An Initial Presentation of Facial Impetigo in IgG4-related Disease: A Case Report
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Keywords
IgG4-related disease, sialadenitis, dacryoadenitis, facial impetigo, case report
Abstract
Background: Immunoglobulin G4-related disease (IgG4-RD) is a rare multi-organ, immune-mediated, fibro-inflammatory condition presenting with tumefactive lesions. Although this condition has characteristic clinical and histopathological features, the phenotypic variability of IgG4-RD provides a diagnostic challenge. Here, we describe a case of facial impetigo presenting as a manifestation of IgG4-RD.
Case Presentation: An 18-year-old female presented to the emergency department with acute facial impetigo in the setting of chronic dacryoadenitis, sialadenitis, parotitis, and lymphadenopathy which had been clinically diagnosed as IgG4-RD. The impetiginized facial rash resolved with oral doxycycline, and the steroid-recalcitrant IgG4-RD symptoms responded to rituximab infusions.
Conclusions: Due to the rarity of IgG4-RD, secondary manifestations and associations of the disease are continuously emerging. Immune-mediated conditions with cutaneous involvement, such as in IgG4-RD, may prime the skin for the inoculation of bacteria and lead to skin infection(s) such as impetigo. Rituximab may be used for steroid-resistant cases of IgG4-RDs without concurrent corticosteroid therapy.
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