SUMMARY
The aim. To present a clinical case of lacrimal and thyroid gland involvement in the context of IgG4-related systemic disease. Material and Methods. A 56-year-old female patient underwent a standard ophthalmological examination, Schirmer and Norn tests, laboratory investigations, and orbital and abdominal magnetic-resonance imaging studies. Results. The patient was found to have bilateral dacryoadenitis, dry eye syndrome, eyelid edema, and a significantly elevated serum IgG4 level. A rheumatologist diagnosed IgG4-related systemic disease, and clinical improvement was observed under immunosuppressive therapy. Conclusion. In patients with long-standing dacryoadenitis and systemic manifestations, IgG4-related disease should be considered in the differential diagnosis, and a multidisciplinary approach should be applied.
Keywords: IgG4-related disease, dacryoadenitis, lacrimal gland, orbit, dry eye syndrome

---

REFERENCES

1. Kim D, Jeong S, Lew H. Unraveling the Clinical Features and Outcomes of IgG4-Related Ophthalmic Disease // J Clin Med. 2024 Jun 27;13(13):3780. doi: 10.3390/jcm13133780
2. Lanzillotta M, Mancuso G, Della-Torre E. Advances in the diagnosis and management of IgG4 related disease. BMJ // 2020 Jun 16;369:m1067. doi: 10.1136/bmj.m1067
3. Stone JH, Zen Y, Deshpande V. IgG4-related disease // N Engl J Med. 2012 Feb 9;366(6):539-51. doi: 10.1056/NEJMra1104650
4. Timakova AA, Radenska-Lopovok SG. Differential diagnosis of IgG4-related disease // Russian Journal of Archive of Pathology. 2023;85(2):60‑65. (In Russ.) doi: 10.17116/patol20238502160
5. Takahira M, Goto H, Azumi A. The 2023 revised diagnostic criteria for IgG4-related ophthalmic disease // Jpn J Ophthalmol. 2024 Jul;68(4):293-301. doi: 10.1007/s10384-024-01072-4
6. Wallace ZS, Naden RP, Chari S, Choi HK, et al; Members of the ACR/EULAR IgG4-RD Classification Criteria Working Group. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease // Ann Rheum Dis. 2020 Jan;79(1):77-87. doi: 10.1136/annrheumdis-2019-216561
7. Umehara H, Okazaki K, Kawa S, Takahashi H, et al; Research Program for Intractable Disease by the Ministry of Health, Labor and Welfare (MHLW) Japan.. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD // Mod Rheumatol. 2021 May;31(3):529-533. doi: 10.1080/14397595.2020.1859710
8. Della-Torre E, Lanzillotta M, Doglioni C. Immunology of IgG4-related disease // Clin Exp Immunol. 2015 Aug;181(2):191-206. doi: 10.1111/cei.12641
9. Detiger SE, Karim AF., Verdijk RM., van Hagen PM, et al. The treatment outcomes in IgG4-related orbital disease: a systematic review of the literature // Acta Ophthalmol. 2019;97(5):451-459. doi: 10.1111/aos.14048.
10. Maritati F, Peyronel F, Vaglio A. IgG4-related disease: a clinical perspective // Rheumatology (Oxford). 2020 May 1;59(Suppl 3):iii123-iii131. doi: 10.1093/rheumatology/kez667.