Although
immunoglobulin G4-related disease (IgG4-RD) has a predilection for the head and neck region, laryngeal pathology is rare. We report a case of supraglottic
stenosis due to
IgG4-RD together with a novel treatment strategy of employing a laryngeal
stent. A 69-year-old man was referred with longstanding dyspnoea and worsening inspiratory
stridor. Despite two supraglottic dilations over a 12-month period, his
stenosis recurred and symptoms persisted. Serum investigations revealed elevated
IgG4 levels (2.390g/l), with
IgG4 infiltrate in laryngeal biopsies. The patient underwent endoscopic balloon dilation, intralesional
Depo-Medrone® injection,
CO2 laser therapy and insertion of a laryngeal
stent to prevent re-
stenosis.
Rituximab and
prednisolone were commenced postoperatively and the
stent was removed at 6weeks. No
stenosis recurrence was visualised over a further 12-month follow-up period. Sixteen cases of laryngeal lesions with confirmed
IgG4 infiltrate in biopsies have been reported in the worldwide literature to date. Based on a literature review and our experience, we recommend that similar laryngeal pathologies undergo early
IgG4 serological testing and biopsy immunohistochemistry. Prompt diagnostic confirmation may prevent unnecessary surgical interventions and optimise immunosuppression. Furthermore, the use of a laryngeal
stent following laryngeal surgery may help reduce stenotic recurrence and promote healing.