Immunoglobulin G4-related disease (IgG4-RD) is a rare fibro-inflammatory condition characterized by IgG4-expressing plasma cell infiltration of the skin and other organs, leading to profound itchiness. Oral corticosteroids are the first-line therapy for IgG4-RD but relapses and potential side effects are common. In this case, we discuss a patient with a hyperpigmented, scaling dermatitis on his arms, back, and chest with lichen amyloidosis (LA) that incompletely responded to corticosteroids. He had reduced quality of life secondary to chronic pruritus. Dupilumab, an IL-4 and IL-13 inhibitor, was initiated. He experienced a transient worsening, followed by complete resolution of his itch with remission of his rash. While the pathogenesis of IgG4-RD is not entirely understood, a T-helper 2 (Th2) immune response has been implicated, with interleukins (IL) 4, 5, 10, and 13 playing a role in IgG4 class switch, resulting in eosinophilia and elevated IgE. The strong response of dupilumab in this case may provide evidence in favor of the involvement of IL-4 and IL-13 in the pathogenesis of cutaneous IgG4-RD. Future clinical studies involving larger patient populations may be warranted.

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BackgroundOver the years, due to technological innovations in medical education, virtual microscopy has become a popular tool used to teach histology. The Virtual Microscopy Project is a faculty and student collaborative project at the University of South Florida (USF) Health to transfer and update online histology slides from an outdated viewer to a completely new viewer. MethodologyThe project goal is to better facilitate the educational experience for students and faculty through the implementation of updated technology and features. ResultsAt USF Health, multiple programs use the online histology slide viewer to teach normal histology. The previous website's organization and lack of additional features severely hindered opportunities for personalized education; users could not write any notes, circle or point to important features, or easily search for specific organs or tissue. An updated website user interface and additional instructional features will improve the students' accessibility and overall quality of their learning. The updated viewer will be more integrated into the USF Health Morsani College of Medicine (MCOM) curriculum, providing faculty with organized and readily available material. USF MCOM has faculty integration directors to create a balanced curriculum that can be reviewed by faculty for consistency and accuracy. Adding this same organizational structure to the online microscopy viewer will assist directors in forming and modifying the curriculum and may also provide them with additional resources for their education delivery. ConclusionThe Virtual Microscopy Project hopes to produce an accessible, user-friendly online microscopy viewer that is beneficial to students for learning, to faculty for teaching/curriculum planning, and to medical education as a whole.

Primary pulmonary meningioma is a rare benign tumor usually presenting as a solitary pulmonary nodule or mass. It can be easily misinterpreted as a primary lung tumor or metastases on imaging studies. We present a 54-year-old woman with an incidentally discovered solitary lung nodule, which was diagnosed as metaplastic primary pulmonary meningioma following resection. Metaplastic meningioma is a rare WHO grade 1 meningioma subtype with focal or global mesenchymal differentiation. To the authors’ knowledge, primary pulmonary meningioma with mesenchymal differentiation has not been described previously in the English literature.

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