Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
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ORIGINAL ARTICLES
  • Takuya Seike, Takuya Komura, Yoshiaki Shimizu, Hitoshi Omura, Tatsuo K ...
    2020 Volume 59 Issue 13 Pages 1581-1588
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 09, 2020
    JOURNALS OPEN ACCESS

    Objective We aimed to examine the dynamics of serum Wisteria floribunda agglutinin-positive human Mac-2-binding protein glycosylation isomer (M2BPGi) in patients with acute liver injury.

    Methods Serum M2BPGi levels at the time of the diagnosis (n=77) and normalization of the serum alanine aminotransferase (ALT) level (n=26) were examined retrospectively. The difference in the serum M2BPGi level according to the etiology, and the correlations with other laboratory parameters were evaluated.

    Results The serum M2BPGi level at the time of the diagnosis was increased in 59 of 77 patients [2.3 cutoff index (COI); range, 0.31-11.1 COI] and was significantly decreased at the time of serum ALT normalization (0.68 COI; range, 0.15-1.87 COI; p<0.0001). The serum M2BPGi level was positively correlated with the duration for which serum ALT normalization was achieved (n=46, Spearman rho=0.53, p<0.0001). A multivariate analysis identified total bilirubin (T-bil), albumin, ALT, alkaline phosphatase, and etiology (e.g., drug-induced liver injury or etiology unknown) as independent factors for increased serum M2BPGi. In patients with infectious mononucleosis, the serum M2BPGi level was higher relative to the degree of increase of serum ALT or T-bil levels in comparison to other etiologies.

    Conclusion The serum M2BPGi level in patients with acute liver injury reflects the magnitude and duration of liver injury. However, it should be noted that the degree of increase of serum M2BPGi in patients with acute liver injury may differ according to the etiology.

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  • Daisuke Yamaguchi, Atsushi Izawa, Yasuko Matsunaga
    2020 Volume 59 Issue 13 Pages 1589-1595
    Published: July 01, 2020
    Released: July 01, 2020
    JOURNALS OPEN ACCESS

    Objective Depression in patients with coronary artery disease (CAD) has been a risk factor for adverse cardiovascular events. However, personality types, strategies for coping with stressors, and their associations with depression have not been fully elucidated in patients with CAD. This study explored depression in patients with CAD and examined its association with personality types and coping strategies.

    Methods A prospective observational study of 89 patients with CAD was conducted between August 2016 and July 2018. The presence of depression and type D personality and types of coping strategies were measured one month after percutaneous coronary intervention. A logistic regression analysis was performed to identify characteristics associated with depression.

    Results Generally, the incidence of depression and type D personality was 55.1% and 44.9%, respectively. The incidence of depression in patients with type D and non-type D personality was 72.5% and 40.8%, respectively. Patients with type D personality coped less frequently using a planning strategy but frequently using a responsibility-shifting strategy. A logistic regression analysis showed that the presence of depression was significantly associated with type D personality and inversely associated with a planning strategy.

    Conclusion The high prevalence of depression in patients with CAD was associated with type D personality and a low rate of adoption of a planning strategy. Specific coping interventions in patients with CAD with type D personality may be potential targets for improving coping skills and preventing the development of depression.

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  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Ma ...
    2020 Volume 59 Issue 13 Pages 1597-1603
    Published: July 01, 2020
    Released: July 01, 2020
    JOURNALS OPEN ACCESS

    Objective In primary percutaneous coronary intervention (PCI), the door-to-balloon time (DTBT) is known to be associated with in-hospital death in patients with ST-segment elevation myocardial infarction (STEMI). However, little is known regarding the association between the DTBT and the mid-term clinical outcomes in patients with STEMI. The purpose of this study was to investigate the association between the DTBT and mid-term all-cause death.

    Methods The study population included 309 STEMI patients, who were divided into the short DTBT (DTBT<60 minutes, n=103), intermediate DTBT (DTBT 60-120 minutes, n=174) and long DTBT (DTBT >120 minutes, n=32) groups. The median follow-up period was 287 days (interquartile range: 182-624 days).

    Results The incidence of all-cause death in the long DTBT group was significantly higher in comparison to the other groups (p<0.001). In the multivariate Cox regression analysis, although a short DTBT [vs. intermediate DTBT: hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.39-2.55, p=0.99] was not associated with all-cause death, a long DTBT (vs. intermediate DTBT: HR 2.80, 95% CI 1.26-6.17, p=0.011) was significantly associated with all-cause death, after controlling for confounding factors such as Killip class 4, an impaired renal function, and the number of diseased vessels.

    Conclusion The DTBT was significantly associated with the incidence of mid-term all-cause death. Our results support the strong adherence to the DTBT in patients with STEMI.

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  • Yoshiko Kaneko, Takako Mouri, Yurie Seto, Naoya Nishioka, Akihiro Yosh ...
    2020 Volume 59 Issue 13 Pages 1605-1610
    Published: July 01, 2020
    Released: July 01, 2020
    JOURNALS OPEN ACCESS

    Objective Patients with suspected lung cancer often experience adverse side effects such as anxiety, depression, and a decreased appetite. These side effects influence the patients' quality of life and their ability to make decisions concerning appropriate treatment. This study examined the psychological status and quality of life of patients with suspected lung cancer before and after bronchoscopy treatment and evaluated the effect of mirtazapine prescribed to patients with depression.

    Methods To assess patient characteristics (e.g. age, gender, and medical history), a questionnaire including the Hospital Anxiety and Depression Scale - Japanese version and the Functional Assessment of Cancer Therapy-L was administered.

    Patients Forty-three patients admitted for bronchoscopy treatment between May 2017 and April 2018 were included.

    Results The results showed that patients with depression reported a worse quality of life than those without depression. Compared with no medication, the administration of mirtazapine alleviated depressive symptoms. Furthermore, the patients' depressive status was affected by their physical symptoms, including coughing, tightness of chest, and dyspnea.

    Conclusion Our results emphasize the importance of detecting depression in the early stages of a cancer diagnosis and have significant implications concerning pharmacological intervention in patients with cancer displaying signs of depression.

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CASE REPORTS
  • Kei Tomiyoshi, Hiroki Sato, Kentaro Tominaga, Yuzo Kawata, Daisuke Oka ...
    2020 Volume 59 Issue 13 Pages 1611-1613
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 09, 2020
    JOURNALS OPEN ACCESS

    Thiopurine drugs are commonly used to treat immunologic diseases. However, the narrow therapeutic safety margin demands evidence-based precision medicine approaches. NUDT15 variants are associated with thiopurine-induced adverse events, particularly in Asians. We herein report a rare genotype of His/His in NUDT15 codon 139 in a case of ulcerative colitis and review the relevant literature. The patient experienced severe thiopurine-associated adverse events, including leukopenia and alopecia. There is no literature on the His/His genotype in NUDT15 codon 139, and our case suggests cautious use or the contraindication of thiopurines for patients with this genotype.

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  • Kotaro Ouchi, Ryosuke Narui, Toru Sakuma, Hiroya Ojiri
    2020 Volume 59 Issue 13 Pages 1615-1620
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: March 26, 2020
    JOURNALS OPEN ACCESS

    Anticoagulation in venous thrombosis associated with Behçet disease (BD) is controversial. We herein report a 47-year-old woman with vessel thrombosis and pulmonary artery aneurysm (PAA) associated with BD who died of massive hemoptysis under oral anticoagulant. Although she was initially diagnosed with oral contraceptive-induced venous thromboembolism, a subsequent investigation led to a diagnosis of BD. Follow-up computed tomography (CT) showed persistent thrombus, so anticoagulant was continued for persistent thrombus. She died of massive hemoptysis after the development of PAA was identified on follow-up CT during the period of anticoagulation. Great care to prevent bleeding events is required when administering anticoagulants for BD with vessel thrombosis.

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  • Takeshi Imakura, Toshifumi Tezuka, Mami Inayama, Ryota Miyamoto, Akane ...
    2020 Volume 59 Issue 13 Pages 1621-1627
    Published: July 01, 2020
    Released: July 01, 2020
    JOURNALS OPEN ACCESS

    Pulmonary tumor thrombotic microangiopathy (PTTM) is an acute, progressive, and fatal disease. PTTM manifests as subacute respiratory failure with pulmonary hypertension, progressive right-sided heart failure, and sudden death. An antemortem diagnosis of PTTM is very difficult to obtain, and many patients die within several weeks. We herein report a case of PTTM diagnosed based on a transbronchial lung biopsy. In this case, we finally diagnosed PTTM due to gastric cancer because of its histological identity. The patient was administered chemotherapy, including angiogenesis inhibitors, against gastric cancer at an early age and survived for a long time.

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  • Toshifumi Tezuka, Mami Inayama, Ryoko Suzue, Kenya Miyamoto, Takashi H ...
    2020 Volume 59 Issue 13 Pages 1629-1632
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 02, 2020
    JOURNALS OPEN ACCESS

    Pulmonary tuberculosis is a common disease that may result in hemoptysis. Fetal hemoptysis is known to be related to the rupture of a pulmonary aneurysm formed in the cavity wall. We herein report a case of non-cavity pulmonary tuberculosis that developed with massive hemoptysis following bronchial artery aneurysm. Bronchial artery embolization was performed, and autofluorescence imaging bronchoscopy was conducted one month after the anti-tuberculosis treatment. Bright-green color was observed in the ulcerative lesion with a white coat, corresponding to the bronchial artery aneurysm. This is the first report of the autofluorescence imaging observation of an ulcerative lesion caused by bronchial tuberculosis.

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  • Yuji Yamamoto, Yuko Ohara, Ami Iwai, Reina Hara, Takanori Matsuki, Kiy ...
    2020 Volume 59 Issue 13 Pages 1633-1637
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: March 19, 2020
    JOURNALS OPEN ACCESS

    Influenza vaccination can trigger various adverse reactions, and thrombocytopenia is also rarely reported. Although patients with mild thrombocytopenia are sometimes asymptomatic, severe thrombocytopenia can cause severe bleeding. We herein report a rare case of severe thrombocytopenia that occurred within one day of influenza vaccination and diffuse alveolar hemorrhage (DAH) leading to acute respiratory failure. The patient was treated with glucocorticoid pulse therapy, intravenous immunoglobulin, and temporary mechanical ventilation, and eventually he made a full recovery. Vaccine-related thrombocytopenia and DAH should be considered adverse reactions, even if they develop very soon after vaccination.

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  • Takahiro Taki, Naohiro Oda, Yusuke Fujioka, Reo Mitani, Takehiko Tokur ...
    2020 Volume 59 Issue 13 Pages 1639-1642
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 09, 2020
    JOURNALS OPEN ACCESS

    We herein report a 75-year-old man with non-small-cell lung cancer who developed tubulointerstitial nephritis due to pembrolizumab administration. He was successfully treated with atezolizumab following steroid administration. He was initially diagnosed with lung adenocarcinoma (T1bN3M1b, stage IV), with a programmed cell death-ligand 1 tumor proportion score of 25-49%. Although the tumor responded well to pembrolizumab, the drug was discontinued because of the diagnosis of tubulointerstitial nephritis on a renal biopsy. Tubulointerstitial nephritis was treated with 30 mg prednisolone, the dose of which was tapered to and maintained at 5 mg. Following lung cancer progression, atezolizumab was administered, and the tumor responded again. Its efficacy has been sustained for >15 months without recurrence of tubulointerstitial nephritis.

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  • Tomohiro Suzuki, Syuichi Tetsuka, Tomoko Ogawa, Ritsuo Hashimoto, Shin ...
    2020 Volume 59 Issue 13 Pages 1643-1647
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 02, 2020
    JOURNALS OPEN ACCESS

    Varicella-zoster virus (VZV) encephalitis in the absence of vasculopathy may rarely occur in association with herpes zoster. We herein report the case of a 67-year-old woman with non-Hodgkin's lymphoma undergoing chemotherapy who presented with an acute alteration in consciousness. Magnetic resonance imaging of the brain revealed multiple and nonspecific lesions of hyperintensity with mild edema in the cortex and subcortex. She was treated with intravenous acyclovir. However, two days after admission, the patient died and was diagnosed with VZV encephalitis. This case highlights the risk of VZV reactivation with severe neurological complications in patients undergoing immunosuppressive therapy.

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  • Yasutoshi Fujii, Mihoko Doi, Hiroaki Yamane, Takehiko Morioka, Daisuke ...
    2020 Volume 59 Issue 13 Pages 1649-1654
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 09, 2020
    JOURNALS OPEN ACCESS

    Immunoglobulin G4-related disease (IgG4-RD) is defined as an inflammatory lymphoproliferative disorder. The relationship between malignancies and IgG4-RD remains unclear. We herein present a case of IgG4-RD that occurred during chemotherapy for advanced breast cancer. In this case, it was challenging to determine which of these diseases was responsible for the patient's mediastinal lymphadenopathy. Lymphadenopathy with IgG4-RD was diagnosed by assessing the reactivity to corticosteroids, which were used as premedication in chemotherapy, over time. The administration of prednisolone, which was initiated to treat active IgG4-RD, led to stable systemic therapy for malignancy. It is imperative to assess the disease activity and consider each treatment.

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  • Satoshi Kitaura, Yoshitaka Wakabayashi, Aiko Okazaki, Yuta Okada, Koh ...
    2020 Volume 59 Issue 13 Pages 1655-1658
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 09, 2020
    JOURNALS OPEN ACCESS

    Hepatitis E virus (HEV) is a common cause of acute hepatitis. Four major genotypes of HEV have been studied, with genotype 4 being the predominant genotype across Asia. We herein describe the case of a 50-year-old man with a history of human immunodeficiency virus (HIV) infection who was admitted with acute transaminitis. Serum anti-HEV-IgA and HEV-RNA were detected at the time of presentation and further testing revealed HEV genotype 4. To the best of our knowledge, this represents the first clinical case report of acute symptomatic HEV genotype 4 infection in an HIV-positive patient in Japan.

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  • Ryosuke Hayashida, Kyoichiro Tsuchiya, Suguru Nakamura, Noriyuki Harim ...
    2020 Volume 59 Issue 13 Pages 1659-1663
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 09, 2020
    JOURNALS OPEN ACCESS

    A 66-year-old man with type 2 diabetes was admitted for glycemic control and weight loss. The rectal mucosa was unfortunately injured during glycerin enema administration in preparation for colonoscopy, after which dark red urine and renal dysfunction were observed. Considering the clinical diagnosis of glycerol-induced hemolysis and acute kidney injury, intravenous hydration and haptoglobin administration were started, which successfully treated the dark red urine and renal dysfunction. This case highlights the importance of appropriate glycerin enema administration and emphasizes the need to recognize glycerol-induced hemolysis and acute kidney injury as complications of glycerin enemas. This case also provides insight into glycerol-induced hemolysis and acute kidney injury as complications of glycerin enemas.

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  • Yu Hee Lee, Min Jeong Kwon, Jeong Hyun Park, Su Jin Jeong, Tae Hyun Ki ...
    2020 Volume 59 Issue 13 Pages 1665-1669
    Published: July 01, 2020
    Released: July 01, 2020
    [Advance publication] Released: April 09, 2020
    JOURNALS OPEN ACCESS

    A 40-year-old woman presented with a left adrenal incidentaloma. Based on the presence of café-au-lait spots, cutaneous neurofibroma, and family history, she was diagnosed with neurofibromatosis type 1 (NF1). Adrenal incidentaloma screening showed an elevated normetanephrine level; the left adrenal mass showed the uptake of I-123 meta-iodobenzylguanidine. She underwent left adrenalectomy, and pheochromocytoma was diagnosed. One year later, the results of a biopsy of a palpable mass in the left breast suggested invasive ductal carcinoma. The patient underwent neoadjuvant chemotherapy followed by left breast-conserving surgery. We herein report a rare case of an NF1 patient who developed both pheochromocytoma and breast cancer.

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