ABSTRACT
A 41-year-old man was diagnosed with immunoglobulin G4-related disease (IgG4-RD) in both eyelids 4 years ago and exhibited good response to steroid therapy. However, rapid swelling of the right eyelid lesion was recently observed. As IgG4-RD progression was suspected, biopsy was performed. Although the histology was consistent with IgG4-RD, the infiltrating large atypical lymphoid cells showed immunoglobulin light-chain restriction and IgH gene rearrangement. Consequently, he was diagnosed with extranodal marginal zone lymphoma with abundant IgG4-positive cells.
Subject(s)
Eye Neoplasms , Eyelids/pathology , Glucocorticoids/therapeutic use , Immunoglobulin G4-Related Disease , Lymphoma, B-Cell, Marginal Zone , Adult , Biopsy/methods , Diagnosis, Differential , Eye Neoplasms/diagnosis , Eye Neoplasms/etiology , Eye Neoplasms/pathology , Humans , Immunoglobulin G/analysis , Immunoglobulin G4-Related Disease/complications , Immunoglobulin G4-Related Disease/diagnosis , Immunoglobulin G4-Related Disease/drug therapy , Lymphoma, B-Cell, Marginal Zone/diagnosis , Lymphoma, B-Cell, Marginal Zone/etiology , Lymphoma, B-Cell, Marginal Zone/pathology , Male , Oncogene ProteinsABSTRACT
We report a 78-year-old man with diabetic nephropathy, who presented with acquired reactive perforating collagenosis, followed by gangrenous infections localized on the lesions. Histopathological findings revealed a feature of transepidermal elimination of degenerated collagen bundles associated with infiltrates of neutrophils. Staphylococcus aureus was isolated from the necrotic tissue. The infection was successfully treated with systemic antibiotics and debridement. We believe that the presence of necrotic plug in the lesions and microangiopathy due to diabetes mellitus may provide a susceptible milieu for bacterial inoculation.