case_images: PMC6721390_01
case_images: CT chest with contrast showing bilateral interlobular septal thickening, multiple ground-glass opacities, and cystic changes.
case_images: CRIRH2019-7572869.001.jpg
case_images: PMC6721390_01_CRIRH2019-7572869.001.jpg
case_images: fig1
case_images: He had a repeat CT chest with contrast after 20 months concerning his progressively worsening weight loss and smoking history which showed 1.4 cm right lower lobe lung nodule, bilateral interlobular septal thickening with lower lobe predominance, multiple bilateral ground-glass opacities, cystic changes, and multiple enlarged mediastinal lymph nodes (Figures 1 and 2).
case_images: CT chest with contrast showing 1.4 cm right lower lobe lung nodule.
case_images: CRIRH2019-7572869.002.jpg
case_images: PMC6721390_01_CRIRH2019-7572869.002.jpg
case_images: fig2
case_images: He had a repeat CT chest with contrast after 20 months concerning his progressively worsening weight loss and smoking history which showed 1.4 cm right lower lobe lung nodule, bilateral interlobular septal thickening with lower lobe predominance, multiple bilateral ground-glass opacities, cystic changes, and multiple enlarged mediastinal lymph nodes (Figures 1 and 2).
case_images: Immunostaining showing abundant IgG4 plasma cells.
case_images: CRIRH2019-7572869.003.jpg
case_images: PMC6721390_01_CRIRH2019-7572869.003.jpg
case_images: fig3
case_images: IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.
case_images: High power field showing obliterative phlebitis with destruction of the vessel wall.
case_images: CRIRH2019-7572869.004.jpg
case_images: PMC6721390_01_CRIRH2019-7572869.004.jpg
case_images: fig4
case_images: IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.
case_images: High power field showing fibrous bands.
case_images: CRIRH2019-7572869.005.jpg
case_images: PMC6721390_01_CRIRH2019-7572869.005.jpg
case_images: fig5
case_images: IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.
case_images: High power field showing arteritis with minimal obliteration of the lumen. The orange arrow shows rich lymphoplasmacytic infiltrate.
case_images: CRIRH2019-7572869.006.jpg
case_images: PMC6721390_01_CRIRH2019-7572869.006.jpg
case_images: fig6
case_images: IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.