J Postgrad Med
· 2025 Jul · PMID 40965013
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Cardiac myxomas (CMs) constitute one of the most common benign tumors of the heart, with a characteristic histomorphology of "lepidic cells" in an eosinophilic myxoid material, warranting immediate recognition. However,...Cardiac myxomas (CMs) constitute one of the most common benign tumors of the heart, with a characteristic histomorphology of "lepidic cells" in an eosinophilic myxoid material, warranting immediate recognition. However, several, though uncommon, alterations in the classic pathological features hinder straightforward diagnosis. This is a report of one such intriguing entity, in which the myxoma shows the presence of glandular components, with a brief overview of the histogenesis, immunohistochemical characteristics, and differential diagnosis of glandular CMs.
Archana MH, Shivane V, Yamichannaiah C
… +1 more, Memon SS
J Postgrad Med
· 2025 Jul · PMID 40965010
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Angioedema without urticaria (AEwU) is an uncommon manifestation of autoimmune thyroid disease (AITD), rarely reported in the pediatric population. A 12-year-old boy presented with recurrent episodes of angioedema affect...Angioedema without urticaria (AEwU) is an uncommon manifestation of autoimmune thyroid disease (AITD), rarely reported in the pediatric population. A 12-year-old boy presented with recurrent episodes of angioedema affecting the lips and eyelids for 6 months, unresponsive to antihistamines. There were no systemic symptoms, wheals, or identifiable allergic triggers. Laboratory evaluation revealed normal C1-inhibitor levels and function, ruling out hereditary angioedema. Notable findings included eosinophilia (14.4%) and elevated serum Immunoglobulin E levels (1617 IU/mL), while bone marrow flow cytometry and serum tryptase levels were normal. Autoimmune screening identified AITD with overt hypothyroidism (thyroid-stimulating hormone: 34 μIU/mL). A diagnosis of AEwU secondary to AITD was considered. Initiation of levothyroxine (62.5 μg/day) led to symptom resolution within 3-4 days, with no recurrence in eight months. AEwU secondary to AITD is a diagnosis of exclusion and should be considered in patients with unexplained angioedema after ruling out hereditary and allergic causes.
Lanjewar CP, Shah BS, Kujur PP
… +2 more, Kumar D, Sabnis GR
J Postgrad Med
· 2025 Jul · PMID 40965008
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INTRODUCTION: The alarming increase in the incidence of myocardial infarction in young population has warranted a different approach to its management. Imaging-based study of the culprit lesion has provided a new dimensi...INTRODUCTION: The alarming increase in the incidence of myocardial infarction in young population has warranted a different approach to its management. Imaging-based study of the culprit lesion has provided a new dimension in understanding this condition. The authors aimed to study the morphological characteristics in young patients (<40 years) as defined by optical coherence tomography (OCT). MATERIALS AND METHODS: This prospective, single-centre, open-label, observational study was conducted at a tertiary care centre and enrolled all young patients presenting with ST-elevation myocardial infarction (STEMI) who fulfilled the inclusion criteria, between January 2020 and June 2022. RESULTS: Out of 36 patients who underwent OCT, plaque rupture was observed in 63.89%, followed by plaque erosion in 36.11%. White thrombus was evident in the majority of patients (55.56%). As most of our patients were fibrinolized and the procedure was not a primary PCI but performed within 48 hours as a pharmacoinvasive approach, the native characteristics of the lesion and thrombus might have changed. A total of five patients underwent balloon predilatation due to a critically stenotic lesion that prevented the OCT catheter from passing distally. CONCLUSION: Plaque rupture was the most common pathology for STEMI among young patients, with plaque erosion being another important contributor. The study also highlighted an early predilection for atherosclerotic changes in the Indian population.
J Postgrad Med
· 2025 Jul · PMID 40843525
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Whether it is the diagnosis, treatment, and prognosis of individual patients or the research results derived from group studies, uncertainties are an integral part of the decision-making process because of the omnipresen...Whether it is the diagnosis, treatment, and prognosis of individual patients or the research results derived from group studies, uncertainties are an integral part of the decision-making process because of the omnipresence of inter- and intra-individual variations. Whereas artificial intelligence methods are poised to steeply reduce the uncertainties at the individual level, they cannot completely eliminate the role of chance. This is especially so with group-based medical research where uncertainties may still confound the decision processes even with the advent of artificial intelligence. Probabilities quantify the uncertainties. Confidence level and the level of significance measure the probability in different contexts in statistical inference and remain the essential features of group-based research. Some researchers mix up these two levels. This article explains the difference between these two levels and offers a new perspective in the era of artificial intelligence.
Parmar UI, Jaju T, Tripathi R
… +2 more, Sundaram S, Bhatia S
J Postgrad Med
· 2025 Jul · PMID 40788293
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INTRODUCTION: Functional bowel disorders (FBD) are chronic, recurrent, debilitating disorders affecting the mid or lower gastrointestinal tract with no identifiable underlying pathology. There is a dearth of Indian studi...INTRODUCTION: Functional bowel disorders (FBD) are chronic, recurrent, debilitating disorders affecting the mid or lower gastrointestinal tract with no identifiable underlying pathology. There is a dearth of Indian studies focusing on treatment awareness and prescription evaluation in FBD. Due to chronic course, patients tend to self-medicate. The study was planned to evaluate disease and drug treatment awareness, self-medication practices, and prescription patterns in FBD patients. MATERIALS AND METHODS: A cross-sectional, single-center, questionnaire-based study was carried out on FBD patients after getting clearance from the Institutional Ethics Committee. The patients were administered two questionnaires, i.e. disease/drug awareness and self-medication questionnaire. Prescriptions were analyzed based on World Health Organization prescribing indicators. RESULTS: A total of 118 FBD patients were enrolled and the common disorder was functional constipation (94/118, 79.7%). Number of males (77/118, 65%) was greater than females (41/118, 34%). In disease awareness (98/118, 83%), patients opined that FBD occurs frequently and agreed that medications can treat FBD. In treatment awareness (106/118, 90%), patients were aware about the importance of drug compliance, but only (10/118, 9%) knew the adverse effects. In prescription patterns, a total of 311 medications were prescribed. A total of 173 medications were primary drugs for FBD. Laxatives were the common class (98/138, 68.9%) prescribed with polyethylene glycol (77/138, 55.7%) as the most common drug prescribed for functional constipation. A total of 28/118 (23.7%) patients' self-medicated prior to visiting the current OPD. CONCLUSIONS: FBD patients were aware of the dosing schedule and consulted their treating doctor but awareness regarding drug name, and adverse effects was poor among the patients. Laxative-polyethylene glycol was the common drug prescribed. Only less than 1/4 th of patients resorted to self-medication commonly with herbal remedies.
Singh PK, Singh S, Ahmad S
… +2 more, Singh VK, Kumar R
J Postgrad Med
· 2025 Apr · PMID 40488556
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Power dynamics in medical education, driven by leadership roles, significantly influence patient care, learning, research, and institutional growth. Hierarchies provide essential structure and mentorship, but can also su...Power dynamics in medical education, driven by leadership roles, significantly influence patient care, learning, research, and institutional growth. Hierarchies provide essential structure and mentorship, but can also suppress communication and ethical behaviour through intimidation and exclusion. This duality underscores the importance of addressing hierarchical dynamics in academic medicine. This narrative review evaluates the impact of hierarchical dynamics on faculty experiences, focusing on both positive and negative leadership behaviours. A comprehensive literature search was conducted across PubMed, Google Scholar, and ScienceDirect using terms such as "power dynamics," "hierarchical structures," and "faculty development." Articles published within the last 20 years were prioritised, with studies selected based on their empirical contribution and relevance to medical education. A thematic synthesis approach was used to identify key themes and strategies for fostering a supportive and inclusive academic culture. Hierarchies in medical education can positively influence faculty by offering structure, mentorship, and clear role expectations, which are critical for professional development. However, pervasive negative behaviours, including micromanagement, favouritism, and exclusion, were identified as major contributors to stress, burnout, and hindered professional growth among junior faculty and colleagues. Hierarchical dynamics are pivotal in shaping faculty experiences in medical education. Mitigating the adverse impacts of power imbalances requires regular behavioural audits, leadership training, and robust mentorship programs. These initiatives can foster an inclusive academic culture that prioritises open communication and equitable professional development. Future research should develop and evaluate targeted interventions to address power imbalances and improve institutional culture.
J Postgrad Med
· 2025 Apr · PMID 40488315
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Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycemia characterized by the presence of insulin autoantibodies. Alpha-lipoic acid (ALA), a widely used nutraceutical, has been increasingly recognize...Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycemia characterized by the presence of insulin autoantibodies. Alpha-lipoic acid (ALA), a widely used nutraceutical, has been increasingly recognized as a potential trigger for IAS. We report two cases of ALA-induced IAS in Indian patients and review existing literature to highlight its clinical presentation, diagnostic challenges, and management strategies. In the first case, rapid-onset severe hypoglycemia mandated the use of oral steroids with gradual tapering and stoppage over a duration of few months, while in the second case, mild hypoglycemia was essentially managed with dietary modifications alone and the condition remitted on its own. ALA-induced IAS should be considered in the differential diagnosis of hyperinsulinemic hypoglycemia. Early recognition and appropriate management can prevent severe complications and avoid unnecessary investigations to evaluate other causes of hyperinsulinemia.
J Postgrad Med
· 2025 Apr · PMID 40488305
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Type I and Type II errors are inherent in any empirical medical research on an antecedent-outcome relationship when it is based on a dataset of a sample of subjects. Type I error is the incorrect rejection of a true null...Type I and Type II errors are inherent in any empirical medical research on an antecedent-outcome relationship when it is based on a dataset of a sample of subjects. Type I error is the incorrect rejection of a true null hypothesis, and its probability in a study is the P value. This error is more serious and is kept under control by specifying a cap called the level of significance. The complement of the probability of Type II error, called power, is the probability of not missing a medically significant effect when present. This article concisely explains P values, power, and medical significance in nontechnical terms for our medical colleagues and their implications for assessing the credibility of medical research.
Rajni E, Bairwa K, Galav H
… +2 more, Upadhyaya H, Gajjar D
J Postgrad Med
· 2025 Apr · PMID 40488303
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INTRODUCTION: Antimicrobial resistance is a global health threat. Carbapenem-resistant Enterobacterales (CRE) are increasingly becoming an important cause of concern. We aimed to present a comprehensive update on CRE, in...INTRODUCTION: Antimicrobial resistance is a global health threat. Carbapenem-resistant Enterobacterales (CRE) are increasingly becoming an important cause of concern. We aimed to present a comprehensive update on CRE, including their prevalence, antimicrobial susceptibility profile, phenotypic and genotypic characterization. The study also evaluated the activity of ceftazidime-avibactam (CZA) against CRE. MATERIALS AND METHODS: This was a prospective observational study conducted in a multispecialty tertiary care teaching hospital in Jaipur, western India. All consecutive non-duplicate CRE strains isolated from various clinical samples received in the laboratory during the study period were included in the study. Detection of carbapenemase enzyme production and phenotypic characterization was done using modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM), respectively, and genotypic detection was performed by multiplex PCR. RESULTS: CRE prevalence was 43%, and 91% were found to be carbapenemase producers. In addition, 94%, 91%, 21%, and 20% susceptibility was observed for tigecycline, colistin, amikacin, and trimethoprim/sulfamethoxazole, respectively. Thirty-three percent of CRE were susceptible to CZA alone, and 93% were found to exhibit synergy between CZA and aztreonam. The most prevalent carbapenemase gene detected in the current study was bla OXA-48 , which was found in 61.4% of the isolates tested. More than one carbapenemase gene was detected in 35% of the isolates. CONCLUSIONS: This study highlights the escalating threat of CRE and emphasizes the pressing need for their continuous surveillance for appropriate management.
Nivethitha V, Daniel RA, Surya BN
… +1 more, Logeswari G
J Postgrad Med
· 2025 Apr · PMID 40488301
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India's healthcare system faces substantial challenges, including a high burden of communicable and non-communicable diseases, limited access to healthcare in rural areas, and a shortage of skilled healthcare professiona...India's healthcare system faces substantial challenges, including a high burden of communicable and non-communicable diseases, limited access to healthcare in rural areas, and a shortage of skilled healthcare professionals. Artificial intelligence (AI) offers promising solutions to address these gaps by enhancing diagnostic accuracy, improving disease prediction, and optimizing treatment management. This scoping review examines AI's role in early detection, treatment, and disease prevention in community health settings. A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Google Scholar from January 2013 to July 2024. Eligible studies focused on the application of AI in public health, emphasizing early detection, disease prevention, and treatment interventions. Data on AI models, health outcomes, and performance metrics were extracted and analyzed in line with PRISMA-ScR guidelines. Forty-eight studies were analyzed and categorized into diagnostic accuracy, disease prediction, treatment management, and clinical validation. AI-based tools, such as AIDMAN for malaria detection, demonstrated high diagnostic accuracy (95%) and AUC (0.96). Predictive models for chronic kidney disease (93% accuracy) and diabetes (91% accuracy) showed substantial promise. TB screening using AI-powered cough analysis achieved 86% accuracy. The studies also emphasized AI's role in managing chronic diseases, facilitating early interventions, and reducing healthcare burdens in resource-limited settings. AI has the potential to revolutionize healthcare delivery in India, particularly in underserved regions, by enhancing early detection and treatment. However, challenges related to data privacy, algorithmic bias, and infrastructure require attention. Continued research and policy development are essential to fully harness AI's capabilities in improving public health outcomes.
Marasakatla S, Gupta M, Ramakrishnan S
… +1 more, Kulkarni GB
J Postgrad Med
· 2025 Apr · PMID 40488299
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Thunderclap headaches and multifocal cerebral artery constrictions characterize reversible cerebral vasoconstrictive syndrome (RCVS). Leucine-rich glioma-inactivated 1 (LGI-1) autoimmune encephalitis (AE) presents as lim...Thunderclap headaches and multifocal cerebral artery constrictions characterize reversible cerebral vasoconstrictive syndrome (RCVS). Leucine-rich glioma-inactivated 1 (LGI-1) autoimmune encephalitis (AE) presents as limbic encephalitis, hyponatremia, and faciobrachial dystonic seizures. Their unusual presentation concurrently is unknown. We describe a rare case of LGI-1 AE with RCVS. A 31-year-old lady presented with acute onset visual loss and encephalopathy on the background of sleep behavioral symptoms. Retrospectively, the patient complained of having muscle twitching, and mood changes. Her blood pressure was high (220/120 mm Hg). Blood investigations revealed hyponatremia and positivity for LGI-1+ and anti-amphiphysin 1+ antibodies. Neuroimaging initially showed features of RCVS. The cerebrospinal fluid study was unremarkable. Electromyography showed florid fasciculations with myokymic discharges. She was treated with steroids and responded to immunotherapy (Azathioprine). She maintained well into follow-up. AE is a great mimicker. Knowledge about atypical presentations is important for guiding treatment and further clinical course.
Patil S, Rawat V, Lad S
… +3 more, Vishwanathan D, Chauhan S, Ingle M
J Postgrad Med
· 2025 Apr · PMID 40488297
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INTRODUCTION: Foreign body ingestion (FBI) is frequently encountered in the pediatric population and sometimes requires emergency removal. This study aimed to investigate the demographical and clinical profile, nature of...INTRODUCTION: Foreign body ingestion (FBI) is frequently encountered in the pediatric population and sometimes requires emergency removal. This study aimed to investigate the demographical and clinical profile, nature of foreign body (FB), and endoscopic management of FBI in a tertiary care center in India. MATERIALS AND METHODS: This is a retrospective observational study of 370 patients with FBI who underwent endoscopic removal at our center from May 2019 to April 2024. Descriptive and analytical statistical tests were used to analyze the data. RESULTS: Out of 370 patients, 61.4% of FBs were blunt, 29.2% were sharp, and 9.5% were corrosive objects. Coin was the most common FB observed (46.5%). Furthermore, 63.78% of patients were asymptomatic. There was a positive correlation between the endoscopic location of FB and symptoms ( P = 0.030). Mucosal injuries were seen in only 34% of patients. There was a positive correlation ( P = 0.012) between the morphological nature of FB and mucosal injury. We found a positive correlation ( P = 0.034) between the size of the FB and its possibility of spontaneous passage in the GI tract. Endoscopic removal of FB was successful in 83.2% of patients. CONCLUSIONS: Sharp and corrosive FBs should be removed on an emergency basis irrespective of their symptoms, location, and time since ingestion to avoid complications. FBs with a diameter of more than 2 cm and a length of more than 5 cm should be removed endoscopically because of their lower chances of spontaneous passage.
J Postgrad Med
· 2025 Apr · PMID 40439035
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Tuberculosis as cause of mediastinal mass, is rare in children, and may be seen in immunodeficiencies. Data on the prevalence of mediastinal tuberculosis and on its clinical spectrum and outcome is lacking in children. A...Tuberculosis as cause of mediastinal mass, is rare in children, and may be seen in immunodeficiencies. Data on the prevalence of mediastinal tuberculosis and on its clinical spectrum and outcome is lacking in children. A 4.5-month-old boy presented with fever and cough since 7 days and increased respiratory activity. He had respiratory distress with hypoxia. Examination revealed decreased breath sounds on the right lung with tracheal shift to the left. Chest radiograph showed homogenous opacity in the right upper zone, with heterogenous opacity in the right middle and lower zones and tracheal shift to left. Computed tomography scan confirmed the presence of mediastinal abscess. Human immunodeficiency virus status of patient's mother and primary immunodeficiency workup of the child were negative. In view of clinical deterioration and non-responsiveness to 10 days of intravenous antibiotics, tuberculosis workup was done. GeneXpert of the abscess aspirate showed Mycobacterium tuberculosis (rifampicin resistant). Patient was labeled as pre-XDR tuberculosis based on the line probe assay. Antitubercular regimen was modified accordingly (linezolid, amikacin, cycloserine, clofazimine, and ethionamide). The child required invasive mechanical ventilation in pediatric intensive care unit (PICU) for 15 days. The patient showed clinical and radiological improvement and was discharged after 6 weeks of inpatient stay. However, the patient was readmitted 16 days later with linezolid-induced lactic acidosis, developed measles, and succumbed to measles complication (pneumonia).
J Postgrad Med
· 2025 Jan · PMID 40107971
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INTRODUCTION: Artificial intelligence (AI) platforms have achieved a noteworthy role in various fields of medical sciences, ranging from medical education to clinical diagnostics and treatment. ChatGPT, Gemini, and Meta...INTRODUCTION: Artificial intelligence (AI) platforms have achieved a noteworthy role in various fields of medical sciences, ranging from medical education to clinical diagnostics and treatment. ChatGPT, Gemini, and Meta AI are some large language models (LLMs) that have gained immense popularity among students for solving questions from different branches of education. MATERIALS AND METHODS: A cross-sectional study was conducted in the Department of Microbiology to assess the performance of ChatGPT, Gemini, and Meta AI in answering higher-order questions from various competencies of the microbiology curriculum (MI 1 to 8), according to CBME guidelines. Sixty higher-order questions were compiled from university question papers of two universities. Their responses were assessed by three faculty members from the department. RESULTS: The mean rank scores of ChatGPT, Gemini, and Meta AI were found to be 102.76, 108.5, and 60.23 by Evaluator 1; 106.03, 88.5, and 76.95 by Evaluator 2; and 104.85, 85.6, and 81.04, respectively, indicating lowest overall mean rank score for Meta AI. ChatGPT had the highest mean score in MI 2,3,5,6,7, and 8 competencies, while Gemini had a higher score for MI 1 and 4 competencies. A qualitative assessment of the three platforms was also performed. ChatGPT provided elaborative responses, some responses from Gemini lacked certain significant points, and Meta AI gave answers in bullet points. CONCLUSIONS: Both ChatGPT and Gemini have created vast databases to correctly respond to higher-order queries in medical microbiology in comparison to Meta AI. Our study is the first of its kind to compare these three popular LLM platforms for microbiology.
J Postgrad Med
· 2025 Jan · PMID 40107967
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INTRODUCTION: Whether the protective role of optimal cardiovascular health (CVH) exists among individuals with preexisting cardiometabolic comorbidities and to what extent these impacts on longevity are unknown. This stu...INTRODUCTION: Whether the protective role of optimal cardiovascular health (CVH) exists among individuals with preexisting cardiometabolic comorbidities and to what extent these impacts on longevity are unknown. This study aims to evaluate the protective effect on mortality in individuals with and without cardiometabolic comorbidities. MATERIALS AND METHODS: This cohort study utilized data from the China Health and Nutrition Survey. CVH was evaluated using the Life's Essential 8 (LE8) metric. Five cardiometabolic comorbidities, namely hypertension, diabetes mellitus (DM), dyslipidemia, chronic kidney disease (CKD), and cardiovascular disease (CVD), were self-reported. The outcome was all-cause mortality. RESULTS: Maintaining intermediate/ideal CVH attenuated the hazardous impact of hypertension (intermediate/ideal CVH: HR: 1.02; 95% CI: 0.71, 1.47; poor CVH: HR: 1.50; 95% CI: 1.16, 1.95), prediabetes (intermediate/ideal CVH: HR: 1.00; 95% CI: 0.64, 1.55; poor CVH: HR: 1.81; 95% CI: 1.30, 2.52), DM (intermediate/ideal CVH: HR: 2.53; 95% CI: 1.65, 3.87; poor CVH: HR: 5.02; 95% CI: 3.74, 6.76), dyslipidemia (intermediate/ideal CVH: HR: 1.13; 95% CI: 0.76, 1.68; poor CVH: HR: 1.29; 95% CI: 0.89, 1.86), and CKD (intermediate/ideal CVH: HR: 1.36; 95% CI: 1.01, 1.84; poor CVH: HR: 1.84; 95% CI: 1.21, 2.79) on longevity ( P for interaction < 0.05). No significant interaction between CVD and CVH was observed in the association with mortality. CVH status significantly interacted with the associations between cardiometabolic comorbidities and the risk of mortality when the number of comorbidities increased up to 3. CONCLUSIONS: CVH significantly attenuated the detrimental impacts of cardiometabolic comorbidities on longevity, highlighting the protective role of CVH even in individuals with preexisting cardiometabolic diseases.
J Postgrad Med
· 2025 Jan · PMID 40085075
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INTRODUCTION: Urinary tract infections make up a major proportion of infections encountered in outpatient setting in hospitals. Treatment is largely based on the epidemiology of locally prevalent flora. Selection of an a...INTRODUCTION: Urinary tract infections make up a major proportion of infections encountered in outpatient setting in hospitals. Treatment is largely based on the epidemiology of locally prevalent flora. Selection of an appropriate antibiotic is crucial, as inappropriate use could contribute to an alarming rise in antimicrobial resistance. MATERIALS AND METHODS: This is a retrospective observational study conducted in a tertiary care teaching hospital. The urine samples were inoculated on cysteine lactose electrolyte-deficient (CLED) media and identification, and antimicrobial susceptibility testing of uropathogens was done using VITEK-2 system. RESULTS: A total of 3893 urine samples were received during the study period, out of which 293 (7.5%) samples were reported positive, including 167 (57%) females and 126 (43%) males. The most common pathogenic isolates were Escherichia coli (191, 65.1%) followed by Klebsiella pneumoniae (42, 14.3%), Enterococcus spp (20, 6.8%), and Pseudomonas aeruginosa (19, 6.4%). Cotrimoxazole resistance was observed in 52.3% Escherichia coli and 47.1% Klebsiella pneumoniae isolates. About, 100% susceptibility was observed for fosfomycin. A total of 58.1% Escherichia coli and 40.7% Klebsiella pneumoniae isolates were found to be multi-drug resistant (MDR). CONCLUSION: According to this study, cotrimoxazole, cephalosporins, and fluoroquinolones need to be curtailed for empirical treatment of UTI in OPD because of high resistance. Nitrofurantoin and fosfomycin may be considered as drugs of choice for empirical therapy of lower UTIs.
J Postgrad Med
· 2025 Jan · PMID 40085066
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We report a case of an elderly female with subacute submental neck swelling, dry cough, and a history of significant weight loss. Unexpectedly, a left submandibular chronic sialadenitis was noted on ultrasound of the nec...We report a case of an elderly female with subacute submental neck swelling, dry cough, and a history of significant weight loss. Unexpectedly, a left submandibular chronic sialadenitis was noted on ultrasound of the neck, along with a thyroid nodule that, on biopsy, showed lymphocytic infiltration. High-resolution computed tomography of the lungs revealed multifocal irregular consolidations with lymphadenopathy, and possible infective causes, including tuberculosis, were ruled out after a thorough microbiological evaluation. It was only after a positron emission tomography-guided lung biopsy with specialized immunohistochemical staining was performed that the diagnosis of IgG4-related disease (IgG4-RD) was confirmed. Our patient exhibited overlapping features of head and neck-limited and Mikulicz/systemic phenotype of IgG4. In this case report, we highlight the clinical phenotypes of IgG4-RD, their respective differential diagnoses, and discuss our approach to this challenging case.