{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:10:03Z","timestamp":1756318203030,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,6]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>A 77-year-old Lithuanian man presented to our institution with recurrent episodes of periorbital cellulitis, submandibular swelling and sialadenitis. Investigations revealed a positive QuantiFERON, raised inflammatory markers and normal autoimmune screen. Cross-sectional imaging showed no signs of occult malignancy, and work-up for mycobacterial infection including imaging and bronchoalveolar lavage did not show active tuberculosis. During hospitalisation, the patient developed fevers of unknown origin, which were investigated with a positron emission tomography (PET) scan and a bone marrow aspiration, without evidence of occult infection or malignancy. Serum IgG4 level was three times the upper limit of normal. The patient responded well to oral steroids but relapsed after completing a slow taper. Serum IgG4 level was three times the upper limit of normal. He had an American College of Rheumatology\/European League Against Rheumatism score of 20, in conjunction with involvement of orbital and salivary tissue. Therefore, IgG4-related disease was considered the most likely diagnosis, despite prominent fevers, which are among the exclusion criteria for this diagnosis. After a multidisciplinary review including rheumatology and ophthalmology, the patient was commenced on maintenance methotrexate with remission of symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2021-242415","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T12:33:30Z","timestamp":1629808410000},"page":"e242415","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Suspected IgG4-related disease of the submandibular salivary gland and periorbital soft tissue in a man with latent tuberculosis"],"prefix":"10.1136","volume":"14","author":[{"given":"Aim\u00e9e","family":"McGreal-Bellone","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Cork University Hospital Group, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Lapthorne","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Cork University Hospital Group, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinna","family":"Sadlier","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Cork University Hospital Group, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geraldine","family":"Moloney","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Cork University Hospital Group, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,24]]},"reference":[{"key":"2025082710313475000_14.8.e242415.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1104650"},{"key":"2025082710313475000_14.8.e242415.2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003785"},{"key":"2025082710313475000_14.8.e242415.3","doi-asserted-by":"crossref","DOI":"10.1136\/annrheumdis-2012-eular.698","article-title":"AB0698\u2005atent tuberculosis: a potential extrinsic factor for IGG4-related disease","volume":"71","author":"Kawano","year":"2013","journal-title":"Ann Rheum Dis"},{"key":"2025082710313475000_14.8.e242415.4","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-746933"},{"key":"2025082710313475000_14.8.e242415.5","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/art.41120","article-title":"The 2019 American college of rheumatology\/European league against rheumatism classification criteria for IgG4\u2010related disease","volume":"72","author":"Wallace","year":"2020","journal-title":"Arthritis Rheumatol"},{"key":"2025082710313475000_14.8.e242415.6","unstructured":"Gorman SCACIOSKAMKPO A . Case report: IgG4 related disease masquerading as tuberculosis, 2017. Irish Society of rheumatology. Available: https:\/\/www.isr.ie\/abstracts\/case-report-igg4-related-disease-masquerading-tuberculosis\/"},{"key":"2025082710313475000_14.8.e242415.7","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.cca.2020.04.001","article-title":"Clinical utility of serum IgG4 measurement","volume":"506","author":"Varghese","year":"2020","journal-title":"Clin Chim Acta"},{"key":"2025082710313475000_14.8.e242415.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204907"},{"key":"2025082710313475000_14.8.e242415.9","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1159\/000509501","article-title":"Atypical manifestations of IgG4-related disease as multiple liver abscesses with subcapsular tracts and migratory pulmonary nodules mimicking parasitic infection","volume":"14","author":"Jandee","year":"2020","journal-title":"Case Rep Gastroenterol"},{"key":"2025082710313475000_14.8.e242415.10","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcl138"},{"key":"2025082710313475000_14.8.e242415.11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s13317-015-0069-3","article-title":"IgG4-related disease: case report and literature review","volume":"6","author":"Nizar","year":"2015","journal-title":"Auto Immun Highlights"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242415","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:31:46Z","timestamp":1756315906000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242415"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":11,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,24]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-242415"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242415","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}