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Letters |

Ocular Adnexal IgG4-Related Lymphoplasmacytic Infiltrative Disorder and Graves Ophthalmopathy

Toshinobu Kubota, MD; Suzuko Moritani, MD; Hiroko Terasaki, MD, PhD
Arch Ophthalmol. 2011;129(6):805-820. doi:10.1001/archophthalmol.2011.138.
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We read with interest the article by Bijlsma and Kalmann.1 The authors described a patient who had both idiopathic orbital inflammation (IOI) and Graves ophthalmopathy (GO). This was unexpected because each has distinct clinical characteristics. They proposed a yet-undetermined common pathogenesis for these disorders.1 We present clinical data obtained from a patient that can explain a relationship between these distinct clinical entities.

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Figure 1.

A, External photograph of patient showing exophthalmos, hypertropia, exotropia, and left upper eyelid swelling. B, Computed tomography shows that the lesions have infiltrated into the anterior superior orbits.

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Figure 2.

Histology and immunohistochemistry of an ocular adnexal lesions. A, Low magnification shows sclerosing inflammation with a reactive lymphoid infiltrate (hematoxylin-eosin, original magnification ×40). B, High magnification show lymphoplasmacytic infiltrations and immunostaining for IgG4 reveals IgG4-positve plasma cells (IgG4 to IgG ratio, 80%) in the reactive lymphoid lesions (hematoxylin-eosin and immunoperoxidase, original magnification ×400).

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