Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Volume 57 , Issue 21
Showing 1-31 articles out of 31 articles from the selected issue
EDITORIAL
ORIGINAL ARTICLE
  • Kyoichi Adachi, Tomoko Mishiro, Eiko Okimoto, Yoshikazu Kinoshita
    2018 Volume 57 Issue 21 Pages 3067-3073
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Objective To clarify the influence of the degree of gastric mucosal atrophy on the serum lipid levels before and after the eradication of Helicobacter pylori infection.

    Methods The subjects were individuals who underwent an annual detailed medical checkup. Serum anti-H. pylori IgG antibody detection and upper endoscopic examinations were performed in all subjects. Gastric mucosal atrophy was evaluated by the classification of Kimura and Takemoto. The serum levels of total cholesterol, high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), LDLC/HDLC ratio, and triglycerides were compared among the different degrees of gastric mucosal atrophy in H. pylori-positive subjects. In addition, changes in those serum lipid levels during a two-year period were compared among H. pylori post-eradication cases that showed different degrees of gastric mucosal atrophy prior to eradication.

    Results In subjects with higher degrees of gastric mucosal atrophy, the serum levels of total cholesterol, LDLC, and triglycerides were elevated. Furthermore, the LDLC/HDLC ratio in subjects with moderate and severe grades of gastric mucosal atrophy was significantly higher than in subjects with mild atrophy. In subjects with higher degrees of gastric mucosal atrophy, the serum level of LDLC and the LDLC/HDLC ratio were decreased following eradication of H. pylori.

    Conclusion Lipid metabolism is influenced by the degree of gastric mucosal atrophy present before the eradication of H. pylori, and the favorable effects of such eradication are significant in patients with higher degrees of atrophy.

    Download PDF (151K)
CASE REPORTS
  • Yasuo Otsuka, Ken Kamata, Kosuke Minaga, Mamoru Takenaka, Tomohiro Wat ...
    2018 Volume 57 Issue 21 Pages 3075-3078
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Although hyperparathyroidism has been reported to cause acute pancreatitis, little is known about the mechanism involved. This study describes the case of an 86-year-old woman with acute pancreatitis and consciousness disturbance caused by hyperparathyroidism and hypercalcemia, respectively. The consciousness disturbance caused by severe hypercalcemia probably masked the typical symptoms associated with pancreatitis because she did not report abdominal pain during the clinical course.

    Download PDF (675K)
  • Kahori Morino, Yuichi Honma, Shinsuke Kumei, Tatsuyuki Watanabe, Keiic ...
    2018 Volume 57 Issue 21 Pages 3079-3085
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Cronkhite-Canada syndrome (CCS) is a rare non-inherited disease characterized by gastrointestinal polyposis, chronic diarrhea, ectodermal dysplasia, skin hyperpigmentation, hair loss and nail atrophy. Although the efficacy of corticosteroid and immunomodulatory agents has been demonstrated, no standard therapy regimen has been established, and the prognosis of CCS is still poor due to various complications. We here in report a CCS patient complicated with severe sepsis and disseminated intravascular coagulation who was successfully treated by combined modality therapies, including recombinant human soluble thrombomodulin.

    Download PDF (1789K)
  • Masaya Iwamuro, Shunsuke Saito, Masao Yoshioka, Haruo Urata, Kumiko Ue ...
    2018 Volume 57 Issue 21 Pages 3087-3091
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 75-year-old Japanese woman presented with nausea and appetite loss. Computed tomography showed a radiopaque substance in the stomach. Esophagogastroduodenoscopy revealed bezoars in the stomach, which were endoscopically retrieved. The bezoars were mainly composed of magnesium and oxide. Although bezoar formation associated with magnesium oxide consumption is infrequently encountered, the present case indicates that pharmacobezoar should be considered among the differential diagnoses in patients who demonstrate a radiopaque mass in the digestive tract and have a history of magnesium oxide use.

    Download PDF (954K)
  • Takuya Seike, Takuya Komura, Yoshiaki Shimizu, Hitoshi Omura, Tatsuo K ...
    2018 Volume 57 Issue 21 Pages 3093-3097
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 37-year-old obese man who was a social drinker was admitted to our hospital to undergo a detailed examination for liver injury with anti-mitochondrial antibody positivity. Abdominal ultrasonography revealed moderate fatty liver. A histological analysis showed steatosis of approximately 30% of the hepatocytes, focal necrosis, a few ballooning hepatocytes and lobular inflammation suggestive of steatohepatitis, epithelioid granuloma and irregularity of the sequence of the bile duct epithelium accompanied by lymphocyte infiltration suggestive of chronic cholangitis. He was diagnosed with non-alcoholic steatohepatitis complicated with primary biliary cholangitis. His liver injury was improved by weight loss and high-dose ursodeoxycholic acid treatment.

    Download PDF (911K)
  • Kosei Hashimoto, Kouichi Miura, Yoshinari Takaoka, Hiroaki Nomoto, Shu ...
    2018 Volume 57 Issue 21 Pages 3099-3104
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 79-year-old Japanese woman was diagnosed with acute hepatitis B based on laboratory tests showing positivity for IgM-class antibody against hepatitis B virus (HBV) core and hepatitis B surface antigen (HBsAg) as well as elevated transaminases. A phylogenetic analysis revealed that the HBV strain obtained from the patient belonged to genotype D/subgenotype D1, similar to strains circulating in foreign countries but different from those in Japan. The clinical course was favorable. HBsAg became negative within 10 weeks after the onset. To our knowledge, this is the first report of acute hepatitis B caused by subgenotype D1 HBV in Japan.

    Download PDF (1135K)
  • Daisetsu Aoyama, Yasuhiro Hamatani, Chizuko Kamiya, Keiko Ohta-Ogo, Ma ...
    2018 Volume 57 Issue 21 Pages 3105-3109
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 35-year-old woman was referred to our hospital for the management of acutely decompensated heart failure due to peripartum cardiomyopathy (PPCM). Generally, cardiac examinations are performed after the manifestation of heart failure in patients with PPCM. Thus, reports of serial cardiac examinations before the onset of PPCM are scarce. In this case, we were able to document the serial echocardiographic findings before the onset of life-threatening PPCM. We found that the left ventricular systolic function was preserved at 35 weeks of gestation but declined acutely after delivery at 38 weeks. Although speculative, these findings suggest that left ventricular dilation might precede the onset of PPCM.

    Download PDF (1415K)
  • Toshiki Takano, Kazuyuki Ozaki, Komei Tanaka, Takao Yanagawa, Takuya O ...
    2018 Volume 57 Issue 21 Pages 3111-3115
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 43-year-old man was diagnosed with acute myocardial infarction (AMI) due to multivessel coronary vasospasm. Accordingly, two coronary vasodilators were administered, and he was discharged without an angina attack. However, from the following day, he reported frequent chest pain and was re-hospitalized. Despite adding multiple coronary vasodilators, it was difficult to completely suppress the angina attack. He also demonstrated hypereosinophilia from the onset of AMI, and his eosinophil count gradually increased up to 6,238/μL. After corticosteroid administration was started, the vasospasm was completely controlled, and his eosinophil count normalized. He remained free from angina attacks for two years with corticosteroid therapy.

    Download PDF (3311K)
  • Naoki Gocho, Ema Aoki, Chiho Okada, Takeshi Hirashima
    2018 Volume 57 Issue 21 Pages 3117-3122
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Gonadotropin-releasing hormone (GnRH) agonists have been used for the treatment of various diseases. Although autoimmune thyroid disease has been reported as a rare complication of these agents, the symptoms are almost always transient and non-life-threatening. We herein report a rare case of an 83-year-old man receiving GnRH agonist treatment for prostate cancer who developed myxedema coma complicated by acute pancreatitis. This is the first report of myxedema coma potentially associated with a GnRH agonist. The follow-up of the thyroid function is necessary for patients undergoing treatment with GnRH agonists, especially those known to have or to be susceptible to autoimmune thyroid disease.

    Download PDF (1657K)
  • Hiroshi Mori, Kenichi Nakajima, Suguru Kadomoto, Atsushi Mizokami, Hir ...
    2018 Volume 57 Issue 21 Pages 3123-3128
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Neuroendocrine-differentiated prostate cancer (NEPC) is a rare pathophysiology. We herein report a patient diagnosed with conventional prostate adenocarcinoma before hormone therapy, which was later diagnosed as NEPC. The nadir of prostate-specific antigen (PSA) was achieved once. However, adenocarcinoma changed to NEPC in recurrence, and the serum progastrin-releasing peptide (Pro-GRP) and neuron-specific enolase (NSE) values increased. A prostate needle biopsy revealed neuroendocrine differentiation. The chemotherapy regimen was changed, and somatostatin receptor scintigraphy (SRS) helped to determine the distribution and features of lesions as well as the effects of therapy. When prostate cancer worsens despite conventional therapy, NEPC should be considered.

    Download PDF (4378K)
  • Seigo Ito, Takahiro Uchida, Hiroki Itai, Aoi Yamashiro, Akira Yamagata ...
    2018 Volume 57 Issue 21 Pages 3129-3133
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 76-year-old woman suddenly developed anasarca and a fever, and an examination revealed thrombocytopenia, reticulin fibrosis, and acute kidney injury, yielding the diagnosis of thrombocytopenia, anasarca, fever, reticulin fibrosis, organomegaly (TAFRO) syndrome. Renal replacement therapy and steroid treatment were soon started. Her proteinuria was minor at first; however, once the kidney function improved, nephrotic syndrome occurred. A kidney biopsy showed membranoproliferative glomerulonephritis-like glomerulopathy with massive macrophage infiltration. Although kidney dysfunction is often observed in TAFRO syndrome patients, its detailed mechanism is unclear. This case suggests that TAFRO syndrome involves both acute kidney injury with minor proteinuria and nephrotic syndrome, and these disorders can develop serially in the same patient.

    Download PDF (730K)
  • Akifumi Tabei, Mitsuharu Watanabe, Hidekazu Ikeuchi, Masao Nakasatomi, ...
    2018 Volume 57 Issue 21 Pages 3135-3139
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Nivolumab is an anti-programmed cell death-1 (PD-1) antibody that is utilized as an immune checkpoint inhibitor (ICI) for cancer therapy. We herein present the case of a 57-year-old man who developed acute kidney injury during treatment with nivolumab for lung cancer. A renal biopsy revealed acute tubulointerstitial nephritis. Immunohistochemical staining demonstrated marked infiltration of macrophages and T cells together with mild B cell infiltration. Of note, strong CD163+ M2 macrophage infiltration was observed. The cessation of nivolumab and high-dose prednisolone therapy improved the renal function of the patient. Further, we review the pertinent literature on renal-infiltrating cells in ICI-induced tubulointerstitial nephritis.

    Download PDF (967K)
  • Seigo Miyoshi, Tomoaki Nagao, Masayoshi Kukida, Ken-ichi Miyoshi, Chik ...
    2018 Volume 57 Issue 21 Pages 3141-3147
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 64-year-old man was admitted to our hospital for purpuric rash, joint pain, and a fever. He had earlier undergone a follow-up examination for interstitial lung disease. At the current visit, the diagnosis was immunoglobulin A (IgA) vasculitis, based on skin and renal biopsy findings. He developed sudden breathlessness and hemoptysis. Chest computed tomography revealed ground glass opacity in the right lower lung fields, suggesting pulmonary hemorrhaging associated with IgA vasculitis. Despite steroid and cyclophosphamide therapy, and plasma exchange, he died 52 days after admission. Early aggressive therapies may be recommended for old patients with IgA vasculitis who have an additional comorbidities.

    Download PDF (2076K)
  • Yoshiro Nakahara, Tomoya Fukui, Masayuki Shirasawa, Shinya Harada, Sei ...
    2018 Volume 57 Issue 21 Pages 3149-3152
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    We herein report the case of a 52-year-old man with stage IV lung adenocarcinoma. The patient was negative for epidermal growth factor receptor (EGFR) mutations and echinoderm microtubule-associated protein-like 4 (EML4) /anaplastic lymphoma kinase (ALK) rearrangement. He was treated with nivolumab as a third-line chemotherapy. After four cycles of nivolumab treatment, a partial response was observed in the brain and at the primary tumor site. Nivolumab treatment has been continued for 11 months without progression. Immunohistochemistry revealed that the programmed death-ligand 1 (PD-L1) expression was 0% (according to the tumor proportion score).

    Our case indicates that the efficacy of programmed cell death 1 inhibitors is not solely predicted by the PD-L1 status, and that immune checkpoint inhibitors might be effective for the treatment of central nervous system metastasis.

    Download PDF (971K)
  • Hironori Ashinuma, Masato Shingyoji, Yuzo Hasegawa, Sana Yokoi, Yasush ...
    2018 Volume 57 Issue 21 Pages 3153-3155
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    The mechanisms underlying anaplastic lymphoma kinase (ALK) resistance have not been well investigated in clinical practice. We herein report the case of a lung cancer patient with carcinomatous meningitis who had an ALK I1171T resistance mutation revealed by direct DNA sequencing of the cerebrospinal fluid after treatment with cytotoxic chemotherapy, crizotinib, and alectinib. I1171T is considered to be sensitive to ceritinib. Although ceritinib was not effective initially, we chose ceritinib again after whole-brain radiotherapy and ventriculoperitoneal shunting. Although the response duration was short, spinal magnetic resonance imaging revealed a marked response. The identification of an acquired ALK resistance mutation will aid in choosing the optimum sequence therapy.

    Download PDF (448K)
  • Yumi Katsume, Tsuyoshi Isawa, Yukihiro Toi, Ryo Fukuda, Yasuteru Kondo ...
    2018 Volume 57 Issue 21 Pages 3157-3162
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Pembrolizumab, a humanized monoclonal IgG4 antibody directed against programmed death-1, is an immune checkpoint inhibitor that has been introduced for the treatment of non-small-cell lung cancer. However, immune checkpoint inhibitors may cause severe immune-related adverse events. We herein present a case of lung cancer with complete atrioventricular block associated with acute myocarditis, which developed 16 days after the administration of pembrolizumab. The clinical course of this case suggested a strong need for close cardiac monitoring when pembrolizumab is administered on an outpatient basis.

    Download PDF (1410K)
  • Naoto Aiko, Akimasa Sekine, Shigeaki Umeda, Takuma Katano, Goshi Matam ...
    2018 Volume 57 Issue 21 Pages 3163-3167
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Lymphomatoid granulomatosis (LYG) is a rare lung disorder diagnosed by radiological imaging of multiple pulmonary nodules and occasionally induced by methotrexate (MTX) use. To date, the treatment of LYG has not been standardized. We herein report the case of a patient with grade 3 MTX-related LYG who presented a bulky lung mass. Importantly, the disease condition only improved after the discontinuation of MTX and remained stable for more than 1 year. Chest physicians should be aware that LYG can develop as a single lung mass and spontaneously regress, even without aggressive chemotherapy, following the cessation of MTX.

    Download PDF (1738K)
  • Naomi Maruyama, Atsuhito Hikiishi, Miho Suginaka, Koichi Furukawa, Koi ...
    2018 Volume 57 Issue 21 Pages 3169-3173
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Nuclear protein in testis (NUT) carcinoma (NUT-C) is an exceedingly rare and aggressive neoplasm. We herein report a case of a 57-year-old man with a rapidly progressing tumor of the thorax and left pleural effusion. The pathological features and immunohistochemical staining of specimens obtained by a transbronchial lung biopsy initially indicated poorly differentiated squamous cell carcinoma. However, given the clinical presentation along with the additional histopathologic features, NUT-C was considered. Immunohistochemical staining for NUT was positive in the pleural fluid cell block, confirming the diagnosis of NUT-C. This report indicates the utility of immunohistochemical staining for diagnosing NUT in the pleural fluid cell block.

    Download PDF (1327K)
  • Nobuhiko Nakamura, Soranobu Ninomiya, Takuro Matsumoto, Hiroshi Nakamu ...
    2018 Volume 57 Issue 21 Pages 3175-3177
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    We herein report a case of long-lasting pure red cell aplasia (PRCA) after major ABO-incompatible allogeneic stem cell transplantation (SCT) for acute lymphoblastic leukemia. The patient needed red blood cell (RBC) transfusion every week after SCT. On day 236, he was diagnosed with odontogenic infection, and the serum levels of Interleukin (IL)-6 were elevated to 12.1 pg/mL. After that, the numbers of reticulocyte rapidly began to increase, and RBC support was not needed from day 251. No standard care for PRCA following SCT has been established. The IL-6 elevation caused by the odontogenic infection therefore appears to have been affected by the improvement in PRCA.

    Download PDF (182K)
  • Jun Yamanouchi, Daiki Tokumoto, Yuichi Ikeda, Masaki Maruta, Masahiko ...
    2018 Volume 57 Issue 21 Pages 3179-3182
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Mild hemophilia A is caused by a missense mutation in the FVIII gene that is responsible for a decrease in the FVIII:C to between 5% and 40%. The development of FVIII inhibitors has been reported in 3-13% of patients with mild hemophilia. Genetic risk factors for the development of inhibitors in mild hemophilia have been investigated. In the present study, we encountered a case of mild hemophilia with an FVIII inhibitor and identified the mutation responsible: a novel Phe595Cys mutation in the FVIII gene. In addition, this study showed that the inhibitor recognized exogenous wild-type FVIII and autologous mutant FVIII.

    Download PDF (248K)
  • Masako Mukai, Kishin Koh, Yuko Ohnuki, Eiichiro Nagata, Yoshihisa Taki ...
    2018 Volume 57 Issue 21 Pages 3183-3186
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    We describe the cases of two sisters with spastic paraplegia 11 (SPG11). The younger sister developed relapsing lesions in the brain white matter with enhancement during the acute phase that mimicked multiple sclerosis (MS). The elevation of myelin basic protein in the cerebrospinal fluid (CSF) suggested demyelination, but a normal IgG index, the absence of oligoclonal bands, and the ineffectiveness of steroid treatment indicate that an autoimmune mechanism may not have been involved. In these affected sisters, we identified novel compound heterozygous mutations in the SPG11 gene. Our cases indicate the possible existence of a broader phenotypic spectrum of SPG11 mutations.

    Download PDF (479K)
  • Kaoru Yagita, Kazuto Tsukita, Akiyo Shinde, Toshihiko Suenaga
    2018 Volume 57 Issue 21 Pages 3187-3191
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Nocturnal hypertension (NH) is a symptom of cardiovascular dysautonomia in multiple system atrophy (MSA); however, care and medication are often insufficient. We herein report a patient with MSA who showed posterior reversible encephalopathy syndrome (PRES) caused by hypertension during sleep. He presented clinically with total blindness; T2-weighted magnetic resonance imaging showed high signal intensities in the bilateral subcortical occipital-temporal lobes. His PRES was completely reversed by blood pressure control. NH may contribute to the development of PRES. The appropriate assessment and management of hemodynamic changes in MSA, including NH, is necessary to prevent severe complications such as PRES.

    Download PDF (1894K)
  • Daisuke Honda, Isao Ohsawa, Yuki Shimizu, Masayuki Maiguma, Teruo Hida ...
    2018 Volume 57 Issue 21 Pages 3193-3197
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: April 27, 2018
    JOURNALS OPEN ACCESS

    A 42-year-old Japanese man with hereditary angioedema suffered accidental trauma to his jaw in Shizuoka Prefecture, Japan, which gradually caused facial edema. Since plasma-derived human C1 inhibitor (pdh C1-INH) was unavailable, he had to be transferred to Juntendo University Hospital in Tokyo. Due to his severe edema, he suffered asphyxiation leading to cardiopulmonary arrest upon arrival. The patient was resuscitated and promptly treated with pdh C1-INH. In Japan, the self-administration of pdh C1-INH is not allowed, and every prefecture does not always possess stocks of pdh C1-INH. This case emphasizes the need for urgent improvements in treatment availability in Japan.

    Download PDF (508K)
  • Motofumi Tosa, Masako Aihara, Junko Murakami
    2018 Volume 57 Issue 21 Pages 3199-3204
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    A 78-year-old man had a fever and exhibited disordered consciousness, which led to his transportation to our hospital. On arrival, he exhibited discharge from the ear. Because extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli was detected in the ear discharge and cerebrospinal fluid specimens, it was inferred to be the causal bacteria. Pulsed-field gel electrophoresis indicated the same ESBL-producing E. coli pattern in the patient's ear discharge, external auditory canal granulation, cerebrospinal fluid, and stool, indicating their common molecular epidemiological origin. Although ESBL-producing E. coli is an extremely rare cause of bacterial meningitis, it should be considered as a potential causal bacteria for community-acquired meningitis.

    Download PDF (924K)
  • Ryohei Ono, Shuku Sato, Satomi Okada, Emiko Kanbe, Eri Tanaka, Yotaro ...
    2018 Volume 57 Issue 21 Pages 3205-3212
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Vertebral aspergillosis is a rare infectious disease with a high mortality rate. We herein report a 70-year-old woman with acute myelogenous leukemia with myelodysplasia-related changes, nontuberculous mycobacteriosis, and bronchiectasis who presented with a fever and cough. Her clinical symptoms and laboratory test results suggested febrile neutropenia and pneumonia. However, her clinical course was further complicated by lower extremity weakness. Magnetic resonance imaging of the spine showed consolidation contiguously spreading toward the epidural space between the T4 and T5. Cytological testing of the pleural effusion revealed Aspergillus fumigatus. We also review and summarize previously reported cases of vertebral aspergillosis in Japan.

    Download PDF (3592K)
  • Takashi Yoshimura, Tatsuya Kawasaki, Ayumi Shirota, Masashi Saeki, Yuk ...
    2018 Volume 57 Issue 21 Pages 3213-3216
    Published: November 01, 2018
    Released: November 01, 2018
    [Advance publication] Released: June 06, 2018
    JOURNALS OPEN ACCESS

    Valacyclovir, a prodrug of acyclovir, is the first-line treatment for herpes zoster, but the renal function must be monitored, because acyclovir is metabolized by the kidneys. We herein report a case of valacyclovir-induced neurotoxicity with no preceding renal impairment. An 88-year-old man was admitted because of an impaired consciousness after the administration of valacyclovir at 3,000 mg daily for herpes zoster on the chest. His consciousness level gradually improved with hydration and valacyclovir withdrawal. It was later confirmed that the level of acyclovir on admission had been 35.45 μg/mL in the blood and 36.45 μg/mL in the cerebrospinal fluid.

    Download PDF (390K)
PICTURES IN CLINICAL MEDICINES
feedback
Top