Objective Coronary spasm plays an important role in the pathogenesis of coronary heart disease (CHD) and angina pectoris caused by coronary spasm or coronary spastic angina (CSA) is prevalent in Japan. However, the precise mechanisms underlying coronary spasm are unclear. Alcohol intolerance is prevalent among East Asians, and we previously reported that coronary spasm could be induced by alcohol intake in CSA patients. We herein examined whether CSA is associated with alcohol intolerance in Japanese subjects.
Methods The study subjects consisted of 80 CSA patients (57 men/ 23 women, mean age 62±12) and 52 non-CSA patients (25 men/27 women, mean age 63±10). The ethanol patch test (EPT) and questionnaire which evaluates flushing after ethanol intake, along with an examination of clinical features and laboratory chemistry data for CHD risk factors were done. Gender (male) and smoking were higher (p=0.007, and p=0.019, respectively) and plasma HDL cholesterol level was lower (p=0.035) in the CSA patients than in the non-CSA patients. Multivariable logistic regression analysis including age, EPT, smoking, and plasma HDL cholesterol level as independent variables revealed that positive EPT and smoking were significant predictors of CSA (p=0.011 and p=0.016, respectively).
Conclusion Positive EPT and alcohol flushing following alcohol intake, as well as smoking and plasma levels of HDL cholesterol, were significantly associated with CSA in Japanese patients. Therefore, alcohol ingestion as well as smoking is a significant risk factor for CSA in Japanese.

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Objective Human T-lymphotropic virus type 1 (HTLV-I) causes adult T-cell leukemia/lymphoma (ATLL), and is associated with chronic inflammatory diseases, including inflammatory pulmonary diseases. HTLV-I bZIP factor (HBZ), which is expressed in all adult T-cell leukemia cells, plays a critical role in the development of lymphoma and systemic inflammation. HTLV-I is harbored by CD4⁺ T cells that express forkhead box P3 (Foxp3), and HBZ interacts with Foxp3. This study investigated the chest computed tomography (CT) findings and expression of HBZ and Foxp3 in the bronchoalveolar lavage (BAL) cells from patients with HTLV-I-associated lung disorders.
Methods CT scans obtained from 37 patients (10 men and 27 women, aged 37-77 years) with HTLV-I-associated lung disorders were retrospectively evaluated. The expression levels of HBZ and Foxp3 mRNA in BAL cells and the levels of inflammatory cytokines in the BAL fluid (BALF) from patients were compared with those in control subjects.
Results CT scans frequently revealed a diffuse panbronchiolitis (DPB)-like pattern, along with a nonspecific interstitial pneumonia (NSIP) pattern. An analysis of the BALF revealed lymphocytosis and increased expression of HBZ mRNA in patients with HTLV-I-associated lung disorders. The expression of Foxp3 mRNA positively correlated with the percentages of lymphocytes present in the BALF. The inflammatory cytokine and IL-10 levels were significantly increased in the BALF from patients with HTLV-I-associated lung disorders.
Conclusion The NSIP pattern may be a manifestation of pulmonary involvement in HTLV-I-infected patients, as is the DPB-like pattern. HBZ and Foxp3 likely have a role in the development of lung inflammation.

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A 64-year-old woman was referred for an examination of the upper gastrointestinal (GI) tract. Endoscopy showed an elevated lesion in the duodenum with central depression and multiple white granules. Biopsy specimens revealed lymphoid follicles composed predominantly of centrocytes with scattered centroblasts. The tumor cells were positive for bcl-2. The patient was diagnosed with follicular lymphoma and underwent antibiotic therapy for Helicobacter pylori (H. pylori) infection. The regression of the lesion was obvious. After 5.5 years of follow-up, there has been no evidence of recurrence. This case suggests that H. pylori eradication therapy is effective for treating follicular lymphoma in the duodenum.

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A 43-year-old woman was first admitted to the ophthalmology clinic with the complaint of a mass compressing the right eye. Based on clinical and laboratory examinations she was diagnosed as having marginal zone lymphoma (MZL) of the right lacrimal gland in addition to hepatitis C virus (HCV) infection. After the treatment for HCV infection with pegylated interferon plus ribavirin, a radiographic response of the MZL was obtained; she remains in remission through thirty months of clinical follow-up. In this case, the treatment of HCV infection led to regression of MZL suggesting the necessity of testing for HCV infection and treatment of the HCV infection should be highly considered in all HCV-positive patients with MZL's.

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A 72-year-old man with a fever and abdominal pain was referred to our hospital. On admission, the patient exhibited the clinical signs of septic shock. Computed tomography revealed a rim-and septal-enhanced lesion in the left lobe of the liver with hemorrhage along the hepatic capsule. Because Klebsiella pneumoniae was detected in both the blood and aspirated abdominal fluid, the patient was diagnosed with a ruptured pyogenic liver abscess. He was successfully treated with percutaneous abscess drainage and the systemic administration of antibiotics. Non-surgical treatment for a ruptured pyogenic liver abscess is therefore effective in at least some cases.

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We herein report the case of a 73-year-old woman with a large and tortuous coronary artery to pulmonary artery fistula treated with percutaneous coil embolization. The patient was hospitalized due to unstable angina with an elevated serum troponin-T level. Coronary angiography revealed no significant atherosclerotic stenosis, with a large and tortuous coronary artery to pulmonary artery fistula originating from the proximal portion of the left anterior descending artery. We successfully performed percutaneous coil embolization of the fistula. In this case, 320-slice multidetector computed tomography played a pivotal role in the diagnosis and percutaneous intervention.

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A 73-year-old Japanese man developed chronic intractable itching due to prurigo nodularis. High-dose glucocorticoid ointment failed, and the treatment resulted in poor glycemic control. Repeated scratching caused hematogenous bacterial dissemination via cutaneous injuries, resulting in the formation of iliopsoas and spinal epidural abscesses that required long-term antibiotic treatment. Pregabalin was administered to treat the pruritus, and a considerable improvement was observed. A reduction in the dose and intensity of the topical corticosteroids improved the patient's glycemic control, resulting in the complete resolution of the abscesses. Pregabalin significantly improved the patient's pruritus and decreased the risk of infection.

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A 52-year-old man was diagnosed with slowly progressive type 1 diabetes (SPIDDM). We expected him to quickly progress to an insulin-dependent state due to a high anti-glutamic acid decarboxylase antibody titer (23.9 U/mL). At SPIDDM diagnosis, he was in a non-insulin-dependent state, with a fasting serum C-peptide immunoreactivity level of 2.5 ng/mL. Therefore, we prescribed metformin. His glycemic control remained stable, and his intrinsic insulin secretion capacity was maintained for five years. Although one case is insufficient to draw firm conclusions, this report suggests that metformin is a therapeutic choice for SPIDDM when the insulin secretion capacity is maintained.

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Sarcoidosis is a systemic granulomatous disease of unknown origin. We herein report a case of sarcoidosis in a chronic dialysis patient diagnosed by hypercalcemia without any common clinical manifestations. The onset of sarcoidosis in chronic dialysis patients is rare; to the best of our knowledge, only 23 cases have been reported. Evaluation of the 23 previously published cases revealed that a diagnosis of sarcoidosis was often achieved by the presence of sarcoidosis-related hypercalcemia without any common clinical presentations, as in the present case. This characteristic may arise from a specific immune deficiency and the unique physiology of 1,25-dihydroxyvitamin D3, a main cause of sarcoidosis-related hypercalcemia, in chronic dialysis patients. These clinical features may be useful to understand the pathogenesis of sarcoidosis.

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Fibrosing mediastinitis is rare. One type of this disease is idiopathic fibrosing mediastinitis. It is necessary to rule out malignancy in order to accurately diagnose fibrosing mediastinitis. We herein report a case of anaplastic large cell lymphoma diagnosed three months after a preliminary diagnosis of fibrosing mediastinitis. Glucocorticoid therapy was not successful in controlling disease progression. Immediately after initiating chemotherapy for lymphoma, the patient's symptoms improved dramatically and the mediastinal lesion decreased in size. Although few similar cases have been reported, hidden malignancy may present as fibrosing mediastinitis. Therefore, physicians should consider the probability of malignancy in patients with fibrosing mediastinitis because treatments may vary accordingly.

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An 80-year-old woman was referred to our hospital due to a persistent productive cough. Acid-fast staining and a commercial Mycobacterium tuberculosis identification kit with TRC (TRC kit) were positive. However, a false-positive result on the TRC kit was suspected because Mycobacterium tuberculosis was not detected in the sputum culture. Finally, Mycobacterium shinjukuense was detected in an analysis of the rpoB and hsp65 gene sequences. As the diagnostic criteria proposed by the American Thoracic Society were met, a diagnosis of Mycobacterium shinjukuense lung disease was made. Following treatment with isoniazid, rifampicin and ethambutol with drug susceptibility, the patient's acid-fast culture became negative, and the areas of opacity improved.

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Propylthiouracil (PTU) is commonly used to treat hyperthyroidism. However, it is also associated with a number of adverse events. In particular, pulmonary complications, although rare, can be serious. Therefore, early detection is paramount. We herein describe a first case of PTU-induced bronchiolitis obliterans organizing pneumonia (BOOP) pathologically confirmed on a surgical lung biopsy. The present case shows that early detection coupled with the immediate withdrawal of PTU can lead to a successful resolution of symptoms and radiographic abnormalities without the need for corticosteroids. Although rare, PTU-induced BOOP should be considered in the differential diagnosis of pulmonary opacity in patients receiving PTU therapy.

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Acquired von Willebrand syndrome (AVWS) is a rare bleeding disorder with laboratory findings similar to those of congenital von Willebrand disease. We herein report a case of AVWS associated with Hashimoto's thyroiditis and subcutaneous mucosa-associated lymphoid tissue lymphoma. An IgG autoantibody against von Willebrand factor (VWF) was detected. The antibody bound to VWF but did not inhibit VWF activity. Rapid clearance of VWF seemed to be the cause of AVWS in the present case. VWF-containing concentrates stopped the bleeding. Even if such a complication is rare, for AVWS patients, prompt recognition of the underlying mechanism can save lives.

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We report the case of a 48-year-old woman presenting with an elevated serum creatine kinase level (hyperCKemia) associated with an initial attack of neuromyelitis optica (NMO). The patient initially showed general fatigue with fever. Laboratory findings showed hyperCKemia and subsequently she developed a slight weakness of both lower limbs and reduced vision. Autoantibodies against aquaporin 4 were found in her serum, and a retrospective examination of viral titers indicated a possible coxsackie virus group A10 infection. The present case suggests that hyperCKemia-mediated disease onset is involved in some patients with NMO, and furthermore, it may be related to muscular destruction associated with viral infection.

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We herein present the case of a 69-year-old Japanese man who had unprotected sexual contact with a local commercial sex worker in an East Asian country and was diagnosed as having disseminated gonococcal infection (DGI). The organism was confirmed to be Neisseria gonorrhoeae based on 16S rRNA sequencing and positive results for the cppB gene. This case indicates that a diagnosis of DGI should also be considered in elderly individuals. DGI potentially causes many complications, and the pathogen has recently been reported to be resistant to various antibiotics. Physicians must therefore pay more attention to the possible occurrence of DGI in various clinical settings.

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A 64-year-old man with a 10-year history of palmoplantar pustulosis, a recent history of cranial surgery and a persistent upper airway infection presented with a high fever and deep coma. The patient was diagnosed with Group A Streptococcal meningitis and promptly treated with antibiotics. Although his general condition recovered well, sensorineural hearing loss and facial palsy remained. Group A Streptococcal meningitis is a rare condition, and its typical clinical picture and epidemiological features remain poorly understood. Physicians need to be more aware of this infection, which is extremely rare but frequently causes various complications and yields a high mortality.

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