Longstanding IgG4-related Ophthalmic Disease Dramatically Improved after Steroid Therapy

A 61-year-old man was admitted to our hospital because of decreased visual acuity. On admission, he had marked blepharoedema, conjunctival injection, exophthalmos, diplopia, and blurred vision. He also had bronchial asthma and urinary retention requiring urethral catheterization. His serum immunoglobulin (Ig) G4 level was elevated to 1,830 U/mL. Fluorodeoxyglucose-positron emission tomography revealed an abnormal uptake in multiple organs. A histopathological examination of the salivary gland revealed IgG4-positive plasma cell infiltration, leading to a diagnosis of IgG4-related ophthalmic disease. After initiating steroid therapy, his longstanding ophthalmic, respiratory, and urinary symptoms dramatically improved. In IgG4-related disease, steroid therapy should be considered even if patients have longstanding symptoms.