Dacryoadenitis post COVID-19 infection and immunization

Dacryoadenitis can be a rare presentation following COVID-19 infection or can be an immunological response post COVID-19 vaccination. Herein we report two cases of lacrimal gland involvement, one post COVID-19 infection, and the other post COVID-19 vaccination. A definitive causal relationship, however, remains uncertain.

Review of a novel disease entity, immunoglobulin G4-related disease

Immunoglobulin G4 (IgG4)-related dacryoadenitis and sialoadenitis (IgG4-DS) are part of a multiorgan fibroinflammatory condition of unknown etiology termed IgG4-related disease (IgG4-RD), which has been recognized as a single diagnostic entity for less than 15 years. Histopathologic examination is critical for diagnosis of IgG4-RD. CD4+ T and B cells, including IgG4-expressing plasma cells, constitute the major inflammatory cell populations in IgG4-RD and are thought to cause organ damage and tissue fibrosis. Patients with IgG4-RD who have active, untreated disease exhibit significant increase of IgG4-secreting plasmablasts in the blood. Considerable insight into the immunologic mechanisms of IgG4-RD has been achieved in the last decade using novel molecular biology approaches, including next-generation and single-cell RNA sequencing. Exploring the interactions between CD4+ T cells and B lineage cells is critical for understanding the pathophysiology of IgG4-RD. Establishment of pathogenic T cell clones and identification of antigens specific to these clones constitutes the first steps in determining the pathogenesis of the disease. Herein, the clinical features and mechanistic insights regarding pathogenesis of IgG4-RD were reviewed.

An Unusual Case of Orbital Inflammation Preceding Herpes Zoster Ophthalmicus

PURPOSE: To present a case of orbital inflammation and optic perineuritis preceding vesicular eruption in herpes zoster ophthalmicus(HZO). CASE SUMMARY: An 84-year-old woman with a history of gall bladder cancer and hypertension complained of left periorbital erythematous edema and discomfort. On examination, visual acuity was 20/25 bilaterally; no tenderness, proptosis or ophthalmoplegia was observed. Pupils were equal, round, and reactive to light without relative afferent pupillary defects. Slit-lamp examination revealed severe conjunctival injection and chemosis without keratitis or uveitis. The remainder of the ocular examination was unremarkable. Magnetic resonance imaging confirmed left-sided preseptal swelling with an enlarged left lacrimal gland, high signal intensity of the retrobulbar fat and optic nerve sheath. Systemic antibiotic therapy with steroids was started under a presumed diagnosis of idiopathic orbital inflammatory disease, but the clinical presentation was unresolved. After 2 days, vesicular lesions confined to the first division of the trigeminal nerve and pseudodendritic keratitis developed on the left side leading to a diagnosis of HZO. Treatment with acyclovir immediately resolved anterior segment inflammation and periorbital edema. While on therapy, visual acuity deteriorated to 20/125 and the pupil became dilated and unresponsive to light over a few days. All signs and symptoms of acute orbitopathy and postherpetic neuralgia had resolved 3 months later with the exception of pupil abnormality and visual acuity. CONCLUSIONS: HZO may present with symptoms and signs of orbital inflammation and optic perineuritis even in the absence of a vesicular rash. Thus, HZO should be considered in the differential diagnosis of unexplained acute orbital syndromes.

First case report of isolated aspergillus dacryoadenitis.

We report a case of isolated Aspergillus dacryoadenitis. A 23‑year‑old male presented with dull ache, diffuse swelling in superolateral quadrant of the right orbit and proptosis for 4 months. Ocular examination showed conjunctival congestion, discharge in the fornix and palpable lacrimal gland (LG) mass. Routine hematological investigations followed by computed tomography scan of orbits were done. He did not respond to a course of systemic and topical antibiotics. Lateral orbitotomy with extended lid crease incision was performed with excision biopsy of LG. Abundant blackish material was found in the LG intraoperatively. The specimen was sent for histopathological examination (HPE). HPE report showed Aspergillus. Thorough ENT and systemic evaluation ruled out any other site with the fungus. To the best of our knowledge, this is the first case report of Aspergillus infection in LG.

A Case of Epstein-Barr Virus-Related Dacryoadenitis

PURPOSE: To report a case of Epstein-Barr virus-related dacryoadenitis. CASE SUMMARY: A 19-year-old female presented with pain, swelling and redness of both upper eyelids. She experienced rhinorrhea, cough and fever for the previous two weeks. Physical exam showed bilateral cervical lymph node enlargement, and orbital computed tomography (CT) revealed diffuse enlargement and inflammation of both lacrimal glands. Serological testing revealed elevated titers for Epstein-Barr virus nuclear antigen immunoglobulin G (IgG) and Epstein-Barr viral capsid antigens IgG and immunoglobulin M (IgM). Based on these results, clinical diagnosis of Epstein-Barr virus-related acute dacryoadenitis was made. The inflammation subsided after conservative management. Relapse was not observed during the three-month follow-up period. CONCLUSIONS: Based on acute bilateral lacrimal gland enlargement, systemic symptoms such as fever, rhinorrhea, cough, lymphadenopathy and serologically-positive results for Epstein-Barr virus, Epstein-Barr virus-related acute dacryoadenitis can be clinically diagnosed and treated with conservative therapy.

Idiopathic Orbital Inflammation Presenting as Unilateral Dacryoadenitis in a Child

PURPOSE: To report a case of idiopathic orbital inflammation presenting as unilateral acute dacryoadenitis in a child. CASE SUMMARY: A nine-year-old boy presented with painful swelling and redness in the right upper eyelid and temporal conjunctiva without systemic symptoms for five days. Acute orbital cellulitis was suspected but did not respond to systemic antibiotics. An orbital computed tomogram and magnetic resonance imaging revealed a diffusely enlarged and inflamed right lacrimal gland. The patient showed dramatic response to systemic corticosteroids, and acute dacryoadenitis due to idiopathic orbital inflammation was diagnosed. Treatment with oral corticosteroids for two months resolved the inflammation. No relapse was observed during four months of follow-up. CONCLUSIONS: Although rare, acute dacryoadenitis as a localized nonspecific orbital inflammation should be considered in the differential diagnosis of acute orbital cellulitis in pediatric patients.

Relative of Th cytokines in MRL/Ipr mice——a model for idiopathic dacryoadenitis / 中华微生物学和免疫学杂志

Objective To determine the distribution of IL-4, IL-17, IFN-γ in the lacrimal gland lesions and submaxillary lymph nodes of MRL/Ipr mice-a model for idiopathic dacryoadenitis, and investi-gate the possible role of T-belper cells in the disease. Methods Frozen sections of lacrimal glands and sub-maxillary lymph nodes from MRL/lpr and BALB/c mice age 3 months were stained with antibodies to the cy-tokines IL-4, IL-17 and IFN-γ, then calculated the numbers or proportions of positive cells respectively,double staining for CD4 and each cytokine was taken in lymph nodes of MRL/Ipr mice additionally. Results The major cytokine in lacrimal gland lesions is IL-4, which contrasts to little IL-17 or IFN-γ/stained(P <0.05), the numbers of cells staining for each cytokine in submaxillary lymph nodes elevate in MRL/lpr mice, and the expressions of IL-4 and IL-17 are greater than IFN-γ significantly. Conclusion Th2 may play an important role in the development of local dacryoadenitis and systemic abnormality in MRL/lpr mice,the role of IL-17 maybe different in lacrimal gland lesions and lymph nodes which need more research.