Omar Ahmad Abu Suliman
King Abdullah Medical City
Kingdom of Saudi Arabia
Omar Ahmad Abu Suliman is a Senior Registrar at the Department of Otolaryngology-Head and Neck Surgery at King Abdullah Medical City in Makkah, Saudi Arabia. He obtained his MBBS at Umm Al Qura University in Makkah, in 2008. He completed his Residency in the Western Region Program of the Saudi Board of Otolaryngology Head & Neck Surgery in Dec 2014. His fields of interest are Rhinology & Endoscopic Skull Base Surgery.
Immunoglobulin G4 (IgG4) related disease is a newly recognized fibroinflammatory condition characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum IgG4 concentrations. We present a 38 years old female complaining of headache which was progressive and unilateral resistant to analgesics. Diagnosed as a case of migraine started anti migraine treatment with no benefit, it was further complicated by 3rd, 4th and 6th Cranial Palsy. Radiological finding of opacification of left sphenoid sinus with extension to the left cavernous sinus along with bone erosion was noted. The biopsy from the sphenoid sinus mass showed a moderately dense lymphoplasmacytic infiltration accompanied with fibrosis. Immunostaining for IgG4 show significant increase in IgG4-positive plasma cells with IgG4-IgG ratio >40% and >100% IgG4 positive plasma cells per High Field Focus (HPF), giving the diagnosis of IgG4 sinusitis. This is a rare case of IgG4 related disease in the sphenoid sinus. Clinical, radiological and therapeutic challenges are discussed.
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