A severe case of bags under the eyes

This woman in her 70s presented with a 20 year history of progressive bilateral palpebral swelling, protrusion of the eyeballs, and diminished visual acuity (fig 1). Positron emission tomography and computed tomography (PET-CT) imaging showed symmetrical swelling of the lacrimal glands, parotid glands, and submandibular glands, as well as lesions affecting the bronchi, kidneys, peritoneum, cervix, and lymph nodes. Magnetic resonance imaging of the orbits showed bilateral swelling of the extraocular muscles. Laboratory test results showed a raised levels of serum IgG4 and biopsy of the lacrimal gland showed dense infiltration of lymphocytes.bmj;385/jun13_8/e078246/F1F1f1Fig 1This patient was experiencing Mikulicz syndrome, a non-specific inflammatory disorder characterised by painless diffuse symmetrical enlargement of the lacrimal, parotid, and submandibular glands. It can arise secondary to multiple diseases, including IgG4 related disease, Sjögren syndrome, malignant lymphoma, sarcoidosis, and tuberculosis.1 Mikulicz syndrome is a manifestation of IgG4 related disease, a rare autoimmune disease marked by elevated…
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