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Abstract Here we report a rare case of immunoglobulin G4 (IgG4)–related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66‐year‐old man was admitted to our hospital with right‐dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right‐dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video‐assisted thoracoscopic surgery showed fibrosis‐associated lymphoplasmacytic infiltration, 45–60 IgG4‐positive plasma cells per high‐power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4‐related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy.

Abstract A 46‐year‐old male was treated with corticosteroids for nonspecific interstitial pneumonia (NSIP). He was referred to our hospital and admitted for worsening dyspnea and diffuse ground‐glass opacity on chest computed tomography (CT) during corticosteroid treatment. Gottron's sign was observed, and the patient was diagnosed with clinically amyopathic dermatomyositis on skin biopsy. We increased the corticosteroid dose and added immunosuppressive agents; however, the opacity on the chest CT worsened. Based on periodic‐acid‐Schiff‐positive granular material in the bronchoalveolar lavage fluid and the presence of anti‐GM‐CSF antibodies, the patient was diagnosed with autoimmune pulmonary alveolar proteinosis (APAP). The concentration of anti‐GM‐CSF antibodies in preserved serum was also elevated when the patient was diagnosed with NSIP. Thus, we assumed that NSIP and APAP coexisted, and that APAP manifested during immunosuppressive therapy. When exacerbation is observed during the treatment of interstitial pneumonia with immunosuppressive agents, it is necessary to consider APAP.

Background: Eosinophilia is often observed in patients with chronic obstructive pulmonary disease (COPD), but the influence of eosinophilia on the clinical outcomes of patients with COPD is unknown. This study aimed to evaluate the clinical characteristics of eosinophilic COPD (E-COPD) and define the effects of treatment with inhaled corticosteroids (ICS) on cardiovascular events in patients with E-COPD. Methods: We included 398 patients with COPD and classified them into two groups: E-COPD (blood eosinophil counts >300 cells/μL or >4%) and non-E-COPD. Patient characteristics and exacerbations between the two groups were compared and the effects of ICS on these variables were studied. Results: E-COPD patients (n = 196) experienced 4.49- and 6.13-time greater numbers of moderate and severe exacerbations, respectively, than non-E-COPD patients (n = 202). In the Cox proportional hazards analysis, higher eosinophil counts and lower pulmonary function values were significantly associated with moderate and severe exacerbations. Patients with E-COPD treated with ICS had fewer cardiovascular events than those treated without ICS (relative risk, 0.39; p = 0.011). Conclusion: These results suggest that eosinophilia may be associated with increased exacerbations of COPD and that treatment with ICS may be considered to reduce cardiovascular events in patients with E-COPD.