IgG4 related lung disease- a rare and novel mimic of malignancy and infections-a case series of three patients with a brief review of updated literature.

IgG4-related lung disease is an extremely rare and novel entity which is still poorly understood. We reviewed the 16 patients diagnosed with IgG4-related disease from October 2014 through December 2019 at our institution. The three cases that showed pulmonary involvement are included in this series. Of these, two patients had cavitary lung disease and developed aspergilloma and chronic cavitating aspergillosis after a prolonged course of steroid therapy, and one had isolated pulmonary nodule and ground glass opacity. We reviewed the updated literature and briefly described disease epidemiology, clinical characteristics, diagnostic approaches, and management strategies for IgG4-related lung disease.

Methylnaltrexone and Naloxone for Opioid-induced Constipation in the Critical Care Setting.

Opioid antagonists in the ICU are often a last-line medication given to patients with opioid-induced constipation. Traditionally, patients have been administered nonopioid-based bowel regimens such as senna, peg, and docusate to treat constipation. Despite the obvious need to treat acute pain with opioids, side effects such as constipation can lead to multiple gastrointestinal (GI) complications such as bowel perforation and even death. Specifically, opioid-induced constipation (OIC) can be very difficult to treat. We examine naloxone and methylnaltrexone (MNTX) assessing GI complications and OIC as well as present a patient case which highlights the importance of treating OIC. We also evaluate the superior reversal agent of choice when treating OIC in the critical care and stepdown unit settings.

Retraction: Neurogenic Stunned Myocardium: A Literature Review.

[This retracts the article DOI: 10.7759/cureus.3129.].

Neurogenic Stunned Myocardium: A Literature Review.

Neurogenic stunned myocardium (NSM) is defined as the occurrence of cardiac abnormalities due to neurological events such as stroke, seizures, etc. These events lead to dysfunction of the autonomic nervous system (ANS) and ultimately cause injury to the myocardium. The clinical features seen in NSM include elevated troponin level, left ventricular dysfunction, and changes on the electrocardiogram (ECG). However, these features are also seen in Takotsubo cardiomyopathy as well as in an acute coronary syndrome (ACS). Hence, diagnosing the condition by clinical presentation alone is difficult. Thus, a patient of NSM who is at increased risk of developing coronary heart disease may require invasive procedures such as cardiac catheterization to rule out ACS. This review aims at raising awareness about NSM among physicians so that management of patients can be individualized.