Mycoplasma pneumoniae primarily affects the lung, but its extrapulmonary manifestations are less common. We report the case of a 37-year old woman who presented with fever, cough, oral ulcers, and red eyes. There was no skin rash. She showed progression of respiratory symptoms, increased oral ulceration, and worsening conjunctivitis. Chest radiography revealed interstitial pneumonia. Azithromycin was started empirically. Serological testing confirmed acute Mycoplasma pneumoniae infection with markedly elevated IgM titres. Although her respiratory symptoms improved, she had persistent conjunctivitis and mucositis. Prednisolone was initiated. Mucositis and conjunctivitis showed dramatic response to corticosteroid therapy. Mycoplasma pneumoniae-induced mucositis and conjunctivitis is part of spectrum of Mycoplasma pneumoniae-induced rash and mucositis (MIRM). It also emphasizes the need for early diagnosis and appropriate management to prevent complications.

Febrile panniculitis encompasses a heterogeneous group of inflammatory, infectious, and neoplastic disorders, and the historical label Weber-Christian disease should be used only with caution after more specific causes have been excluded. We report a 61-year-old woman with two months of recurrent remittent fever, cough, progressive dyspnea, weight loss, and episodic erythematous lesions that appeared one to two days before each febrile episode and faded with residual hyperpigmentation. Broad infectious and autoimmune investigations were unrevealing, and antibacterial therapy produced no improvement. Hypoxemic respiratory failure worsened during hospitalization, requiring high-flow nasal oxygen. A deep skin biopsy showed mixed septal and lobular inflammation with focal liquefactive fat necrosis and neutrophilic infiltration, supporting acute panniculitis. Her family subsequently reported marked improvement after systemic glucocorticoid therapy, although intermittent recurrence persisted during six months of follow-up. The close temporal coupling of fever and cutaneous inflammation, together with severe respiratory compromise, makes this presentation clinically instructive. However, pulmonary panniculitis could not be established without respiratory-tissue histology. This case supports a pattern-based diagnosis of idiopathic febrile panniculitis rather than uncritical use of an eponym-Weber-Christian disease, and highlights the need for deep biopsy, systematic exclusion of secondary causes, and longitudinal diagnostic reassessment.

Acute eosinophilic pneumonia (AEP) is often triggered by smoking or inhaled antigens, but AEP associated with zygomycetes (order Mucorales) remains poorly documented. A 56-year-old male tomato farmer presented with cough, dyspnea, and hypoxemia approximately one month after handling mold-infested tomatoes and soil without wearing a mask. Marked eosinophilia was noted in peripheral blood (10,500/μL) and bronchoalveolar lavage fluid (92%). Transbronchial cryobiopsy demonstrated prominent eosinophilic infiltration of the alveoli and interstitium without evidence of vascular invasion. Cunninghamella and Rhizopus species were isolated from sputum and soil cultures, respectively. Following initial mild improvement with empirical antibiotics and antigen avoidance, the patient improved further with corticosteroid therapy, without antifungal treatment, and showed no recurrence during three months of follow-up after discontinuation. Whereas previously reported zygomycete-associated eosinophilic lung disease has progressed to fatal disseminated mucormycosis, this case remained confined to allergic inflammation and followed a favorable clinical course.

Pneumocystis jirovecii pneumonia (PJP) is a severe and potentially life-threatening opportunistic infection in immunocompromised patients, especially those with hematologic malignancies. Although routine prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) has significantly reduced its incidence, breakthrough infections still occur, most commonly due to poor adherence to prophylactic therapy. This case report highlights the risks of non-adherence to PJP prophylaxis in adolescents and underscores the importance of early diagnostic suspicion and multidisciplinary management. A 15-year-old female patient with acute lymphoblastic leukemia presented during her seventh month of maintenance therapy (methotrexate and 6-mercaptopurine) in a compromised general condition with tachycardia, tachypnea, and hypoxemia, following a 24-hour history of fever and dry cough. Heteroanamnestic data revealed prolonged non-adherence to TMP-SMX prophylaxis. Imaging showed diffuse bilateral interstitial infiltrates on chest radiography and ground-glass opacities on high-resolution computed tomography (HRCT). PJP was confirmed via polymerase chain reaction (PCR) from bronchoalveolar lavage and a positive serum 1,3-β-D-glucan test. Treatment included intravenous TMP-SMX, corticosteroids, and high-flow nasal cannula oxygen therapy. The course was complicated by pancytopenia, likely secondary to TMP-SMX, and febrile neutropenia. A multidisciplinary approach, including social and psychiatric support, addressed non-adherence. The patient was discharged in good condition; maintenance therapy was continued, and prophylaxis was switched to monthly aerosolized pentamidine administered in the hospital setting. PJP prevention in pediatric oncology remains a significant challenge, as inconsistent adherence can rapidly lead to severe clinical deterioration. Our experience suggests that successful outcomes depend on addressing psychosocial barriers early. Transitioning to supervised, hospital-administered alternatives, such as aerosolized pentamidine, alongside multidisciplinary support, may help ensure adherence to prophylaxis in vulnerable oncology patients.

Pneumomediastinum typically results from trauma, iatrogenic injury, or an acute rise in intrathoracic pressure, as occurs with forceful coughing or vomiting. Here, we report an adolescent male patient with a congenital lesser omental defect, which led to small bowel herniation into the lesser sac. The incarcerated intestinal loop compressed the pylorus, resulting in gastric outlet obstruction, intractable vomiting, and subsequent pneumomediastinum. This case illustrates lesser sac herniation leading to vomiting-induced pneumomediastinum via the "Macklin effect".