To enhance clinical recognition of oculomotor nerve palsy as a rare presentation of IgG4-related disease (IgG4-RD) and provide diagnostic and therapeutic insights, given its incidence of less than 1%.
Approach:
Case Presentation: A 76-year-old man presented with a two-month history of bilateral plantar numbness, nausea, vomiting, and headache. He was diagnosed with IgG4-RD after comprehensive laboratory and imaging evaluations during two hospitalizations.
Key Findings:
Oculomotor nerve palsy is an exceptionally rare manifestation of IgG4-RD, with an incidence of less than 1%.
The patient exhibited isolated right oculomotor nerve palsy with no structural abnormalities on MRI.
Treatment resulted in significant clinical improvement within four months, with normalization of serum IgG4 levels.
Interpretation:
IgG4-RD should be considered in the differential diagnosis of unexplained cranial neuropathies, even in the absence of radiographic abnormalities. Neurological recovery may be gradual and require sustained immunosuppression.
Limitations:
The case highlights the rarity of oculomotor nerve involvement in IgG4-RD, which may complicate timely diagnosis.
The potential for misattribution of symptoms to other conditions may delay appropriate treatment.
Conclusion:
Neurological recovery in IgG4-RD may be gradual and require sustained immunosuppression, emphasizing the importance of multidisciplinary collaboration in managing atypical manifestations of IgG4-RD.
