PMC8349094_01
Chest radiographs(panel A) showed an irregularly demarcated infiltrative shadow in the right middle lung field with peripheral predominance, and chest computed tomography(panel B) showed a ground glass opacity and infiltrative shadow in the right lung with upper lobe predominance.
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Chest radiographs revealed an irregularly demarcated infiltrative shadow in the right middle lung field with peripheral predominance, and chest computed tomography demonstrated a ground-glass opacity and infiltrative shadow in the right lung with the upper lobe predominance (Fig. 1).
With steroid treatment, clinical symptoms, peripheral blood eosinophil count, CRP, and serum IgE decreased, and MPO-ANCA became negative. Lung abnormal shadows and bronchoscopic findings also improved quickly 1 month after treatment. One and a half years after the start of treatment, signs of relapse were observed, and anti-IL-5 antibody (Mepolizumab) was added.. PBE: peripheral blood eosinophil.
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The clinical course is illustrated in Fig. 2.
Bronchoscopy revealed multiple white flattened lesions (white moss) on the airway mucosa (panel A, B). A biopsy from the tracheal mucosa revealed airway inflammation with marked eosinophil infiltration.
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Bronchoscopy revealed multiple white flattened lesions (white moss) on the airway mucosa, suggesting mycobacterial infection or malignancy (Fig. 3).
Biopsy of the tracheal mucosa revealed a marked infiltration of eosinophils(panel A). Additional immunostaining showed an IgG4(panel C)/IgG(panel B) positive cell ratio of 98% and infiltration of IgG4 positive cells.
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Additional immunostaining revealed an IgG4/IgG positive cell ratio of 98% and infiltration of IgG4 positive cells (Fig. 4).