case_images: PMC11259488_01
case_images: Computed tomography of nose and paranasal sinuses without contrast demonstrated: mild to moderate mucosal thickening of frontal/ ethmoid air cells/sphenoid/maxillary sinus consistent with pansinusitis with erosion of right lamina papyracea (arrowhead). Mucosal thickening obscures the ostiomeatal units bilaterally. Leftward deviation of the nasal septum (star) with a left-sided spur contacting the left inferior turbinate.
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case_images: PMC11259488_01_jchim-14-03-113f1.jpg
case_images: f1-jchim-14-03-113
case_images: To further investigate potential sinonasal disease, a computed tomography (CT) scan of the nose and paranasal sinuses (Fig. 1) was performed that showed mild to moderate mucosal thickening in the frontal, ethmoid, sphenoid, and maxillary sinuses, indicative of pansinusitis with erosion of right lamina papyracea.
case_images: Histopathology A. Respiratory mucosa with marked inflammatory infiltrate, with prominent plasma cells throughout. (H&E, 100x). B: IgG4-positive plasma cells highlighted on immunostain (IgG4, 200x).
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case_images: PMC11259488_01_jchim-14-03-113f2.jpg
case_images: f2-jchim-14-03-113
case_images: The specimens from the right and left maxillary sinus antrostomy showed glandular tissue with chronic inflammation (Fig. 2A). IgG4 demonstrated a significant presence of IgG4 plasma cells, with up to 60 IgG4 plasma cells per high-powered field (Fig. 2B). In-situ hybridization for Kappa and Lamda indicated a polyclonal population of plasma cells, suggesting IgG4-associated sclerosing disease involving both the bilateral nasal cavities and the eye orbit.