{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T12:14:16Z","timestamp":1788178456642,"version":"build-2803163510"},"reference-count":31,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>IgG4-related disease (IgG4-RD) is a rare fibroinflammatory condition that can mimic infectious or neoplastic diseases, leading to diagnostic challenges. We report a case of a man in his mid-40s presenting with rapidly progressive orbital symptoms initially diagnosed as orbital cellulitis. Despite appropriate surgical and medical management, the patient\u2019s condition worsened with multiple cranial nerve involvement.<\/jats:p>\n                  <jats:p>MRI revealed an infiltrative process with perineural extension involving the optic, infraorbital, facial and auriculotemporal nerves. Histopathological examination confirmed IgG4-RD, demonstrating dense lymphoplasmacytic infiltration, storiform fibrosis and numerous IgG4-positive plasma cells. Serum IgG4 levels were markedly elevated.<\/jats:p>\n                  <jats:p>The patient responded well to corticosteroid therapy with significant clinical and radiological improvement. This case highlights an unusual presentation of IgG4-RD masquerading as orbital cellulitis and emphasises the importance of reconsidering the diagnosis when the clinical course is atypical or discordant with an infectious process.<\/jats:p>\n                  <jats:p>Early recognition is crucial to avoid unnecessary surgical interventions and prevent irreversible neurological damage.<\/jats:p>","DOI":"10.1136\/bcr-2025-267278","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:20:14Z","timestamp":1788175214000},"page":"e267278","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["IgG4-related disease involving facial, infraorbital, auriculotemporal and optic nerves: multinervous cranial involvement in an adult patient"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5721-7160","authenticated-orcid":false,"given":"Fadoua","family":"El 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