Objective Identifying patients at high risk of steatotic liver disease (SLD) is crucial. The liver fibrosis stage is the most reliable marker of liver-related mortality. However, non-invasive risk stratification methods remain controversial. Therefore, we analyzed the risk of liver-related events in patients who underwent a liver biopsy for metabolic dysfunction-associated steatotic liver disease (MASLD) or cryptogenic SLD at our hospital.

Methods We retrospectively reviewed the clinical course of the patients to identify the occurrence of liver-related events.

Patients This study included 146 patients diagnosed with SLD through a liver biopsy.

Results Liver-related events occurred in 20 patients and were more frequent in those with advanced fibrosis than in those without advanced fibrosis. However, patients with advanced steatosis exhibit reduced disease progression. Patients with obesity and/or diabetes complications had a lower stage of fibrosis and better prognosis than the others. The non-invasive fibrosis-4 (FIB-4) index and non-alcoholic fatty liver disease (NAFLD) prognosis-related "NAFLD outcomes score (NOS)" effectively differentiated patients with disease progression. Standard laboratory data analyses revealed that high total bilirubin and low albumin levels were risk factors. A multivariate analysis with significant factors other than NOS score revealed that the absence of obesity and/or diabetes complications, a high FIB-4 index, and a high total bilirubin level were independent factors for liver-related events.

Conclusion A high NOS score, absence of obesity and/or diabetes complications, a high FIB-4 index, and high total bilirubin levels are risk factors for disease progression. Patients with lean phenotypes or non-diabetic SLD should also be assessed using non-invasive markers to determine their risks and potential outcomes.

Mixed neuroendocrine-non-neuroendocrine neoplasm of the gallbladder (GB-MiNEN) is an exceptionally rare and aggressive tumor with no established treatment guidelines. We herein present the case of a 53-year-old woman with GB-MiNEN who was treated with irinotecan and cisplatin therapy, which led to a significant tumor reduction and subsequent conversion surgery. Despite a later recurrence, multimodal therapy extended survival for over two and a half years. This case underscores the potential benefit of conversion surgery combined with systemic chemotherapy, thus suggesting that multimodal treatment may improve the outcomes of GB-MiNEN. Our findings highlight the need for further studies to optimize the treatment strategies for this rare malignancy.

Although the liver is often involved in sarcoidosis, the majority of patients are asymptomatic and have a normal liver function; therefore, hepatic sarcoidosis may sometimes not be recognized in clinical practice. Radiologically, most hepatic nodules show hypoenhancement on contrast-enhanced computed tomography or magnetic resonance imaging (MRI) and they are hypointense across all sequences of MRI. In this case, hepatic nodules were slightly hyperintense on T2-weighted images and contrasted from the early phases on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid. We faced difficulties in distinguishing hepatic sarcoidosis from metastatic liver tumors with concurrent duodenal adenocarcinomas. Consequently, this case was diagnosed based on the pathological findings from a laparoscopic lateral segment hepatectomy.

In 2020, a 56-year-old woman with a history of Helicobacter pylori (H. pylori) eradication 9 years previously presented with a hemorrhagic hyperplastic polyp. Endoscopic and histological findings led to the diagnosis of advanced-stage autoimmune gastritis (AIG). A review of endoscopic findings from 2014 was available, and narrow-band imaging showed swelling of the gastric areas, characteristic of early-stage AIG. Together with the rapid growth of a hyperplastic polyp, these findings suggest a case of AIG that rapidly exacerbated after eradication. To our knowledge, this is the first case report of a rapidly developing hemorrhagic hyperplastic polyp associated with AIG after H. pylori eradication.

A 77-year-old man underwent a colonoscopy. A submucosal cecal tumor was found, and localized colorectal MALT lymphoma (Lugano stage I) was diagnosed with a Helicobacter pylori infection. The first-line eradication therapy was successful, and the cecal lesion regressed. However, a new lesion was observed in the lower rectum. The rectal lesion regressed after the second-line eradication therapy. Two new lesions were identified in the sigmoid colon. However, no additional treatment was administered and a watch-and-wait strategy was adopted. Both of the lesions regressed. There are no established treatments for colorectal MALT lymphomas. The watch-and-wait strategy may be effective in cases of recurrence after eradication therapy.

The causes of hypercalcemia vary. There are high-calcium-containing preparations in Chinese herbal medicine, which may contribute to drug-induced hypercalcemia. We encountered a case of hypercalcemia following the simultaneous administration of an active vitamin D3 preparation and several Chinese herbal medicines. The patient had been treated at several medical institutions, with one institution administering eldecalcitol and another institution administering Keishikaryukotsuboreito, Borei powder, and Goreisan. The patient presented with drug-induced hypercalcemia due to an unexpected synergistic effect. Confirmation of prescriptions for patients with multiple medical visits and recognition of the components and side effects of Chinese herbal medicines is thus considered to be extremely important.

We describe the case of a 25-year-old male with Duchenne muscular dystrophy and acute kidney injury who was receiving mechanical ventilation. The patient's estimated glomerular filtration rate (eGFR) was assessed using formulas based on creatinine, cystatin C, and inulin levels over time during the recovery of his renal function. The creatinine-based eGFR was extremely high throughout the study period. The cystatin C-based eGFR was also higher than the inulin clearance. These findings suggest that cystatin C-based eGFR may also exceed inulin clearance in patients with an extremely reduced fat mass, in addition to a reduced muscle mass.

Post-transplant lymphoproliferative disorder (PTLD) affects from 0.8-2.5% of kidney transplant patients, with peaks in incidence within 1 year and 10-14 years post-transplant. Very late-onset PTLD (VL-PTLD) can occur over 10 years post-transplant, reportedly up to 30 years, but its characteristics remain unclear. A 61-year-old man developed PTLD 45 years after kidney transplant, presenting with fever and shortness of breath. Computed tomography revealed lung and liver masses and biopsy-confirmed stage IVB monomorphic PTLD. Despite obtaining an initial improvement, the patient died on day 66. VL-PTLD may differ from early- or late-onset PTLD, thus necessitating further research on both the associated risks and management.

We herein report a case of acute kidney injury and Fanconi syndrome associated with a red yeast rice supplement. A 72-year-old woman's serum creatinine rose from 0.7 to 3.97 mg/dL after starting the supplement, accompanied by metabolic acidosis, proteinuria, hematuria, and glucosuria. A kidney biopsy showed proximal tubular injury without abundant tubulitis. Immunostaining showed dilated tubules that were positive for CD 10, confirming proximal tubule localization. Discontinuation of the supplement and steroid pulse therapy improved the patient's condition. This case highlights the health risks associated with unregulated dietary supplementation.

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are highly effective against EGFR-mutant non-small-cell lung carcinoma but can cause serious adverse events, such as interstitial lung disease (ILD). Treatment strategies for osimertinib-induced ILD are not well established. Cytotoxic anticancer drugs are considered first, although several cases of successful rechallenge with EGFR-TKIs have been reported. We herein report a 67-year-old woman with symptomatic osimertinib-induced ILD who was switched to afatinib and later rechallenged with osimertinib and corticosteroids. Neither treatment resulted in ILD relapse, suggesting that these may be viable treatment options when alternative treatments are limited.

We present the case of a patient with lung cancer who developed brachial plexitis following treatment with immunochemotherapy, which included atezolizumab and palliative radiotherapy for a metastatic cervical spine tumor. This case highlights the importance of considering immune-related adverse events (irAEs) when initiating immune checkpoint inhibitor therapy, in addition to other recognized causes such as radiation, tumor compression and invasion, and paraneoplastic syndromes. While brachial plexitis has been reported as an irAE associated with programmed cell death 1 (PD-1) antibodies, this is the first report associated with the administration of programmed cell death ligand 1 (PD-L1) antibodies.

We report the case of a 68-year-old man who presented with pleural effusion and dyspnea during treatment for alcoholic liver cirrhosis. The pleural effusion was transudative and it was diagnosed to be hepatic pleural effusion. Thoracic drainage was continued, but the amount of pleural fluid drainage did not decrease. The patient was strongly positive for antinuclear antibodies and anti-SS-A and anti-SS-B antibodies, thus leading us to suspect pleurisy caused by Sjögren's syndrome. Steroid administration decreased pleural drainage; however, cirrhosis progressed and the patient eventually died. An autopsy revealed pleurisy. Other causes may also be involved in treatment-resistant hepatic effusion.

Cardiac amyloidosis (CA), predominantly caused by amyloid transthyretin (ATTR) or immunoglobulin light chain (AL), has a poor prognosis, and a precise diagnosis is crucial because the optimal treatments differ between the two conditions. However, diagnosing AL-CA is challenging because of the unavailability of effective AL-detecting antibodies, particularly in cases with coexisting AL- and ATTR-CA. This report presents a successfully diagnosed case of complicated AL- and ATTR-CA that was successfully treated with tafamidis for ATTR-CA and combination chemotherapy for AL-CA. This case highlights the importance of a precise diagnosis of CA and supports the efficacy and safety of concurrent treatment for coexisting amyloidosis.

Idiopathic multicentric Castleman disease (iMCD) accompanied by thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal insufficiency, and organomegaly (TAFRO) frequently develops into prolonged severe thrombocytopenia and multiorgan dysfunction, which is associated with a high mortality rate. We herein describe three cases of iMCD-TAFRO in which serum soluble interleukin-2 receptor (sIL-2R) levels varied in relation to disease activity following the initiation of treatment. Thrombocytopenia persisted for several weeks to months after the normalization of the patients' C-reactive protein levels, whereas their sIL-2R levels normalized 10-47 days prior to platelet recovery (≥100×10⁹/L). The serum sIL-2R measurement may therefore be an effective method for evaluating the disease activity in iMCD-TAFRO patients with prolonged thrombocytopenia.

Anemia is not known to cause intermittent claudication. We herein present the case of a 74-year-old male patient with intermittent claudication, in whom the primary symptom was severe iron-deficiency anemia. The characteristics of claudication mimicked a neurogenic disorder, but lumbar magnetic resonance imaging ruled out lumbar spinal stenosis, and the symptoms resolved after the anemia improved. This case highlights the need to consider anemia in the differential diagnosis of patients presenting with intermittent neurogenic claudication. A comprehensive evaluation, including tests to rule out anemia, is crucial for making an accurate diagnosis and carrying out the appropriate management of intermittent claudication.