Clinical Report: Prominent Oculomotor Nerve Palsy as a Presentation of IgG4-RD

Overview

This case study presents a 76-year-old man with oculomotor nerve palsy as a rare manifestation of IgG4-related disease (IgG4-RD). The diagnosis was confirmed through laboratory evaluations and histopathology.

Background

IgG4-RD is a systemic fibroinflammatory disorder that can involve various organs, but cranial nerve involvement is exceptionally rare. Oculomotor nerve palsy may be misdiagnosed due to nonspecific symptoms.

Data Highlights

Case study of a 76-year-old man with bilateral plantar numbness, nausea, vomiting, and headache leading to the diagnosis of IgG4-RD. Laboratory tests showed elevated immunoglobulins, and histopathology confirmed IgG4-RD.

Key Findings

• Oculomotor nerve palsy is a rare presentation of IgG4-RD, with an incidence of less than 1% among patients.
• Histopathology revealed reactive lymphoid hyperplasia with abundant IgG4+ plasma cell infiltration.
• Contrast-enhanced MRI showed no structural abnormalities.
• Treatment with immunosuppressive therapy was initiated.
• IgG4-RD should be considered in the differential diagnosis of unexplained cranial neuropathies.

Clinical Implications

IgG4-RD should be considered in patients presenting with unexplained cranial nerve palsies.

Conclusion

This case highlights the need for recognition of IgG4-RD as a potential cause of oculomotor nerve palsy.

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