a b s t r a c tPulmonary infarction is an infrequent complication of pulmonary embolism due to the dual blood supply of the lung. Autopsy studies have reported cavitation to occur in only 4e5% of all pulmonary infarctions with an even smaller proportion of these cases becoming secondarily infected. Patients with infected cavitating pulmonary infarction classically present with fever, positive sputum culture, and leukocytosis days to weeks following acute pulmonary embolism. We describe a rare case of acute pulmonary embolism with pulmonary infarction leading to cavitation and subsequent abscess formation requiring left lower lobe resection.Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

INTRODUCTION: Wong type dermatomyositis is a rare subset of dermatomyositis which presents with atypical cutaneous findings such as hyperkeratotic papules and palmoplantar keratoderma. To the best of our knowledge, we present the first case of Wong type dermatomyositis complicated by interstitial lung disease (ILD). CASE PRESENTATION: A 39-year-old white male presented to rheumatology clinic with a rash, decline in physical endurance, and a dry cough. Physical examination revealed a scaly rash of the bilateral palms, Gottron's papules, Holster sign of the bilateral anterior thighs, and keratoderma of the soles of the feet (Figure 1). Laboratory analysis showed elevated creatine kinase and aldolase with negative myositis antibodies. CT chest exhibited subpleural bibasilar predominance of ground glass opacities and nodules (Figure 2). Contrast enhanced MRI of the lower extremities demonstrated enhancement of the fascia consistent with inflammatory myopathy, which was confirmed by the presence of perivascular inflammatory infiltrate on muscle biopsy. Bronchoalveolar lavage showed a cell differential of 43% macrophages, 33% lymphocytes, 12% neutrophils, and 12% eosinophils with negative cultures. Mild restriction was discovered on pulmonary function testing (PFT). The patient started on pulse dose corticosteroids and hydroxychloroquine. He responded well to therapy with near resolution of cutaneous findings and significant improvement on subsequent PFT. Extensive evaluation did not show evidence of internal malignancy. DISCUSSION: ILD is a common complication of dermatomyositis however, it has never been described in patients with the Wong variant. Patients classically present with features of dermatomyositis and atypical cutaneous findings as described in our case. Management is based solely on case reports given the rarity of the disease. High dose corticosteroids and hydroxychloroquine is the initial treatment of choice. CONCLUSIONS: Clinicians should consider Wong type dermatomyositis in patients presenting with palmoplantar keratoderma and interstitial lung disease.

Use of nitrofurantoin for uncomplicated cystitis and recurrent urinary tract infections is common practice. While the majority of patients tolerate this medication without issue, it is important to be cognizant of adverse reactions, as these can impact patient's quality of life. Nitrofurantoin-induced pulmonary toxicity is a rare side effect that can present with various clinical manifestations, imaging abnormalities, and pathologic findings. We describe a case of chronic pneumonitis in a patient on suppressive nitrofurantoin therapy presenting with dyspnea and hypoxemia.

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