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In their insightful correspondence, Akiyama et al1 focus on a peculiar feature of eosinophilic granulomatosis with polyangiitis (EGPA), that is, the involvement of salivary and lacrimal glands, which mimics the Mikulicz disease, a common manifestation of IgG4-related disease (IgG4-RD). Given that EGPA shows high serum IgG4 levels (particularly in its active phases),2 and that IgG4-RD often features allergy, eosinophilia and respiratory tract involvement, the differential diagnosis between these two disorders may be challenging. The observation that patients with EGPA can present with Mikulicz-like salivary and lacrimal gland involvement enhances the difficulty in the differential diagnosis with …
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