case_images: PMC6362419_01
case_images: Bronchoscopy showing multiple ulcers of the pharynx, highly vulnerable mucous membranes and granulomatous changes of the vocal cords.
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case_images: PMC6362419_01_fmed-06-00008-g0001.jpg
case_images: F1
case_images: To exclude an involvement of trachea a bronchoscopy was done revealing multiple ulcers of the pharynx, highly vulnerable mucous membranes and granulomatous changes of the vocal cords (Figure 1).
case_images: Immunoblotting of extracellular matrix showing circulating IgG4-autoantibodies to gamma2-chain of laminin-332.
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case_images: PMC6362419_01_fmed-06-00008-g0002.jpg
case_images: F2
case_images: As serology testings were negative, immunoblotting of extracellular matrix was performed, which was positive for circulating IgG4-autoantibodies to gamma2-chain of laminin-332 (Figure 2).
case_images: Active bilateral stage 4 symblepharon according to Tauber und Foster classification.
case_images: fmed-06-00008-g0003.jpg
case_images: PMC6362419_01_fmed-06-00008-g0003.jpg
case_images: F3
case_images: Given both, the critical laryngal involvement causing dyspnoea and the ocular bilateral stage 4 symblepharon according to Tauber und Foster classification (Figure 3), systemic treatment was initiated.
case_images: Post-treatment pictures showing a stable ocular involvement and no new enoral lesions 5 month after rituximab treatment.
case_images: fmed-06-00008-g0004.jpg
case_images: PMC6362419_01_fmed-06-00008-g0004.jpg
case_images: F4
case_images: The follow-up examination 8 weeks later revealed a stable disease with no new oral lesions (Figure 4).