IgG4-Positive Conjunctival Tumor with Systemic Allergy: A Case Report.

PURPOSE: To report a case of IgG4-positive conjunctival tumor with allergic rhinitis and bronchial asthma.

METHOD: Case report.

RESULTS

A 55-year-old female presented with bilateral eye itching and recurrent eyelid swelling for one year, worsening in the past month with difficulty opening her eyes. Initial treatment for allergic conjunctivitis included corticosteroid eye drops, but symptoms recurred. Examination revealed significant eyelid swelling and a conjunctival tumor with abundant mucous discharge. CT scans showed bilateral eyelid thickening without lacrimal gland involvement. Laboratory tests indicated IgG4 levels were 844 mg/dL. Surgical excision of the conjunctival tumor revealed extensive inflammatory cell infiltration. Histopathological findings indicated more than 50 IgG4+ plasma cells and IgG4+/IgG+ ratio about 60% per high power field (x400), leading to a diagnosis of IgG4-related conjunctival tumor.

CONCLUSIONS

This case highlights isolated allergic conjunctivitis as a manifestation of IgG4-related disease, underscoring the critical need for comprehensive evaluation in patients enduring conjunctival symptoms. Surgical excision of the conjunctival lesions alleviated tissue compression, yielding a resolution of symptoms; this intervention was complemented by postoperative topical corticosteroid therapy. Substantiating the link between tumor formation and IgG4-RD demands further case evidence. Even in instances of isolated conjunctival IgG4-related ophthalmic disease (IgG4-ROD), a persistent risk of multi-organ involvement emerges over time, making long-term follow-up and vigilant observation imperative.