case_images: PMC10811138_01
case_images: Chest images during the clinical episode. (A, B) The baseline chest CT before initiating therapy showed a nodule in the right upper lobe without any interstitial change. (C, D) Chest CT after onset of dyspnea showed new bilateral subpleural opacities, which were more severe in the right lung. (E-H) Chest CT on intubation day showed bilateral ground-glass opacities and consolidation with reticulation. (I-L) Chest CT after extubation revealed severe subcutaneous and mediastinal empysema, along with bilateral opacities consistent with interstitial pneumonitis.
case_images: fimmu-14-1309531-g001.jpg
case_images: PMC10811138_01_fimmu-14-1309531-g001.jpg
case_images: f1
case_images: Figures 1A, B ) four months before admission. Chest computed tomography (CT) showed new bilateral subpleural opacities, which were more severe in the right lung ( Figures 1C, D ). Chest CT ( Figures 1E-H ) showed bilateral ground-glass opacities and consolidation with reticulation. His respiratory support level stabilized with the high-flow nasal cannula (flow rate of 30 L/min; fraction of inspired oxygen, 35-50%) until severe mediastinal and subcutaneous emphysema developed, which involved the neck and chest and extended to the scrotum and lower extremities ( Figures 1I-L ).
case_images: Summary of the clinical course. IVIG, intravenous immunoglobulin; HFNC, high-flow nasal cannula; IMV, invasive mechanical ventilation; MP, methylprednisolone; Pred, prednisone; TAC, tacrolimus; CTX, cyclophosphamide.
case_images: fimmu-14-1309531-g002.jpg
case_images: PMC10811138_01_fimmu-14-1309531-g002.jpg
case_images: f2
case_images: The details of his treatment are summarized in  Figure 2 .