RESUMO
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.
Assuntos
Neoplasias Oculares , Pálpebras/patologia , Glucocorticoides/uso terapêutico , Doença Relacionada a Imunoglobulina G4 , Linfoma de Zona Marginal Tipo Células B , Adulto , Biópsia/métodos , Diagnóstico Diferencial , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/etiologia , Neoplasias Oculares/patologia , Humanos , Imunoglobulina G/análise , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/etiologia , Linfoma de Zona Marginal Tipo Células B/patologia , Masculino , Proteínas OncogênicasRESUMO
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.