Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Advance online publication
Showing 1-50 articles out of 309 articles from Advance online publication
  • Takashi Inao, Masashi Amano, Seishu Hashimoto, Chisato Izumi, Yodo Tam ...
    Article ID: 6525-20
    Published: 2021
    [Advance publication] Released: May 07, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Few reports have highlighted the serial changes in pulmonary hypertension during respiratory management. An 18-year-old girl with severe scoliosis was referred to our hospital for worsening dyspnea on exertion. Based on chest X-ray and transthoracic echocardiography findings showing a tricuspid regurgitation pressure gradient (TRPG) of 64 mmHg, the patient was diagnosed with severe alveolar hypoventilation due to thoracic deformity and severe pulmonary hypertension. Her oxygenation improved rapidly under noninvasive positive pressure ventilation, although partial pressure of carbon dioxide remained >80 Torr. Transthoracic echocardiography on day 7 showed clinically significant and rapid improvement of pulmonary hypertension with a TRPG of 30 mmHg.

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  • Tsunetaro Morino, Hiroto Ohto
    Article ID: 6711-20
    Published: 2021
    [Advance publication] Released: May 07, 2021
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  • Taichi Nomura, Kosuke Iwami, Azusa Nagai, Kazufumi Tsuzaka, Ichiro Yab ...
    Article ID: 7031-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
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    Anti-mitochondrial antibody type 2 is a diagnostic marker of primary biliary cirrhosis and complicates myositis. Myositis with anti-mitochondrial antibody type 2 is clinically characterized by slowly progressive limb, cardiac, and respiratory muscle weakness as well as serum creatinine kinase elevations. However, there has been few cases with eye symptoms. We herein report a 59-year-old woman with anti-mitochondrial antibody type 2 who presented with diplopia and ptosis. Magnetic resonance imaging revealed bilateral ocular muscle enlargement and abnormally high intensities in the lower limb muscles. Corticosteroid therapy improved these symptoms. Myositis with anti-mitochondrial antibody type 2 can present with eye symptoms.

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  • Masaki Tago, Toru Oishi, Seijiro Makio, Shu-ichi Yamashita
    Article ID: 7096-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
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  • Tatsuhiro Yamazaki, Takeshi Tomoda, Hironari Kato, Kazuya Miyamoto, Ak ...
    Article ID: 7168-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Objective Strict follow-up is recommended for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) to avoid missing the development of high-risk stigmata (HRS) at a premalignant stage. This study explored the risk factors associated with the development of HRS during follow-up.

    Methods We performed a retrospective analysis of 283 patients with BD-IPMN, treated at Okayama University Hospital in Japan between January 2009 and December 2016. Only patients with imaging studies indicative of classical features of BD-IPMN without HRS and followed for over one year were included in the study. We performed radiological follow-up every six months and collected patients' demographic data, cyst characteristics, and clinical outcomes and used univariate logistic regression models to determine the odds of developing HRS.

    Results Ten patients (3.5%) developed HRS after a median surveillance period of 55.8 months. The main pancreatic duct (MPD) size (5-9 mm) and cyst growth rate (>2.5 mm/year) were both suggested to be possible risk factors for the development of HRS (odds ratio, 14.2; 95% confidence interval [CI], 3.1-65.2, p=0.0006, and odds ratio, 6.1; 95% CI 1.5-25.5, p=0.014). Regarding the number of worrisome features (WFs), the rate of HRS development was 2.0% (4/199) in cases with no WF, 1.6% (1/62) in cases with single WF and 22.7% (5/22) in cases with multiple WFs, respectively. The rate of HRS development was significantly higher in cases with multiple WFs than in the other cases (p<0.0001).

    Conclusion MPD dilation, rapid cyst growth, and multiple WFs were significant risk factors for the development of HRS. In the presence of such features, it is necessary to closely follow the development of HRS and avoid missing the best opportunity to perform surgical intervention.

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  • Yasuyuki Tanaka, Yumi Tokubayashi, Mitsuya Kikuchi, Shigehiko Fujii, T ...
    Article ID: 7218-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
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    An 80-year-old woman was found to have a 40-mm depressed-type gastric cancer. Computed tomography showed multiple lymph node enlargement, including paraaortic lymph nodes. The extent of lymph node enlargement was significant compared with the depth of the primary lesion. We conducted distal gastrectomy, D2 lymph node dissection, and a paraaortic lymph node biopsy. Microscopically, the tumor was diagnosed as mucosal cancer. In the dissected lymph nodes, noncaseating granuloma was found without metastasis of adenocarcinoma. Immunohistochemical staining using Propionibacterium acnes-specific antibodies showed a large number of P. acnes-positive cells in the granulomas. Finally, the tumor was diagnosed as early-stage gastric cancer and sarcoidosis.

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  • Yoshio Hisata, Yuuki Oka, Mai Watanabe, Koichi Tomikashi
    Article ID: 7349-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
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  • Hiroko Iizuka, Sakiko Harada, Noriaki Iwao, Michiaki Koike, Masaaki No ...
    Article ID: 7391-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
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    Primary skeletal muscle lymphoma is extremely uncommon, and there have only been eight previous case reports on primary skeletal muscle peripheral T-cell lymphoma, not otherwise specified (PSM-PTCL, NOS). We herein report an autopsy case of a 71-year-old woman with PSM-PTCL, NOS, who had a 24-year history of systemic sclerosis treated with immunosuppressive drugs. A post-mortem examination revealed infiltration of lymphoma cells positive for T-cell markers, cytotoxic markers, and p53. This case was considered to be one of other iatrogenic immunodeficiency-associated lymphoproliferative disorder (OIIA-LPD). This is the first case categorized under both PSM-PTCL, NOS, and OIIA-LPD.

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  • Yuya Ando, Sachiko Ono, Yosuke Ono, Jinghua Yin
    Article ID: 7414-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
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  • Taro Kogami, Haruki Uojima, Takasuke Ebato, Yuki Bando, Akiyoshi Hoshi ...
    Article ID: 7483-21
    Published: 2021
    [Advance publication] Released: May 07, 2021
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    We herein report a rare case of cartilage-hair hypoplasia (CHH) complicated with liver cirrhosis. A 20-year-old Japanese man with CHH was found incidentally to have liver cirrhosis and an esophageal varix. This patient had been treated for infections due to immunodeficiency since early childhood. He ultimately died of liver failure at 31 years of age. An autopsy revealed an abnormality of the interlobular bile ducts and intrahepatic cholestasis. Liver cirrhosis was thought to have been caused by chronic intrahepatic cholestasis due to biliary duct hypoplasia and changes in the intestinal microbiome. Therefore, CHH may cause biliary cirrhosis due to multiple effects.

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  • Masato Asaoka, Eri Hagiwara, Satoshi Etori, Katsuyuki Higa, Satoshi Ik ...
    Article ID: 5300-20
    Published: 2021
    [Advance publication] Released: April 26, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Objective Although multiple non-tuberculous mycobacteria (NTM) species can be isolated from the same patient, little has been reported on co-isolation. We clarified the trends and characteristics of the co-isolation of multiple NTM species.

    Methods To collect data on multiple NTM isolation, we first extracted all patients who visited our hospital from 2006 through 2015 with a diagnosis of NTM lung diseases other than Mycobacterium avium complex (MAC) and then reviewed their medical records to evaluate the co-isolation of multiple NTM species.

    Results Of 213 patients with non-MAC lung disease, the most common NTM species was M. gordonae (32%), followed by M. kansasii (20%) and M. abscessus (14%). Non-MAC NTM lung disease tended to be associated with middle age with a low body mass index and male predominance. Multiple NTM species were isolated from 55 (26%) of the 213 patients. The clinical characteristics associated with multiple NTM species isolation included female predominance, never smokers and the absence of cavity lesions in the lungs. The highest co-isolation rate was observed in patients with M. gordonae isolation (30%), followed by M. furtuitum isolation (26%) and M. abscessus isolation (20%). Only MAC was isolated when co-isolated with M. abscessus. Among M. szulgai, M. peregrinum and M. terrae isolation, no other NTM species were detected.

    Conclusion Co-isolation of multiple NTM species was not uncommon, with 26% of patients with non-MAC NTM lung diseases showing co-isolation with multiple NTM species. Each NTM species had distinct characteristics in terms of co-isolation.

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  • Yuki Yoshimatsu, Kazunori Tobino, Ryunosuke Ooi, Takuto Sueyasu, Saori ...
    Article ID: 6052-20
    Published: 2021
    [Advance publication] Released: April 26, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We experienced a patient who presented with lung abscess one month after aspirating barium during a gastric cancer screening examination. The patient had no subjective symptoms suggesting a swallowing disorder. Rigorous history taking under suspicion of aspiration and a further assessment of the cause of aspiration revealed hypopharyngeal cancer. Lung abscess and hypopharyngeal cancer, both treatable but potentially fatal conditions, were not diagnosed until one month after the aspiration. This highlights the need for guidance for patients and physicians to follow in the event of barium aspiration, as it is the most common complication of a barium examination. A health checkup for one condition (gastric cancer) may also be an opportunity to diagnose another underlying condition.

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  • Kunihisa Miwa
    Article ID: 6082-20
    Published: 2021
    [Advance publication] Released: April 26, 2021
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    Objective Central nervous system dysfunction associated with myalgic encephalomyelitis (ME) has been suggested to be the main cause of chronic fatigue syndrome. In animal models of chronic fatigue, minocycline was reported to act as a suppressor of neural inflammation. Minocycline may thus exert favorable therapeutic effects in patients with ME.

    Methods Oral minocycline (100 mg ×2 on the first day, followed by 100 mg/day for 41 days) was administered to 100 patients with ME. The performance status score (0-9), orthostatic intolerance during the 10-min standing test, neurologic disequilibrium, and neuropathic pain were compared before and after treatment.

    Results After therapy completion, favorable effects were observed with a decrease in the performance status score of ≥2 points in 27 patients (27%). Before treatment, 6 of the 27 patients had orthostatic intolerance with an inability to complete the 10-min standing test; after treatment, this symptom resolved in 4 and improved in 2 patients. In addition, after treatment, postural orthostatic tachycardia resolved in five of eight patients, disequilibrium resolved in five of eight patients, and fibromyalgia or neuropathic pain was attenuated in four of five patients. The favorable effects appeared dependent on a shorter disease duration, primarily for a duration of less than three years and most frequently within six months of the disease onset. However, acute adverse effects with nausea and/or dizziness caused 38 patients (38%) to discontinue treatment in the first few days.

    Conclusion Oral minocycline therapy may be an effective treatment option for patients with ME, especially in the initial stage of the disease.

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  • Yasutaka Mochizuka, Masato Kono, Ryutaro Hirama, Yuiko Ohshima, Kenich ...
    Article ID: 6693-20
    Published: 2021
    [Advance publication] Released: April 26, 2021
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    A 78-year-old man was admitted to our hospital with a fever and left chest pain. Computed tomography showed multiple lung nodules, narrowing of the right bronchus intermedius with mediastinal lymphadenopathy, and an osteolytic lesion. Bronchoscopic findings showed rapid progression of multiple polypoid lesions and the bronchial stenosis. A biopsy of the endobronchial lesions revealed non-necrotizing granulomatous inflammation, and a tissue culture identified Mycobacterium avium. An anti-human immunodeficiency virus antibody was negative. Finally, anti-interferon-gamma (IFN-γ) autoantibodies were detected, and the patient was diagnosed with disseminated nontuberculous mycobacterium infection with anti-IFN-γ autoantibodies. Antimycobacterial therapy was effective, and radiographic findings, including the endobronchial lesions, were resolved.

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  • Tomoyo Oguri, Shinji Sasada, Takashi Shimada, Kota Ishioka, Saeko Taka ...
    Article ID: 6833-20
    Published: 2021
    [Advance publication] Released: April 26, 2021
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    Background Homeless persons are those who carry out their activities of daily living in city parks and other facilities. Little is known about homeless patients with lung cancer in Japan. Therefore, we characterized the clinical features and outcomes of homeless people in metropolitan Tokyo.

    Methods Between January 2014 and August 2018, 2068 homeless patients were admitted to the homeless patient care unit at Tokyo Saiseikai Central Hospital. Of these, 13 patients were treated for primary lung cancer. We retrospectively analyzed the patients' clinical characteristics, including their age, gender, treatment, and outcome, obtained from the hospital's electronic medical records.

    Results A total of 13 patients were treated for lung cancer. The median age was 66.2 (range, 51-77) years old. Twelve patients (92.3%) were smokers. All of the patients were men and had advanced lung cancer. Of these, four patients had adenocarcinoma, four had squamous carcinoma, and four had other histologies. Ten patients received chemotherapy, and 3 received chemoradiotherapy (carboplatin, n=8; cisplatin, n=2, immune check point inhibitor, n=2; other, n=1). Of the patients on first-line treatment, 58% discontinued treatment, with 71% doing so willfully. The median overall survival was 7.5 (1-44) months. During the study, nine patients died in the hospital, and four were lost to follow up.

    Conclusion It is difficult for homeless patients to continue chemotherapy, and they often quit therapy willfully. Therefore, it is necessary to develop an education and health insurance support system to ensure treatment continuity in a good social environment.

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  • Megumi Koshiishi, Toru Odate, Yukie Nakagawa, Jun Suzuki, Takuya Kumag ...
    Article ID: 6979-20
    Published: 2021
    [Advance publication] Released: April 26, 2021
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    A 71-year-old woman with a four-year history of chronic lymphocytic leukemia (CLL) received ibrutinib as initial treatment due to progressive anemia and thrombocytopenia. Eleven months after the start of the treatments, although her cytopenia had ameliorated, she developed classic Hodgkin lymphoma, a rare form of Richter's transformation. She was successfully treated with two courses of adriamycin, vinblastin, bleomycin and dacarbazine followed by radiotherapy. In general, several clinical, genetic and molecular factors are associated with Richter's transformation. In addition, our present case suggested that ibrutinib could be a potential risk factor for Richter's transformation in CLL patients.

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  • Takehiro Tsuchiya, Atsushi Sano, Mai Kaneko, Satomi Mizutani, Tsutomu ...
    Article ID: 7030-21
    Published: 2021
    [Advance publication] Released: April 26, 2021
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    Polycarbophil calcium (Polyful®; Mylan, Tokyo, Japan) is a stool stabilizer that absorbs liquid and swells to form a soft, bulky mass. A 75-year-old woman experienced sore throat and difficulty breathing immediately after taking the drug. Chest computed tomography showed a foreign body in the right intermediate bronchus. Bronchoscopy showed a white mass blocking the right intermediate bronchus. Since the mass was very fragile, we performed suctioning while breaking up the mass with a suction tube. The mass consisted of polycarbophil calcium. Since aspirated polycarbophil calcium swells and can obstruct bronchi, complete removal is crucial.

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  • Masami Minemura, Kazuto Tajiri, Yuka Hayashi, Naoki Takahashi, Kasumi ...
    Article ID: 7132-21
    Published: 2021
    [Advance publication] Released: April 26, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Accurate genotyping is important to improve the treatment of hepatitis C virus (HCV) infection. We herein report a 44-year-old Japanese man with hemophilia A and coinfection of HCV and human immunodeficiency virus (HIV) who was diagnosed with HCV genotype 4 by direct sequencing. Two genotyping tests based on the nested polymerase chain reaction method that we used misdiagnosed his genotype as 2b and 1b. Although several HCV genotyping tests are available in Japan, it is important to recognize that some cannot detect genotype 4. Care should be taken when genotyping HCV patients who have received non-heated coagulation factor preparations or were infected abroad.

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  • Ryo Ishizawa, Nobuaki Mori
    Article ID: 7230-21
    Published: 2021
    [Advance publication] Released: April 26, 2021
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  • Shotaro Yamamoto, Takao Nagashima, Yoichiro Akiyama, Katsuya Nagatani, ...
    Article ID: 7309-21
    Published: 2021
    [Advance publication] Released: April 26, 2021
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    A 56-year-old woman presented with dermatomyositis positive for anti-melanoma differentiation-associated gene 5 antibody. No interstitial lung disease was detected. Despite treatment with methylprednisolone pulse therapy and cyclosporine, dysphagia developed. Furthermore, the presence of thrombocytopenia, elevated lactate dehydrogenase levels, and an undetectable haptoglobin level suggested the possibility of thrombotic microangiopathy (TMA). Disturbed consciousness developed shortly after TMA onset, and brain magnetic resonance imaging revealed hyperintensity lesions in the bilateral basal ganglia, thalami, and brainstem. The patient was diagnosed with atypical posterior leukoencephalopathy syndrome before dying of heart failure later that day. In conclusion, early TMA recognition and prompt intensive treatment are critical in such cases.

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  • Yoshihiro Kaneko, Noriaki Yagi, Tomoaki Suzuki, Yoshihisa Nakagawa
    Article ID: 7315-21
    Published: 2021
    [Advance publication] Released: April 26, 2021
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  • Kaito Koshino, Akihiro Endo, Nobuhide Watanabe, Koichi Okazaki, Kazuak ...
    Article ID: 7382-21
    Published: 2021
    [Advance publication] Released: April 26, 2021
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    An 82-year-old woman was admitted to our hospital because of dyspnea and bradycardia during exertion. Electrocardiography revealed complete atrioventricular block. During pacemaker implantation, a small dose (12.5 mg) of hydroxyzine was injected for sedation, and torsade de pointes (Tdp) occurred. The QT interval was prolonged after administration of hydroxyzine, and Tdp was observed after the R on T phenomenon occurred, indicating that hydroxyzine was capable of prolonging the QT interval and causing Tdp. Therefore, we must be cautious when administering hydroxyzine for sedation during surgery, especially in patients with bradycardia.

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  • Ryo Deguchi, Hidenori Nakagawa
    Article ID: 6300-20
    Published: 2021
    [Advance publication] Released: April 19, 2021
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  • Masataka Kudo, Takayuki Uchida, Takahiro Sakano, Takashi Matono
    Article ID: 6605-20
    Published: 2021
    [Advance publication] Released: April 19, 2021
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  • Kazuhide Takata, Takahiro Nagata, Yotaro Uchida, Takanori Kitaguchi, T ...
    Article ID: 6855-20
    Published: 2021
    [Advance publication] Released: April 19, 2021
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    We report a case of anorexia nervosa (AN) with gastroesophageal varices (GEV) in a 36-year-old woman. The patient presented to our hospital with progressive bloating due to severe ascites. She had no history of alcohol intake. Esophagogastroduodenoscopy and enhanced computed tomography revealed GEV and multiple hepatic nodules, respectively. The histological examination of a liver biopsy specimen revealed similar features to nonalcoholic fatty liver disease and showed hyperplastic nodules that were suspected to be related to the uneven distribution of portal blood flow in the liver. In conclusion, patients with long-term AN should undergo abdominal imaging to detect signs of portal hypertension.

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  • Ryuto Yoshida, Takuya Sasaki, Takashi Sunouchi, Masayuki Ueda, Mizuki ...
    Article ID: 6885-20
    Published: 2021
    [Advance publication] Released: April 19, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Steroid administration to patients with urea cycle disorders can cause hyperammonemia. We encountered a 36-year-old woman with neuromyelitis optica (NMO) complicated by ornithine transcarbamylase (OTC) deficiency. By reducing the doses of steroids and adequate infusion management, we were able to administer pulse steroid therapy without any severe complications. This case indicates the safety of steroid treatment in patients with urea cycle disorders.

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  • Shusuke Yagi, Tomoko Takahashi, Keiji Murakami, Momoyo Azuma, Mikio Su ...
    Article ID: 6902-20
    Published: 2021
    [Advance publication] Released: April 19, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Infective endocarditis (IE) may be acquired in the community as community-acquired (CA) IE or in the healthcare setting. In Japan, cases of CA-methicillin-resistant Staphylococcus aureus (MRSA) infection as skin infection have been increasing. CA-MRSA strains, including the USA300 clone, have higher pathogenicity and are more destructive to tissue than healthcare-associated MRSA strains because of the toxins they produce, including arginine-catabolic mobile element (ACME) and Panton-Valentine leukocidin (PVL). However, only a few IE cases induced by USA300 have been reported. We herein report a 64-year-old man who developed CA-IE from a furuncle caused by USA300 MRSA producing PVL and ACME, which resulted in complications of meningitis.

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  • Yuya Kobayashi, Ryo Itabashi, Takuya Saito, Yuichi Kawabata, Yukako Ya ...
    Article ID: 6994-21
    Published: 2021
    [Advance publication] Released: April 19, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    A 68-year-old man was admitted to our department because of left incomplete homonymous hemianopia accompanied by hyperglycemia. Both T2-weighted and diffusion-weighted imaging revealed a low signal intensity along the subcortex and high signal intensity along the cortex on the right parietal and occipital lobes. Furthermore, arterial spin labeling and single-photon emission computed tomography showed hyperperfusion at the right parieto-occipital lobe. However, the electroencephalography result was normal. Hyperperfusion improved after controlling the blood glucose levels; nevertheless, homonymous hemianopia remained. We suspect that the irreversible brain damage was attributable to hyperperfusion associated with long-term hyperglycemia.

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  • Yoichi Hoshino, Isao Yamada, Shun-ichi Shimano
    Article ID: 7142-21
    Published: 2021
    [Advance publication] Released: April 19, 2021
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  • Tatsuya Ueno, Norihiro Hanabata, Atsuko Katagai, Rena Okudera, Akira A ...
    Article ID: 7210-21
    Published: 2021
    [Advance publication] Released: April 19, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel (LCIG) is an established device-aided therapy for advanced Parkinson's disease (PD). Phytobezoar associated with LCIG is a rare device-related complication and presents with exacerbations of gastrointestinal and PD symptoms. We herein report the case of a phytobezoar that was formed at a knot on the pigtail-shaped J-tube and developed only in association with postprandial abdominal pain, similar to a feeling of a tube being pulled in without an exacerbation of PD symptoms. Such abdominal pain may be a warning sign of phytobezoar in LCIG-treated patients. Despite device-related complications, high-pressure alarms are not always present, and PD symptoms are not always exacerbated.

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  • Toru Ishikawa, Michitaka Imai, Terasu Honma, Toshiaki Yoshida
    Article ID: 7334-21
    Published: 2021
    [Advance publication] Released: April 19, 2021
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  • Hiroshi Moro, Toshiaki Kikuchi
    Article ID: 4361-19
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Nontuberculous mycobacterial (NTM) infections are an emerging problem. Common organisms include Mycobacterium avium, M. intracellulare, and M. kansasii, along with the M. avium intracellulare complex (MAC), which includes both M. avium and M. intracellulare. Typically, NTM infections affect the lungs and subsequently demonstrate a chronic course. Therefore, persistent respiratory symptoms generally indicate of the presence of pulmonary NTM diseases, and chest radiography, along with a sputum examination, are essential for its diagnosis. Because NTM are ubiquitous environmental organisms, a positive culture from a minimum of two separate expectorated sputum samples are required to make a diagnosis. The repertoire of effective drugs for treatment is considerably limited, indicating the need for long-term management with multiple drugs. Establishing a treatment regimen with high therapeutic efficacy and safety is an important issue for the future.

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  • Takumi Tamura, Keisuke Miyajima, Kazuki Watanabe, Kazuki Ito, Fumihiko ...
    Article ID: 6355-20
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    A 41-year-old man was admitted with a chief complaint of dyspnea. Echocardiography showed diffuse severe hypokinesis in the left ventricle. Although his heart failure improved, high creatine kinase levels persisted. A muscle biopsy of the biceps brachii showed necrotic and regenerating fibers along with positive findings for major histocompatibility complex class I and membrane attack complex. He was diagnosed with antibody-negative immune-mediated necrotizing myopathy (IMNM). Steroid therapy was started, but he died due to ventricular fibrillation. Autopsy findings revealed CD68- positive macrophages in the myocardium and quadriceps. To our knowledge, this is the first case of antibody-negative IMNM with cardiac involvement.

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  • Shiika Watanabe, Tomo Suzuki, Wei Han, Mayumi Nakata, Kenichiro Koitab ...
    Article ID: 6413-20
    Published: 2021
    [Advance publication] Released: April 12, 2021
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    Membranous nephropathy often achieves spontaneous remission. However, there are scarce reports of spontaneous remission of thrombospondin type-1 domain-containing 7A (THSD7A)-associated membranous nephropathy. A 64-year-old female presented with nephrotic syndrome and edema of the lower extremities. We diagnosed membranous nephropathy by kidney biopsy and confirmed positive THSD7A on immunofluorescence using frozen sections; serum THSD7A antibodies were also detected. Thirty-four months after the initial diagnosis, she achieved a spontaneous complete remission without immunosuppressive therapy. With the complete remission, no serum THSD7A levels were detected. In this study, we describe serial examinations of kidney biopsies and serum THSD7A antibodies.

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  • Takashi Egawa, Keita Masuzawa, Sohei Nakayama, Ichiro Maeda, Satoshi T ...
    Article ID: 6442-20
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Chemotherapy for multiple primary malignancies is challenging. We herein report a case of synchronous primary lung adenocarcinoma and hepatocellular carcinoma (HCC). A 72-year-old man was admitted for the evaluation of an abnormal shadow on his lung. Computed tomography revealed a lung nodule in the right upper lobe and multiple liver masses. He was diagnosed with synchronous primary lung adenocarcinoma and HCC. Atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) chemotherapy was efficacious for both tumors. ABCP chemotherapy may be a potential treatment option for synchronous primary lung adenocarcinoma and HCC.

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  • Naoki Arakawa, Kazuo Eguchi, Yuki Nakamura, Yuta Tsukahara, Youhei Kou ...
    Article ID: 6577-20
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    A 94-year-old woman with rheumatoid arthritis who had been treated with low-dose methotrexate was referred to our hospital because of a 3-day history of a fever and pancytopenia. With a diagnosis of febrile neutropenia of unknown origin, empirical antibiotic treatment and folinic acid therapy were initiated. Despite a recovery from pancytopenia, the high fever remained, and dyspnea developed. She was clinically diagnosed with Pneumocystis jirovecii pneumonia (PCP) and successfully treated with trimethoprim/sulfamethoxazole and adjunctive corticosteroid therapy. Folinic acid treatment effectively brought about rapid immune recovery but might have led to a clinical manifestation of PCP resembling immune reconstruction inflammatory syndrome.

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  • Tsunetaro Morino, Hiroki Kuroyanagi, Taichi Yanagihara, Hiroto Ohto
    Article ID: 6688-20
    Published: 2021
    [Advance publication] Released: April 12, 2021
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  • Takahiro Kanda, Kei Tawarahara, Naoki Nakamura, Yusuke Tokonami, Hiroy ...
    Article ID: 7009-21
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Acute type A aortic dissection is a potentially fatal disease, and emergency surgery should be considered when it is diagnosed. We herein report two cases of retrograde type A aortic dissection with intramural hematoma, followed by re-dissection, rupture, and cardiac tamponade. The diagnoses in these cases had to be made carefully, as the false lumen of the ascending aorta was sometimes unclear on contrast-enhanced computed tomography.

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  • Zen Kobayashi
    Article ID: 7060-21
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION
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  • Noboru Hamada, Takafumi Yamano, Yusaku Tada, Yasuhiro Ooue, Junko Itan ...
    Article ID: 7064-21
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    We herein report the first case of low-dose oxygen therapy for pneumatosis cystoides intestinalis (PCI) using PaO2 as a therapeutic index to prevent acute exacerbation of interstitial pneumonia. An 86-year-old man was admitted to our hospital with abdominal distension. PCI was diagnosed by abdominal computed tomography. Low-dose oxygen therapy was started to avoid acute exacerbation of interstitial pneumonia. The oxygen dose was adjusted so that the PaO2 value was approximately 100 mmHg. After seven days of treatment, the colon gas had disappeared, and no acute exacerbation of interstitial pneumonia was observed. A PaO2 value around 100 mmHg is effective for PCI without inducing acute exacerbation of interstitial pneumonia.

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  • Masanori Minato, Taichi Murakami, Naoki Takahashi, Hiroyuki Ono, Kenji ...
    Article ID: 7118-21
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Tubulointerstitial nephritis (TIN) with IgM-positive plasma cells (IgMPC-TIN) is an autoimmune kidney disease characterized by IgM/CD138-double-positive plasma cell infiltration in the tubulointerstitium. A 50-year-old man developed IgMPC-TIN and presented with crystalline inclusions in the rough endoplasmic reticulum. Intracellular crystal formation is a rare finding in paraprotein-related kidney diseases, but this case showed no pathogenic monoclonal immunoglobulin. Prednisolone (PSL, 30 mg) improved the TIN, but PSL tapering resulted in the recurrence of TIN. Combination therapy with 15 mg PSL and 150 mg mizoribine ultimately stabilized TIN. This case offers original evidence concerning the pathophysiology and treatment strategy of IgMPC-TIN.

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  • Naonori Inoue, Kei Takumi, Daiki Sone, Atsushi Sirakawa, Takuji Kawamu ...
    Article ID: 7130-21
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Malignant peritoneal mesothelioma (MPM) is a rare malignant tumor with peritoneal thickening. Tuberculous peritonitis also shows peritoneal thickening, so differentiating between the two is important but difficult if latent tuberculosis infection (LTBI) is present. We herein report a patient with MPM and LTBI. A 79-year-old man was diagnosed with peritoneal thickening on computed tomography. Interferon gamma release assay (IGRA) results were positive, suggesting tuberculous peritonitis. He underwent a laparoscopic omental biopsy and was diagnosed with MPM, which can occur together with LTBI. If peritoneal thickening is observed, an IGRA should be performed early, and the possibility of LTBI should be considered.

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  • Ai Kawada, Shinichi Iwamura, Kenji Yorita, Rikiya Daike, Yu Tanaka, Na ...
    Article ID: 7155-21
    Published: 2021
    [Advance publication] Released: April 12, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    The onset of autoimmune hepatitis (AIH) during pregnancy is rare and often poses a diagnostic challenge. A 29-year-old Japanese woman experienced epigastric pain and nausea during the third trimester of her third pregnancy. Three days after the symptom onset, an emergency Caesarean section was performed because of suspected acute fatty liver of pregnancy; however, the patient's liver dysfunction worsened afterward. Despite normal serum IgG concentration and absence of autoantibodies, biopsy-proven severe hepatitis with centrilobular zonal necrosis and good biochemical response to corticosteroids led to a diagnosis of AIH. Therefore, AIH should be included in the differential diagnosis of liver dysfunction during pregnancy.

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  • Tetsuya Hirato, Kenichi Komatsu, Namiko Nishida, Sadayuki Matsumoto
    Article ID: 7327-21
    Published: 2021
    [Advance publication] Released: April 12, 2021
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  • Wataru Shioyama, Toru Oka, Risa Kamada, Toshinari Yagi, Katsuhiko Naka ...
    Article ID: 5347-20
    Published: 2021
    [Advance publication] Released: April 05, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Pazopanib, a multi-targeted tyrosine kinase inhibitor, is associated with cardiovascular adverse events, such as hypertension, cardiac dysfunction, and thromboembolism. However, symptomatic pazopanib-related bradycardia is uncommon. We herein report a case of symptomatic bradycardia of 35 beats per minute in a patient with solitary fibrous tumor/hemangiopericytoma (SFT/HPC) treated with pazopanib for 1 month. His heart rate recovered to a normal range soon after pazopanib cessation. He restarted pazopanib at a reduced dose, which was continued without SFT/HPC progression or bradycardia recurrence. This case highlights the possibility of bradycardia induced by pazopanib and the importance of monitoring the patient's heart rate.

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  • Nobuhiro Matsumoto, Hironobu Tsubouchi, Kensuke Setoguchi, Takanori Ho ...
    Article ID: 6109-20
    Published: 2021
    [Advance publication] Released: April 05, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Objective Visceral larva migrans (VLM) caused by Ascaris suum is a major health problem in pig farming regions. The clinical characteristics of pulmonary VLM caused by A. suum, however, are unclear. We assessed the clinico-radiologic features of this disease.

    Methods Medical records, including the results of chest radiography and high-resolution computed tomography (HRCT), were retrospectively reviewed from January 2000 through June 2019, at the University of Miyazaki Hospital and Kyoritsuiin Hospital in Miyazaki Prefecture, Japan.

    Results Seven patients with VLM caused by A. suum were identified. All seven patients had a unique habit of consuming raw foods, such as organic vegetables, chicken, turkey, wild boar, and venison. All but one patient, who had eosinophilic pneumonia with a fever and severe fatigue, had only mild or no respiratory symptoms. All 7 patients had remarkable eosinophilia (median, 1960/μL) and high serum IgE levels (median, 1346 IU/mL). Chest HRCT revealed multiple nodules and multiple nodular ground-glass opacities in 57% and 29% of the patients, respectively. The pulmonary lesions were located predominantly in subpleural areas. All seven patients were treated with albendazole, which led to improvement within two to three months. Neither eggs nor parasites were detected in the feces or sputum of any patient.

    Conclusion Consumption of raw organic vegetables or raw meat is a possible route of A. suum infection. Infected patients exhibit mild respiratory symptoms, and multiple nodules with a halo in the subpleural area are a common finding on chest HRCT. Treatment with albendazole was effective in these cases.

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  • Natsuko Atsukawa, Toshinari Yagi, Chiaki Kubo, Katsuyuki Nakanishi, Ke ...
    Article ID: 6309-20
    Published: 2021
    [Advance publication] Released: April 05, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    A 60-year-old woman presented with multiple lung and bone metastases with unknown primary cancer. Chest CT images showed multiple pulmonary cysts, predominantly of the middle and lower lobes. She also had a history of pneumothorax. Four years after chemotherapy and radiation therapy, multiple hypervascular tumors eventually developed in the bilateral kidneys, suggesting the possibility of Birt-Hogg-Dube (BHD) syndrome. Genetic testing revealed a folliculin mutation, which confirmed the diagnosis of BHD syndrome. When we encounter cancer of unknown primary with multiple pulmonary cysts in a patient with a history of pneumothorax, thorough imaging of the kidneys and genetic testing for BHD syndrome is necessary.

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  • Sota Nakamura, Teppei Fujioka, Shoji Kawashima, Takatsune Kawaguchi, M ...
    Article ID: 6457-20
    Published: 2021
    [Advance publication] Released: April 05, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    A 29-year-old man presented with a high-grade fever, headache, and urinary retention, in addition to meningeal irritation and myoclonus in his upper extremities. A cerebrospinal fluid (CSF) examination showed pleocytosis and high adenosine deaminase (ADA) levels with no evidence of bacterial infection, including Mycobacterium tuberculosis. T2-weighted brain magnetic resonance imaging showed transient hyper-intensity lesions at the splenium of the corpus callosum (SCC), bilateral putamen, and pons during the course of the disease. The CSF was positive for anti-glial fibrillary acidic protein (GFAP) antibodies. He was diagnosed with autoimmune GFAP astrocytopathy. The present case shows that the combination of an elevated ADA level in the CSF and reversible T2-weighted hyper-intensity on the SCC supports the diagnosis of autoimmune GFAP encephalopathy.

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  • Koki Nakashima, Yoshiki Demura, Masayuki Sato, Yuya Fujii, Kazunari Ig ...
    Article ID: 6509-20
    Published: 2021
    [Advance publication] Released: April 05, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Pseudo-progression is a phenomenon induced by treatment with immune checkpoint inhibitors and is characterized by an increase in tumor size or the appearance of new lesions, followed by tumor regression. However, life-threatening conditions, such as cardiac tamponade, can develop in such patients.

    We herein report on a 69-year-old man with lung adenocarcinoma who developed cardiac tamponade as a manifestation of pseudo-progression induced by treatment with atezolizumab combined with cytotoxic chemotherapy. After managing the cardiac tamponade, atezolizumab was successfully re-administered along with cytotoxic chemotherapy without disease progression.

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  • Kohei Yoshimine, Kazunori Tobino, Mitsukuni Sakabe, Ryunosuke Ooi
    Article ID: 6559-20
    Published: 2021
    [Advance publication] Released: April 05, 2021
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Laryngeal and endobronchial cryptococcosis are rare conditions, and to our knowledge, there have been only 23 cases of laryngeal cryptococcosis, and 18 cases of endobronchial cryptococcosis previously reported in the English literature. We herein report an extremely rare case of cryptococcosis with simultaneous laryngeal and endobronchial involvement. This case highlights the importance of paying close attention to possible occurrence of cryptococcosis of the airway tract in patients with asthma treated with high-dose inhaled corticosteroids.

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