42 | 18 | 60 |
| 2023 January | 55 | 26 | 81 |
| 2022 December | 76 | 29 | 105 |
| 2022 November | 77 | 33 | 110 |
| 2022 October | 65 | 47 | 112 |
| 2022 September | 51 | 25 | 76 |
| 2022 August | 51 | 41 | 92 |
| 2022 July | 44 | 41 | 85 |
| 2022 June | 62 | 35 | 97 |
| 2022 May | 46 | 48 | 94 |
| 2022 April | 40 | 36 | 76 |
| 2022 March | 46 | 37 | 83 |
| 2022 February | 49 | 32 | 81 |
| 2022 January | 85 | 39 | 124 |
| 2021 December | 34 | 37 | 71 |
| 2021 November | 41 | 49 | 90 |
| 2021 October | 61 | 53 | 114 |
| 2021 September | 29 | 40 | 69 |
| 2021 August | 19 | 25 | 44 |
| 2021 July | 24 | 28 | 52 |
| 2021 June | 31 | 21 | 52 |
| 2021 May | 43 | 49 | 92 |
| 2021 April | 69 | 85 | 154 |
| 2021 March | 39 | 27 | 66 |
| 2021 February | 19 | 22 | 41 |
| 2021 January | 28 | 19 | 47 |
| 2020 December | 23 | 19 | 42 |
| 2020 November | 28 | 23 | 51 |
| 2020 October | 5 | 0 | 5 |
| 2020 May | 1 | 2 | 3 |
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