Object Although previous studies reported that late reperfusion might prevent left ventricular dilation after acute myocardial infarction (AMI), implication of persistent ischemic chest pain on admission remains to be investigated. This study was undertaken to assess the implication of persistent ischemic chest pain on in-hospital outcome and left ventricular function after late reperfused AMI.
Methods and Patients We studied 63 patients with a first anterior AMI who underwent percutaneous coronary intervention 6 to 24 hours (11.2±4.5 hours) after the onset. Of 63 patients, 48 (76%) had persistent ischemic chest pain on admission.
Results Incidence of in-hospital death, reinfarction or congestive heart failure was similar between the 2 groups. Pretreatment left ventricular ejection fraction and end-diastolic volume were similar between the 2 groups. Predischarge angiography was performed at 17±5 days after the onset. Late reperfusion prevented the dilation of left ventricular end-diastolic volume in patients with chest pain (78±12 to 75±17 ml/m², p=0.15), but did not in those without (75±20 to 93±28 ml/m², p=0.03). A multivariate analysis revealed that absence of persistent ischemic chest pain was an independent predictor of predischarge left ventricular end-diastolic volume >100 ml/m² (odds ratio 0.10, p=0.04).
Conclusions Our data demonstrated that absence of persistent ischemic chest pain appears to be a simple and reliable marker which predicts left ventricular dilation after late reperfused AMI.
(Internal Medicine 41: 920-924, 2002)

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Objective We retrospectively investigated the factors influencing the left ventricular hypertrophy (LVH) occurrence in patients with chronic renal failure (CRF).
Methods and Patients Blood pressure and echocardiographyically determined LVH were assessed in 110 patients on the basis of availability of monthly follow-up data obtained during the period of 2 years before the start of dialysis. When the patients showed the left ventricular mass index of not less than 125 g/m², they were diagnosed as having LVH. Mean casual blood pressure distribution was classified into 5 groups: Group 1; <93 mmHg, Group 2; 93-100 mmHg, Group 3; 100-106 mmHg, Group 4; 106-114 mmHg and Group 5; >114 mmHg.
Results LVH frequencies were 31.8, 72.7, 72.7, 81.8 and 95.5 (%) in Groups 1-5, respectively. Logistic regression showed that the factors influencing the progression of LVH were the duration of hypertension (per 1 year relative risk) (RR) 1.13, 95% confidential interval (CI) (1.01-1.26), treatment with angiotensin-converting enzyme inhibitors (ACE-I) (RR: 0.20, 95%CI: 0.04-0.99), pulse pressure (RR: 1.06, 95%CI: 1.00-1.11) and mean blood pressure (MBP). The RR of developing LVH increased progressively as MBP increased: Compared with LVH frequency in Group 1, RR of Group 2 was 4.38 (95%CI: 1.05-18.19), that of Group 3 was 5.50 (95%CI: 1.08-28.02), that of Group 4 was 5.66 (95%CI: 1.22-26.15), and that of Group 5 was 19.13 (95%CI: 1.75-209.4).
Conclusion Strict blood pressure control and ACE-I treatment could prevent LVH in patients with CRF.
(Internal Medicine 41: 925-930, 2002)

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Objective The present study was undertaken to evaluate clinical application of serum cystatin C as a new marker of glomerular filtration rate (GFR) in patients with various renal diseases.
Patients and Methods A total of 140 patients were enrolled in the study. We measured the serum cystatin C levels and compared them with creatinine clearance (Ccr) and inulin clearance (Cin) as an indicator of GFR.
Results There was a significant positive correlation between serum cystatin C and creatinine levels (r=0.928). Serum cystatin C was inversely correlated with creatinine clearance. Moreover, the reciprocal serum cystatin C level was positively correlated with Cin (r=0.882). The receiveroperating characteristic curve of serum cystatin C and creatinine demonstrated that the diagnostic accuracy of the serum cystatin C level is superior to that of creatinine in identifying individuals with reduced GFR.
Conclusion These results indicated that measurement of serum cystatin C is useful to estimate GFR, and in particular, to detect a mild reduction of GFR in patients with renal diseases.
(Internal Medicine 41: 931-935, 2002)

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Objective To determine whether a different renal histopathology is associated with the characteristic IgG subclass distribution, and whether a distinct IgG subclass distribution is involved in a unique immunopathological expression, we compared the distributions of glomerular and serum IgG subclasses in diffuse proliferative lupus nephritis (DPLN), membranous LN (MLN), and idiopathic membranous nephropathy (MN).
Patients and Methods The glomerular IgG subclass distributions in patients with DPLN (n=7), MLN (n=10) or MN (n=16) were assessed by direct immunofluorescence microscopy. Serum levels of each IgG subclass were quantitated by ELISA in DPLN, MLN, and MN patients, and in normal human sera (NHS) (n=14).
Results IgGl, IgG2, IgG3, and, to a lesser degree, IgG4 were similarly present in glomerular deposits in both DPLN and MLN. In contrast, IgG4 was the predominant glomerular IgG subclass in MN. Regarding the serum IgG subclasses, the mean IgG subclass concentrations and the mean proportion of each IgG subclass to the total IgG (%IgG subclass) in DPLN and MLN were not significantly different from those in NHS, except for the increased %IgGl in MLN. In MN, the mean %IgG4 was selectively increased (p<0.01 vs NHS) in association with a slightly elevated IgG4 concentration; however, the mean concentrations of other IgG subclasses were significantly decreased (p<0.01 vs NHS), and the %IgG subclasses were not significantly different from those in NHS.
Conclusions The results indicate that the IgG subclass distribution is not associated with the different renal histopathologies of DPLN and MLN. This study also shows the selective significance of IgG4 in MN, but not in MLN, another form of membranous glomerulopathy.
(Internal Medicine 41: 936-942, 2002)

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Objective To investigate the clinical features of Chlamydia pneumoniae pneumoniae in Japan and to evaluate the newly created Japanese community-acquired pneumonia (CAP) guidelines.
Patients and Methods A multicenter CAP surveillance study was carried out in 20 hospitals between December 1999 and March 2000. The diagnosis of C. pneumoniae infection was based on isolation in cell culture, the polymerase chain reaction and serologic testing of antibodies by the microimmunofluorescence test.
Results Among 232 CAP cases, C. pneumoniae was identified as the etiologic agent in 15 cases (6.5 %). C. pneumoniae was the only pathogen identified in nine of these cases, while one or more additional etiological agents were found in the other six cases. Of the present and previously reported single agent C. pneumoniae pneumonia cases, about 50% were more than 60 years old and had underlying diseases. A relatively slow pulse rate in relation to fever was not seen in these patients. The mean WBC count of all patients was normal. No patient required respiratory support or admission to an intensive care unit and no deaths occurred among these patients.
Conclusion The clinical pictures of C. pneumoniae pneumonia as a single agent were mild to moderate and were remarkably different from those of cases of C. pneumoniae pneumonia concomitant with other bacteria. If the patient is less than 60 years old and some guideline headings are excluded, we think it would be possible to distinguish between C. pneumoniae and bacterial pneumonia.
(Internal Medicine 41: 943-949, 2002)

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Hepatic portal venous gas (HPVG) was detected by CT in a 64-year-old woman who suddenly complained of lower abdominal pain. However, the abdominal symptoms disappeared rapidly, and lower gastrointestinal endoscopy indicated only terminal ileitis. Conservative treatment alone was performed, and HPVG completely disappeared approximately 18 hours later. The use of CT proved to be useful for following the course of HPVG.
(Internal Medicine 41: 950-952, 2002)

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Systemic capillary leak syndrome (SCLS) is characterized by recurrent hypovolemic shock attributable to increased systemic capillary leakage. A 46-year-old man was admitted to our hospital because of recurrent episodes of generalized edema with hypovolemic shock. Blood laboratory data revealed severe hypoproteinemia with a small monoclonal IgG-κ protein. These findings suggested strongly the diagnosis of SCLS. A regimen with steroid pulse therapy was tried; however, intravascular overloading accompanied by the recruitment of the initially extravasated fluids resulted in acute pulmonary edema. Intensive care and careful monitoring of fluid volume are required in SCLS.
(Internal Medicine 41: 953-956, 2002)

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A 47-year-old Japanese woman with a continuing high fever was promptly diagnosed as having infected atrial myxoma one day after admission based on transthoracic echocardiographic findings and positivity for bacteria in blood culture. The mass was removed by an urgent open heart surgery. Histopathological examination confirmed that this mass was a myxoma with gram-positive bacterial colonies. Generally, antemortem diagnosis is difficult and there is a high mortality of patients with infected myxoma; however, this patient completely recovered from the illness because of the prompt diagnosis. This is the 37th case of definite infected myxoma reported in the literature. The cause of infection of this patient might have been the acupuncture therapy she underwent for weight reduction.
(Internal Medicine 41: 957-960, 2002)

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We report a 71-year-old man with right heart failure due to chronic pulmonary thromboembolism. Oral medications failed to control the condition but he was later successfully treated with intermittent administration of a PDE-III inhibitor for 2 years. Such therapy did not result in exacerbation of right heart failure but improvement of ANP/BNP levels to 32/104 pg/ml from a pretreatment value of 61/158 pg/ml, although no improvement was noted in pulmonary artery pressure or cardiac index. Intermittent administration of PDE-III inhibitors is a useful treatment for patients with right heart failure resistant to oral agents.
(Internal Medicine 41: 961-966, 2002)

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A 43-year-old Japanese woman presented hypertension, hypokalemia and typical Cushingoid signs. Autonomous secretion of both aldosterone and cortisol was shown. Abdominal computed tomography demonstrated a single tumor in the right adrenal gland, which established the diagnosis of combined primary aldosteronism and Cushing's syndrome. The resected tumor was a golden yellow-colored adenoma (diameter 4.3 cm) which expressed P450_aldo and P450_11β, causing oversecretion of both hormones from this adenoma. After tumor resection, overproduction of both hormones disappeared and she developed adrenal insufficiency, suggesting the strong suppression of normal adrenal function. This case was complicated by Hashimoto's thyroiditis.
(Internal Medicine 41: 967-971, 2002)

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We report a patient with primary amenorrhea accompanied by adrenal adenoma. A 21-year-old woman was admitted to our hospital because of primary amenorrhea and hyperprogesteronemia without virilization. Venous sampling showed progesterone overproduction at the left adrenal gland. Computed tomography revealed a 7 cm mass in left adrenal gland. Serum pregnenorone, 17-hydroxypregnenorone, dehydroepiandrosterone, 17-hydroxyprogesterone, deoxycorticosterone, and 11-deoxycortisol were elevated. The diagnosis of steroid hormone producing tumor was made. Following tumor resection, serum progesterone normalized 4 days later, and menarche occurred 51 days after operation. The present case indicated that adrenal functioning tumor should not be overlooked in patients with primary amenorrhea.
(Internal Medicine 41: 972-976, 2002)

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It has been reported that various types of immunoactivators can induce Graves' disease. We describe here a case of Graves' disease during treatment with sizofiran, an immunoactivator. A 42-year-old woman who had previously been in an euthyroid state with Hashimoto's thyroiditis, experienced thyrotoxicosis during continuous administration of sizofiran as immunotherapy for endometrial carcinoma. Since the TSH receptor-antibody was positive, and a thyroid scintigram showed diffuse goiter and high uptake, she was diagnosed as having Graves' disease. It is suggested that the administration of sizofiran may be one of the triggers of Graves' disease.
(Internal Medicine 41: 977-978, 2002)

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We report a patient with KL-6-producing invasive thymoma. A 58-year-old man was admitted complaining of dyspnea and fatigability. Computed tomography of the chest revealed interstitial pneumonia and an anterior mecliastinal tumor. The tumor was surgically extirpated and diagnosed as invasive thymoma. Serum KL-6 levels later increased further and another tumor was found in the liver. That liver tumor was resected and histologically diagnosed as a metastasis of thymoma. Following resection, the serum KL-6 level decreased. Tumor cells of both primary and metastatic lesions exhibited positive reactivity to immunohistochemical staining for KL-6. A review of this case is presented.
(Internal Medicine 41: 979-982, 2002)

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We describe a 25-year-old man with Fabry disease who remained undiagnosed until progressive renal involvement had begun, because of few clinical signs or symptoms except intermittent acroparesthesia. He had non-nephrotic proteinuria and normal renal function. Renal biopsy revealed focal and segmental glomerular sclerosis with vacuolated podocytes. Electron microscopy demonstrated characteristic lamellated bodies. α-Galactosidase A (α-galA) activity was markedly decreased. Early diagnosis of Fabry disease is becoming important because of the prospect of recombinant α-galA replacement therapy. Careful history taking, physical examinations, and renal histology with electron microscopy are essential for the diagnosis in the course of the disease.
(Internal Medicine 41: 983-985, 2002)

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A 40-year-old woman undergoing prednisolone and cyclosporine therapy for subcutaneous panniculitic T-cell lymphoma complained of a cough for a few weeks. A chest X-ray revealed bilateral diffuse granular shadows. Additionally, the patient was discovered to have multiple subcutaneous abscesses. Gram-stained smears of sputum and pus from the abscess showing branched gram-positive rods led to a diagnosis of pulmonary nocardiosis with dissemination to the lungs and subcutaneous tissues. Combination therapy consisting of sulfamethoxazole/trimethoprim and panipenem/betamipron produced rapid improvement of radiographic abnormalities. It is suggested that pulmonary nocardiosis should be considered in the differential diagnosis of diffuse granular shadows on chest X-rays, especially in immunocompromised patients.
(Internal Medicine 41: 986-989, 2002)

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A case of a 29-year-old woman with intralobar pulmonary sequestration infected with Mycobacterium intracellulare is presented. A chest CT scan revealed a density in the posterior segment of the left lower lobe, and an acid-fast bacillus sputum culture yielded Mycobacterium intracellulare. After 3 months of treatment with clarithromycin, streptomycin, rifantpicin and ethambutol, the patient underwent partial resection of the left lower lobe. At the 6-month follow-up the patient's clinical status is excellent. A review of the literature revealed only three case reports of pulmonary sequestration associated with Mycobacterium aviumintracellulare complex infection.
(Internal Medicine 41: 990-992, 2002)

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Smoking causes various changes in the lung. This report describes a case of cigarette smoke-induced acute eosinophilic pneumonia (CS-AEP) with neutrophilia in the blood. However, the precise mechanism is unknown, so we examined the effect of exposure to cigarette smoke extracts on the production of interleukin (IL)-4, IL-5, IL-8, IL-18, granulocyte macrophage-colony stimulating factor (GM-CSF), and vascular endothelial growth factor (VEGF) by human bronchial epithelial cells (HBECs) obtained from the patient. We found that IL-8 released from HBECs was involved in neutrophilia in the blood, and is a new factor in the development of AEP, especially in the early phase.
(Internal Medicine 41: 993-996, 2002)

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A 65-year-old man was found to have a mass lesion surrounded by ground-glass attenuation in the left upper lobe on chest radiography. He was diagnosed with stage IA adenocarcinoma of the lung. The resected lung specimen revealed papillary adenocarcinoma associated with infiltration of numerous lymphocytes in the alveolar septa, which was consistent with focal lymphocytic interstitial pneumonia (LIP). However, it was not associated with Sjögren's syndrome or any other immunologic abnormalities. Iminunohistochemical study disclosed that CDS positive T-cells constituted the major element of the infiltrated lymphocytes in the tumor, and were also found in the enlarged alveolar septa, suggesting an association between lung cancer and LIP. To our knowledge, this is the first description of an association between LIP and lung cancer. In addition, the focal LIP in this case probably reflected local immune response to an antigenic stimulus caused by lung cancer.
(Internal Medicine 41: 997-1001, 2002)

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It has been suggested that lung cancer sometimes aggregates in families. However, the familial occurrence of bronchioloalveolar carcinoma (BAC) is extremely rare. We present a family in which two brothers had BAC. The clinical features and immunohistochemical findings of BAC in the two brothers were compared. Immunohistochemical findings revealed that both cases of BAC had very similar immunopathological features in epithelial marker expression. A review of the literature revealed that this is the third case of BACs in a single family.
(Internal Medicine 41:1002-1006, 2002)

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Giant cell interstitial pneumonia (GIP) is a very uncommon respiratory disease. We report a juvenile patient with GIP aged 15 years. Although he has a negative past history of direct exposure to hard metals, we could not exclude possible exposure in very small amounts through his parents. Microscopic examination of lung biopsy specimen obtained by video-assisted thoracoscopy revealed marked cellular interstitial infiltrates and prominent intraalveolar macrophages as well as giant cells showing cellular cannibalism. Analysis of the biopsied lung tissue for cobalt and tungsten was negative. Clinical symptoms, laboratory, and radiological findings improved markedly after treatment with corticosteroids. To our knowledge, only eleven cases of GIP have been reported in Japan. Although possible exposure to hard metals was identified in 9 of the 11 reported cases, there is no clear dose-dependent relationship with onset and prognosis. The average age at onset was 46.2±15.0 years. Our patient is the youngest case of GIP reported in the world.
(Internal Medicine 41:1007-1012, 2002)

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A case of a 19-year-old man with ulcerative colitis (UC) developed multiple pulmonary nodular shadows with cavity formation, elevated perinuclear antinuclear cytoplasmic antibody (pANCA) and positive lymphocyte stimulation test by drug (DLST) for mesalazine suggesting mesalazine induced Wegener's granulomatosis (WG). Transbronchial biopsy specimens were consistent with WG and thoracoscopic biopsy specimens were consistent with bronchiolitis obliterans organizing pneumonitis (BOOP). We diagnosed WG with BOOP-like variant, which was induced by mesalazine. To our knowledge, this is the first report of a limited form of WG associated with orally administered mesalazine.
(Internal Medicine 41:1013-1015, 2002)

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A 21-year-old woman presented with acute progressive dyspnea. Chest computed tomography (CT) revealed diffuse bilateral infiltrates. Based on the results of transbronchial lung biopsy (TBLB) and bronchoalveolar lavage fluid (BALF) and her clinical course, she was diagnosed as having acute eosinophilic pneumonia. We suspected that the disease was related to smoking because she had started smoking ten days before the onset of symptoms. Therefore, a cigarette-smoking challenge test was done with the patient's informed consent. After the challenge, eosinophilic pneumonia was documented by BALF and TBLB findings, which were similar to those detected on admission, without significant radiographic findings.
(Internal Medicine 41: 1016-1020, 2002)

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A 64-year-old man was admitted to our hospital complaining of non-productive cough and right chest pain. Chest radiographs showed bilateral hilar lymphadenopathy, diffuse granular nodules and right pleural effusion. Serum angiotensin-II-converting enzyme and lysozyme levels were elevated. Since thoracentesis indicated bloody pleurisy, video-assisted thoracoscopy was performed and revealed multiple white nodules on both the visceral and parietal pleura. Resected pleural biopsy specimens showed non-caseous granulomas. Furthermore, some nodules were observed to compress and involve small vessels and capillaries. The bloody pleurisy was assumed to have been derived from the rupture of small vessels that had been compressed and affected by the granuloma with sarcoidosis.
(Internal Medicine 41: 1021-1023, 2002)

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A 69-year-old man developed a cough and fever during treatment with corticosteroid (P.O and external use) for erythroderma. Chest X-ray films revealed a consolidation shadow in the right upper lung field. Initial treatment with sulbactam sodium/ampicillin followed by imipenem/cilastatin was not effective. A urinary antigen test for Legionella was positive, making for a diagnosis of Legionella pneumonia. Intravenous treatment with ciprofloxacin (CPFX) was remarkably effective. His symptoms, chest X-ray and laboratory data rapidly improved after its initiation. Our findings strongly suggest that intravenous treatment with fluoroquinolones including CPFX should also be a first choice for Legionella pneumonia in Japan.
(Internal Medicine 41: 1024-1028, 2002)

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We report an unusual case of pulmonary edema and rapid collection of bilateral pleural effusion caused by a fistulous large aneurysm of the ductus arteriosus (DAA). The diagnosis was performed by contrast CT and aortography. The cause of pulmonary edema and effusion was thought to be both elevated capillary pressure due to overload of the pulmonary circulation and decreased water clearance due to compression of the lymphatic system by the large DAA itself. Therefore, fistulous DAA should be considered when a continuous heart murmur and swelling in the aortic window are recognized. Once DAA is diagnosed, surgery should be performed without delay.
(Internal Medicine 41: 1029-1031, 2002)

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A 71-year-old man was diagnosed as having an abdominal aortic aneurysm when he was treated for idiopathic interstitial pneumonia (IIP). Three years later, he developed severe thrombocytopenia and had disseminated intravascular coagulation (DIC) that was associated with the inflammatory abdominal aortic aneurysm (IAAA). The coagulation abnormalities were corrected by low-molecular weight heparin, however the platelet count remained low. Bone marrow showed normocellularity with an increase of immature and mature forms of megakaryocytes. Plateletassociated IgG level was high. These findings suggested that the patient had severe thrombocytopenia caused by unusual complications of immune thrombocytopenic purpura and IAAA-associated DIC.(Internal Medicine 41: 1032-1035, 2002)

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A 59-year-old man with abnormal vascular features (intracranial aneurysm, a cervical arteriovenous shunt, bilateral internal jugular vein occlusions, and left transverse sinus hypoplasia), as well as left optic atrophy was suspected to have familial polycystic kidney disease. The possibility of autosomal dominant polycystic kidney disease complicated by Ehlers-Danlos syndrome type IV due to the coexistence of vasculopathy and polycystic kidneys was considered. However, the negative results of a skin fibroblast culture rendered the diagnosis of Ehlers-Danlos syndrome type IV unlikely. The cause of left optic atrophy in our patient remains unclear although it was suspected to be a secondary consequence of papilledema, which was caused by intracranial hypertension.
(Internal Medicine 41: 1036-1038, 2002)

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A 33-year-old man was referred to our hospital because of intractable cellulitis in his left lower leg. He was diagnosed with agammaglobulinemia at the age of 6 years and had been receiving γ-globulin supplementation since then. Laboratory examination revealed a markedly reduced number of B cells, decreased protein amount of Bruton's tyrosine kinase (BTK) in monocytes, and a single base substitution of C994→T(missense mutation of Arg288→Trp) in BTK gene, confirming the diagnosis of X-linked agammaglobulinemia (XLA). The patient also had characteristic features of von Recklinghausen disease, such as numerous subcutaneous nodules, café-au-lait spots, Lisch nodules in the iris and spinal scoliosis. Biopsy of a subcutaneous nodule confirmed a neurofibroma. Although the influence of XLA on the development of von Recklinghausen disease is unknown for the moment, this is, to our knowledge, the first report of a patient with XLA who also developed von Recklinghausen disease.
(Internal Medicine 41: 1039-1043, 2002)

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A 51-year-old woman had been administered 5 mg/day of prednisolone due to systemic lupus erythematosus (SLE). She developed hypertension, hypokaleniia and a pathologic pubic fracture during two years before admission. Although iatrogenic Cushing's syndrome was initially suspected, we diagnosed her as concomitant Cushing's syndrome due to a left adrenal tumor. The elevated endogeneous glucocorticoids were evaluated from urinary excretions of 17-hydroxycorticosteroids, which was 2-fold higher than normal and equivalent to 10 mg of prednisolone. After laparoscopic left adrenalectomy, SLE was favorably controlled with 15 mg of prednisolone, the dosage of which was equivalent to the estimated amount of preoperative glucocorticoids.
(Internal Medicine 41:1044-1046, 2002)

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We report a case of an anti-nuclear antibody (ANA)-negative patient with systemic lupus erythematosus (SLE) accompanied with anti-phospholipid antibody syndrome (APS) and lupus nephritis (LN). Histological examination of placenta obtained by an artificially-induced abortion revealed multiple thromboses in the placental villi. Histology of biopsied kidney tissue revealed minimal change with deposits of immunoglobulin and complement. Anti-ribosomal P antibodies (anti-P) and lupus anticoagulant (LAC) were positive and anti-double stranded DNA antibody (anti-DNA) showed only a slightly positive titer in her serum. The intensity of proteinuria of the patient was correlated with the anti-P, but not anti-DNA liters.
(Internal Medicine 41: 1047-1051, 2002)

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A 49-year-old Japanese female was initially diagnosed as having monoclonal gammopathy of undetermined significance in June 1993 (IgGλ: 3, 120 mg/dl). Four years later, she developed AL amyloidosis complicated by nephrotic syndrome and renal failure. Before receiving 5 courses of MP therapy (melphalan plus prednisolone), her serum IgG level had decreased in accordance with the appearance of nephrotic syndrome, which led to the leakage of serum immunoglobulin into the urine. After the discontinuation of the MP therapy, hypogammaglobulinemia has been kept over 24 months, though she still shows a leakage of 4-5 g/day of serum protein, including IgG into the urine. There were no signs of the progression of amyloidosis or renal failure, resulting in a good clinical performance status. Hypogammaglobulinemia due to nephrotic syndrome may have prevented the progression of AL amyloidosis in this case.
(Internal Medicine 41: 1052-1055, 2002)

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A 77-year-old Japanese woman with massive painless ascites caused by chronic lupus peritonitis is reported. Peritoneal effusion had been resistant to the administration of steroids during the whole treatment period. It was characteristic that the titers of anti-DNA antibodies and the level of immune complex were elevated in the peritoneal fluid with suppressed levels of complements in ascites, although serum immunological markers reflecting the activity of SLE presented improvement after initiation of the treatment. Fifteen patients with chronic lupus peritonitis were reported previously. We reviewed the literature and suggest that chronic lupus peritonitis at elderly onset may demonstrate a poor response to the glucocorticoid therapy because of persistent inflammation in the peritoneum and the presence of impaired vascular circulation in addition to immunological mechanisms.
(Internal Medicine 41: 1056-1061, 2002)

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In a rare case of Good's syndrome with pernicious anemia, one year after thymectomy, recurrent respiratory infections developed. Both panhypoglobulinemia and pernicious anemia were disclosed. An immunological analysis revealed the absence of circulating B cells, but T cell numbers and mitogenic responses were normal. Regular gammaglobulin and vitamin B₁₂ injections were successful in keeping the patient symptom free.
(Internal Medicine 41: 1062-1064, 2002)

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A 41-year-old man was admitted to the hospital because of focal swelling of the left supraclavicular lymph nodes. Eighteen months prior to admission, he had been diagnosed with human immunodeficiency virus type 1 (HIV-1) infection and was started on highly active antiretroviral therapy (HAART). He responded well to HAART with an increase in CD4+ cell count and improvement in symptoms. However, one year after the initiation of HAART, he developed progressive enlargement of left supraclavicular lymph nodes. An excisional lymph node biopsy was performed for diagnosis, which revealed tuberculous lymphadenitis. Rifabutin, isoniazid, and ethambutol were initiated for treatment.
(Internal Medicine 41: 1065-1068, 2002)

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Primary infection of human immunodeficiency virus type 1 (HIV-1) is occasionally associated with common cold-like symptoms, and rarely with a self-limited illness resembling infectious mononucleosis. We report a 32-year-old man who presented with infectious mononucleosis-like blood picture on admission. Five days after admission he developed hepatic encephalopathy, which was ameliorated by administration of bolus corticosteroid. Based on the results of serologic studies, we diagnosed that he had primary HIV-1 infection. To our knowledge, this is the first published report of hepatic encephalopathy as a clinical manifestation of primary HIV-1 infection.
(Intrenal Medicine 41: 1069-1072, 2002)

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Listerial brain abscess is extremely rare; only two cases have been reported in Japan. We encountered a female patient with immunoblastic lymphadenopathy, who developed listerial brain abscess after 8 years of treatment with antineoplastic agents and corticosteroids. Brain MRI revealed multiple space occupying lesions, suggesting abscesses which were possibly caused by hematogenous spread of the bacteria. Immediate blood culture enabled early diagnosis, and she entered into complete remission with high-dose ampicillin. Blood culture and brain imaging seem to play a crucial role in making an early diagnosis, and the administration of high dose of antibiotics is recommended for improvement of this disease.
(Internal Medicine 41: 1073-1078, 2002)

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