Background:IgG4-related disease (IgG4-RD) represents a chronic, immune-driven fibroinflammatory condition capable of affecting diverse organ systems; within this spectrum, pulmonary involvement (IgG4-RLD) remains comparatively uncommon. This case report outlines the clinical, imaging and pathological features of a patient with IgG4-related lung disease. Case Description:We report a 60-year-old male patient with recurrent fever, chest pain, and cough with hemoptysis. Chest computed tomography (CT) initially showed right upper lobe lesions suggestive of pneumonia, but the patient failed to respond to multiple courses of antibiotics including levofloxacin, nemonoxacin malate, ceftizoxime, and amoxicillin. Further investigations revealed significantly elevated serum IgG4 level (266 mg/dL). Endobronchial ultrasound-guided transbronchial lung cryobiopsy (EBUS-GS-TBLC) confirmed dense lymphoplasmacytic infiltration in the lung tissue, with IgG4-positive plasma cells >50 per high powered field (HPF) and IgG4-positive/IgG-positive cell ratio >50%, consistent with the diagnosis of IgG4-related interstitial lung disease. The patient was treated with oral cyclosporine and mycophenolate mofetil, resulting in significant clinical and radiological improvement. Conclusions:IgG4-RLD should be considered in the differential diagnosis of patients with pulmonary lesions unresponsive to antibiotic therapy. Comprehensive evaluation including serum IgG4 measurement and targeted pathological biopsy is essential for accurate diagnosis. Early initiation of immunosuppressive therapy can effectively improve outcomes and prevent disease progression.
Background:Open flail chest is a rare but life-threatening condition characterized by severe chest wall instability and contaminated wounds, which increase the risk of postoperative hardware infection. Surgical stabilization of rib fractures (SSRF) has shown benefits in blunt thoracic trauma; however, its application in open flail chest remains controversial due to infection concerns. Evidence guiding the decision to perform SSRF in this setting is limited. Case Description:We retrospectively analyzed three patients with open flail chest who underwent SSRF. Clinical data were collected, including demographics, injury characteristics, surgical management, postoperative recovery, and long-term outcomes. All patients underwent timely debridement and internal fixation. Postoperatively, all patients showed favorable recovery with restoration of chest wall stability. No hardware-related infections or chest wall deformities were observed during follow-up periods of 19, 72, and 122 months. Conclusions:For selected patients with open flail chest, when the time from injury to surgery is no more than 8 hours, the open wound contamination is mild, and thorough debridement is performed, chest wall reconstruction and internal fixation surgery may be relatively safe. This approach can help save patients' lives in the early stage and may lead to favorable long-term outcomes. However, caution should be exercised when considering primary surgery for patients with open contaminated wounds and an injury-to-surgery time exceeding 8 hours. Admittedly, our conclusions need to be validated with more cases.
Background:Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast disease that frequently mimics infection or malignancy, resulting in diagnostic and therapeutic challenges. Although erythema nodosum is a recognized extramammary manifestation, it occurs in approximately 10% of cases and may further obscure timely diagnosis. Our objective is to present a rare case of granulomatous mastitis and highlight the challenges associated with its diagnosis and management. Case Description:We report the case of a 25-year-old Hispanic female who presented with persistent right breast inflammation unresponsive to multiple courses of antibiotic therapy. Diagnostic evaluation with core needle biopsy confirmed IGM. The patient developed concurrent erythema nodosum, representing a rare clinical presentation. Initial management with high-dose systemic corticosteroids resulted in significant adverse effects and progressive disease. Given refractory symptoms and intolerance to medical therapy, the patient underwent a right total mastectomy. Final surgical pathology confirmed the diagnosis of IGM. Conclusions:This case underscores a rare association between IGM and erythema nodosum and highlights the importance of early tissue diagnosis to guide management. While systemic corticosteroids and immunosuppressive therapy remain the cornerstone of treatment, surgical intervention should be considered in patients with severe, refractory disease or those experiencing significant complications from medical therapy. An individualized, severity-based approach and multidisciplinary management are essential for optimizing outcomes in this uncommon condition.
Background:Superior sulcus tumors represent a rare and aggressive subset of non-small cell lung cancer characterized by early invasion of adjacent osseous, vascular, and neural structures. Diagnosis may be challenging when clinical and radiographic features overlap with infectious etiologies, particularly in the setting of cavitary lung disease. The increasing prevalence of nontuberculous mycobacterial pulmonary infection further complicates this distinction and may delay recognition of underlying malignancy. This report aims to highlight the diagnostic challenges posed by cavitary pulmonary lesions with confirmed infection and to describe the multidisciplinary management of a superior sulcus tumor with vertebral invasion. Case Description:A 48-year-old woman with a history of tobacco use initially presented with a cavitary right upper lobe lesion and microbiologically confirmed nontuberculous mycobacterial infection. Initial management focused on antimicrobial therapy, with partial radiographic improvement. Persistent symptoms and evolving imaging findings prompted further evaluation. Robotic navigational bronchoscopy revealed a locally advanced superior sulcus adenocarcinoma with invasion of the T3 and T4 vertebral bodies and neural foramina. Invasive mediastinal staging by endobronchial ultrasound confirmed absence of nodal involvement. The patient staged as cT4N0 disease and underwent induction chemoradiotherapy with carboplatin, pemetrexed, and 60 Gy of radiation, achieving a significant metabolic and radiographic response. She subsequently underwent multidisciplinary en bloc resection, including right upper lobectomy, mediastinal lymphadenectomy, and partial T3 corpectomy with T2 to T4 spinal stabilization. The postoperative course was uneventful. Final pathology demonstrated a complete pathologic response with negative margins and no nodal involvement (ypT0N0). Conclusions:This case highlights the diagnostic pitfalls associated with cavitary pulmonary lesions in high-risk patients and emphasizes the importance of maintaining suspicion for malignancy despite microbiologic confirmation of infection. It also underscores the role of multidisciplinary reassessment and induction therapy in facilitating successful resection of selected locally advanced superior sulcus tumors.
