case_images: PMC11818687_01
case_images: The initial presentation of the patient was a bilateral non-painful mass on the orbital rim.
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case_images: This was accompanied by conjunctival congestion, eyelid edema, and a severe limitation of ocular mobility (Figure 1).
case_images: (A,B): The patient presents with sialoadenitis and parotidomegaly, which impede the ability to close the mouth. * The area of greatest inflammation is indicated on the diagram.
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case_images: During the evaluation conducted by the rheumatology department, the presence of bilateral exophthalmos was identified, accompanied by the observation of non-painful dacryoadenitis, sialoadenitis, and parotidomegaly (Figure 2A,B).
case_images: CT scan of the patient. (A) Axial plane, (B) sagittal, and (C) coronal plane where the arrows show infiltration of the adjacent orbital tissue, causing the patient's bilateral proptosis.
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case_images: Additionally, there was evidence of bilateral maxillary sinusitis, with no indication of periorbital cellulitis (Figure 3A-C).
case_images: (A) (Hye, 40x). Mucinous salivary gland with diffuse lymphoplasmacytic inflammatory infiltrate in the central part of the photomicrograph, replacing acinar and ductal structures. (B) (Hye, 400x) dense, mature lymphoplasmacytic infiltrate. The red arrow shows plasma cells, and the yellow arrow shows lymphocytes. (C) (IHC, 100x) Mature plasma cells, positive with IgG4 immunostaining (brown). * Salivary gland duct lights +: Area of chronic dense inflammatory infiltrate.
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case_images: Furthermore, additional findings are presented in Figure 4A-C.