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Título

Ophthalmoparesis secondary to IgG4-related disease – a case report.

RESUMO

CASE REPORT: A.L.O.S, female, 61 years old. The patient related binocular diplopia, ophtalmoparesis – there was no horizontal movement and limited vertical movement - and fixed semiptosis in the left eye that started 3 days before the medical care. The patient experienced similar symptoms two years ago, wich solved spontaneously. Previous diseases were osteoporosis, dilispidemia and systemic arterial hypertension. The Magnetic Resonance Imaging showed expansive/infiltrative formation compromising the left lateral rectus musculature and a lesion with the same sign in the temporal musculature in the same side. Cerebrospinal fluid analysis was normal. Lateral rectus muscle biopsy confirmed IgG4-related disease. The patient started corticotherapy (prednisone 40 mg/ per day). DISCUSSION: IgG4-related disease is an imunomediated disease characterized by enlargement of the organs and lymphoplasmtyc infiltration. It is a rare condition that affect 2,2 to 100000 people. Extraocular muscle involvement in this disease has been related but with a poor description of the eye movement. The literature describes IgG4-related disease eye movement muscles involvement as a condition that is associated to pain, proptosis and ophtamoplegia. The case reported above had a different clinical presentation because semiptosis and sever ophtalmopharesis that is uncommon in IgG4-related disease; also, there was no eye pain. FINAL COMMENTS: IgG4-related disease usually appear as a condition with normal ocular motility. Once there are lots of other diseases that compromisse eye movement muscles this case repor is important to neurologists to show na unexpectd clinical presentation and call atention to the need to make a correct diagnosis despite of na atypical presentation.

Palavras Chave

IgG4-related disease; Ophthalmoparesis; Extraocular muscle involvement.