IgG4-related disease is a fibroinflammatory condition characterized by dense lymphoplasmacytic infiltrates rich in IgG4-positive plasma cells affecting multiple organs. Though the most common renal manifestation of IgG4-related disease is tubulointerstitial nephritis, it can rarely present as secondary membranous nephropathy. We present a case of a 75-year-old male with phospholipase A2 receptor-negative membranous nephropathy as an atypical manifestation of IgG4-related disease. The patient presented with nephrotic syndrome and was found to have elevated serum IgG4 levels and IgG4-positive plasma cells in the kidney biopsy. He was successfully treated with corticosteroids and rituximab, resulting in significant improvement in proteinuria and normalization of IgG4 levels. This case highlights the importance of considering IgG4-related disease in patients with phospholipase A2 receptor-negative membranous nephropathy, especially in those with a history of other organ involvement. Early recognition and treatment of IgG4-related disease are crucial to prevent progressive kidney damage and improve patient outcomes.

Idiopathic inflammatory myopathies are characterized by chronic inflammation of skeletal muscle. The main subtypes of idiopathic inflammatory myopathies include dermatomyositis, polymyositis, and necrotizing autoimmune myopathies. Dermatomyositis is characterized by symmetrical proximal muscle weakness, distinctive skin lesions, and systemic manifestations. Dermatomyositis commonly presents with elevated creatinine kinase levels. However, we report a case of a 19-year-old female presenting with dermatomyositis positive for anti-small ubiquitin-like modifier 1 and melanoma differentiation-associated gene 5 antibodies presenting with classic signs and symptoms like progressive proximal muscle weakness, dysphagia, hyperpigmented rash, and Gottron’s papules but had severe inflammatory myopathy on muscle biopsy and normal creatinine kinase levels. This case emphasizes an atypical presentation of dermatomyositis where she did not have amyopathic dermatomyositis despite having a positive anti-melanoma differentiation-associated gene 5 antibody and normal creatinine kinase. This underscores the importance of history and physical examination despite contradictory laboratory results.

Chordoma is a rare malignant neoplasm derived from notochordal tissue that primarily affects the axial skeleton. Almost 40% of patients have non-cranial chordoma metastases. The most common metastatic sites are the lungs, bones, lymph nodes, and subcutaneous tissue. We present a 52-year female with a history of sacral chordoma presenting with abdominal fullness, early satiety, and a palpable abdominal mass. Abdominal magnetic resonance imaging (MRI) revealed an isolated, highly vascularized, and multilobed liver mass in the left lateral segment. The mass was surgically removed using a clean surgical margin. A histological examination and immunohistochemical staining were consistent with a metastatic chordoma. Two years later, follow-up imaging studies showed a 6.5 × 4.0 × 2.0 cm right liver lesion with multiple lungs, chest wall, pleural, and diaphragmatic lesions. Microscopic- and immunohistochemical staining revealed a recurrent metastatic chordoma. Herein, we present a unique case of metastatic recurrent chordoma in the liver with the involvement of other sites. To the best of our knowledge, no other case of recurrent liver metastasis has been reported.

Lung cancer is the leading cause of cancer-related deaths. Surgery remains the best option to treat lung cancer when feasible. However, many cases are diagnosed beyond the initial stages. There has been tremendous progress in the treatment of lung cancer over the last few years. Studies have shown that biomarker-driven targeted therapies lead to better outcomes. Due to the technical difficulties and significant procedural risk associated with repeated tissue biopsies, analysis of tumor constituents circulating in the blood, such as circulating tumor DNA (ctDNA) and various proteins, is becoming more widely recognized as an alternative method of tumor sampling, i.e., liquid biopsy. Liquid biopsy is superior to tissue biopsy, as it is minimally invasive and easily repeatable. Given the recent data on changes in mutations as the disease progresses or responds to treatment, liquid biopsies can help monitor the changes and guide us in giving targeted drugs. Here we present a case of advanced NSCLC who was initially started on Alectinib based on positivity for ALK gene rearrangement found in the FISH study. At the time of progression, molecular profiling liquid biopsy was obtained, which revealed KRAS-p.G12C mutation. Thus, the patient’s therapy was later on changed to sotorasib after the FDA approved a KRAS-p.G12C mutation inhibitor.

Obesity has been associated with worse outcomes in patients with COVID-19 infection, but nationally representative data across multiple pandemic years remain limited. We conducted a retrospective cohort study using the National Inpatient Sample database from 2020 to 2022 to evaluate the association between obesity and in-hospital outcomes among adults hospitalized with COVID-19 in the United States. Adult hospitalizations with COVID-19 infection were identified and stratified according to the presence or absence of obesity. Multivariable regression analyses were performed to assess the association of obesity with in-hospital mortality, respiratory support, renal complications, thromboembolic events, sepsis-related outcomes, cardiovascular complications, hospital length of stay, total hospitalization charges, and discharge disposition. A total of 5,934,565 adult COVID-19 hospitalizations were included, of which 1,450,164 patients had obesity, and 4,484,401 did not. Patients with obesity were younger, more likely to be female, and more commonly African American or Hispanic. After multivariable adjustment, obesity was associated with increased odds of mortality (aOR, 1.27; 95% CI, 1.25–1.29; p < 0.001), respiratory support, vasopressor use, sepsis, septic shock, acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO), acute pulmonary embolism, acute deep venous thrombosis, tracheostomy, acute kidney injury, and renal replacement therapy, along with longer hospital stays and higher total hospitalization charges. Mortality among patients with obesity peaked in 2021 and declined in 2022. Obesity appears to be an independent predictor of adverse in-hospital outcomes in adults hospitalized with COVID-19.

Background: Obesity has been associated with adverse COVID-19 outcomes, but nationally representative data across multiple pandemic years remain limited. We evaluated the association between obesity and in-hospital outcomes among adults hospitalized with COVID-19 infection in the United States during 2020–2022. Methods: We conducted a retrospective cohort study using the National Inpatient Sample. Adult COVID-19 hospitalizations were categorized according to obesity status. Survey-weighted multivariable regression analyses assessed associations with in-hospital mortality, respiratory support, renal complications, thromboembolic events, sepsis-related outcomes, cardiovascular complications, length of stay, hospitalization charges, and discharge disposition. Results: The study included 1,186,914 COVID-19 hospitalizations, representing 5,934,565 weighted hospitalizations of which 1,529,022 had obesity and 4,406,543 did not have obesity. Hospitalizations with obesity involved younger individuals and greater proportions of female individuals.After adjustment, obesity was associated with increased odds of mortality (adjusted odds ratio, 1.38; 95% confidence interval, 1.36–1.40; p < 0.001), mechanical ventilation, vasopressor use, sepsis, septic shock, acute respiratory distress syndrome, extracorporeal membrane oxygenation, acute pulmonary embolism, venous embolism and thrombosis, tracheostomy, acute kidney injury, and renal replacement therapy. Obesity was also associated with longer hospital stays and higher hospitalization charges. Mortality among hospitalizations with obesity peaked in 2021 and declined in 2022. Conclusions: Obesity was independently associated with adverse clinical outcomes and greater hospital resource utilization among adults hospitalized with COVID-19 infection.