A young male with long-standing type 1 diabetes mellitus, chronic kidney disease, and known ventricular hypertrophy presented with dyspnea and abdominal pain and was diagnosed with coronavirus disease 2019 (COVID-19) infection. On day nine of hospital admission, patient developed ventricular tachycardia with electrocardiogram (ECG) changes and elevation in troponin level consistent with myocarditis and development of cardiogenic shock. Bedside limited echo demonstrated signs of tamponade and patient underwent surgical pericardial window procedure. He was also noted to develop marked prolongation of corrected QT interval (QTc) while on amiodarone.
Patient: Male, 60Final Diagnosis: IgG4 related diseaseSymptoms: Cough • hemoptysisMedication: —Clinical Procedure: NoneSpecialty: PulmonologyObjective:Rare diseaseBackground:Immunoglobulin (Ig) G4-related disease, previously referred to as IgG4-related sclerosing disease or hyper-IgG4 disease, may occur in the lung, involving alveolar parenchyma, airways, and pleura. Various pulmonary manifestations of IgG4-related disease have been reported, but to the best of our knowledge a cavitating lung disease has not been reported previously.Case Report:We describe a 60-year-old man who presented with hemoptysis and cavitating lung disease with clinical, laboratory, and histopathologic findings compatible with IgG4-related disease. Other potential causes of cavitation were excluded. Treatment was initiated with oral prednisone and subsequently mycophenolate mofetil was added. Follow-up 1 year later shows stable pulmonary function with complete resolution of the cavitary lesions.Conclusions:We present a case of cavitating lung disease as a previously unreported manifestation of IgG4-related disease. Our patient had an excellent response to immunosuppression. An increased awareness of IgG4-related disease and its myriad of manifestations is very important for pulmonologists.
Ipilimumab is a monoclonal antibody used in the treatment of unresectable or metastatic melanoma. Several immune-related adverse events including potential fatal events have been reported following its use. We report a case of a 66-year-old man who presented with severe acute exertional dyspnea and orthopnea following administration of ipilimumab for metastatic melanoma. Although various peripheral neuropathy syndromes associated with ipilimumab have been reported, bilateral phrenic nerve paralysis has not been previously reported. This case also highlights the clinical features of bilateral phrenic nerve neuropathy. Pulmonologists have to be aware of these unusual immune-related respiratory adverse events in patients being treated with monoclonal antibodies.
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