TAFRO syndrome is a rare, severe, and sometimes refractory condition characterized by thrombocytopenia, anasarca, a fever, reticulin myelofibrosis, and organomegaly. Although several treatment options have been proposed for this condition, there are few reported cases in the literature on successful treatment using cyclophosphamide in patients with TAFRO syndrome. We herein report two cases of refractory TAFRO syndrome successfully treated with intravenous cyclophosphamide. In both cases, after the initial treatment with high-dose glucocorticoids and tocilizumab failed, the administration of intravenous cyclophosphamide led to significant improvement. These cases suggest that intravenous cyclophosphamide may be a viable therapeutic option for refractory TAFRO syndromes.

There is a lack of established methods to explore the etiology of sudden cardiac arrest. We herein report sudden cardiac arrest as pulseless electrical activity in a young woman triggered by coronary artery spasm. There were no health issues except for situs inversus totalis, but the patient experienced sudden cardiac arrest after suffering chest pain. ST-segment depression was observed in leads V₃-V₆ on electrocardiography. However, urgent angiography did not reveal any coronary stenosis. Cardiac magnetic resonance imaging revealed myocardial edema localized to the inferior and posterior segments without evidence of late gadolinium enhancement. Additionally, a provocation test with acetylcholine confirmed a coronary artery spasm. Inexplicable sudden cardiac arrest may result in missing the chance to detect hidden cardiac disease. Cardiac MRI may help to elucidate the etiology of sudden cardiac arrest.

MYC amplification and overexpression are uncommon in acute myeloid leukemia (AML). An 82-year-old man developed leukocytosis during monoclonal gammopathy of renal significance. A chromosomal analysis revealed 46,XY,+r(8)[20]. Amplified MYC signals were detected on chromosome 8. The patient was diagnosed with AML and administered venetoclax and azacitidine. After the third course, clones with ring chromosome 8 had decreased in number, but clones unrelated to t(8;21)(q22;q22) had subsequently emerged. After the sixth course, the white blood cell count had markedly increased, and a chromosome analysis showed replacement of ring chromosome 8 with 46,XY,t(8;21)[20]. This case highlights the role of MYC amplification and overexpression in AML and suggests that BCL2 inhibition is a potential treatment.

Objective Optimal medical therapy (OMT) is recommended for the secondary prevention of acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). We investigated the relationship between the OMT prescription rate at hospital discharge and clinical outcomes in patients with AMI who underwent successful PCI.

Methods We enrolled 294 consecutive AMI patients who underwent successful emergency PCI between January 2017 and December 2020. The patients were divided into two groups based on their medications at discharge: OMT, defined as a combination of statins, beta-blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers; and non-OMT, defined as the absence of at least one of the aforementioned agents. The primary outcome measure was major adverse cardiovascular events (MACEs), defined as the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and heart failure requiring hospitalization.

Results According to prescription data, 186 patients (63.3%) were prescribed OMT at discharge. During a median follow-up period of 957 (591-1,308) days, 45 patients developed MACEs. Kaplan-Meier curves showed a significantly lower incidence of MACE in the OMT group than in the non-OMT group (log-rank p<0.001). In the multivariate analysis, OMT remained independently associated with a reduced risk of MACE (hazard ratio, 0.47; 95% confidence interval: 0.25-0.88; p=0.017).

Conclusions Fundamental OMT at discharge was associated with a reduced risk of MACE in AMI patients after successful PCI. Therefore, OMT may be necessary to improve the clinical outcomes of patients with AMI after discharge.

A 66-year-old man who was receiving treatment for B-cell non-Hodgkin lymphoma presented with fever. He tested positive for severe acute respiratory syndrome coronavirus 2 antigen. Chest computed tomography (CT) revealed pneumonia. Therefore, remdesivir was administered to the patient. However, steroid pulse therapy was initiated owing to the lack of any symptom improvement and a worsening of the CT findings. The patient developed recurrent fever following a reduction in the steroid dose. His respiratory condition gradually worsened, and he eventually died. Autopsy revealed diffuse alveolar damage. In high-risk patients with hematologic malignancy, COVID-19 vaccination should be repeated at shorter intervals to avoid increasing the viral load during the COVID-19 infection.

Objective Although chronic kidney disease (CKD) is independently associated with hypertension or hyperglycemia, there is no consensus on the thresholds of obesity, dyslipidemia, or visceral fat accumulation to predict CKD onset and progression.

Methods We performed a multivariable logistic regression analysis for the association of the subsequent rate of estimated glomerular filtration rate (eGFR) decline with body mass index (BMI), blood high-density lipoprotein (HDL) cholesterol and triglycerides (TG) levels on 308,174 subjects who underwent health examinations conducted by the Public Health Research Center Foundation from 2015 to 2022. In addition, a Poisson regression analysis was used to evaluate the association between the appearance of urinary protein in participants without baseline urinary protein levels and eGFR decline.

Results The median age of the subjects was 46 years old, and the median observation period was approximately 3 years. An eGFR decline rate of ≥5%/year was significantly associated with low HDL-cholesterol levels (<40 mg/dL), independent of the BMI and TG levels. A high baseline BMI (≥25 kg/m²) or waist circumference (≥85 cm for men and ≥90 cm for women), high TG levels (≥150 mg/dL), and low HDL-cholesterol levels were significantly associated with new-onset proteinuria. Furthermore, the higher the baseline BMI, the higher the incidence rate ratio of new-onset proteinuria.

Conclusion Independent of hyperglycemia and hypertension, dyslipidemia according to the Japanese metabolic syndrome criteria and an elevated BMI were associated with a high risk of new-onset proteinuria, and a low HDL-cholesterol level was significantly associated with a rapid eGFR decline.

We report the case of a 61-year-old man with chronic myelomonocytic leukemia, who underwent unrelated peripheral blood stem cell transplantation. Fusariosis was suspected prior to identification of the fungal species, and voriconazole and liposomal amphotericin B combination therapy were administered. The patient developed fusarium-related endophthalmitis, accompanied by eye pain. Despite vitrectomy, the endophthalmitis was poorly controlled, and the left eye was enucleated. No recurrence of fusariosis was observed until death following multiple-organ failure due to steroid-resistant graft-versus-host disease.

Lateral medullary infarction is rarely associated with Opalski syndrome and autonomic dysfunction. Herein, we present the first case involving a 66-year-old patient with cancer who developed mild dysarthria, left-sided Horner's syndrome and lower limb-dominant ataxic hemiparesis, reduction in right-sided painful thermal sensation, and severe truncal ataxia, followed by orthostatic headache. The Schellong test revealed severe orthostatic hypotension. The patient was diagnosed with Opalski syndrome associated with headache attributed to orthostatic hypotension caused by the cerebral infarction in the caudal part of the lateral medulla oblongata. The patient's headache had poor response to analgesics. However, it resolved with orthostatic hypotension improvement.

Pseudomonas aeruginosa (P. aeruginosa) infection, often diagnosed in immunocompromised patients, is a chronic disease. However, peritonsillar and deep cervical abscesses caused by P. aeruginosa are rare. We herein present the rare case of a 70-year-old male patient with a 5-day history of sore throat and difficult oral intake. The oral cavity was filled with pus and the left palatine tonsil was destroyed. A peritonsillar abscess caused by P. aeruginosa was diagnosed using a pus culture. Emergency incisions were made for tonsil drainage, tracheostomy, and antibacterial drug treatment. Despite infection resolution in 20 days, recovery from swallowing dysfunction required one year of rehabilitation.

Some copy number variations (CNVs) in DNA are associated with the development of pathological phenotypes. Regarding the diagnosis of recurrent radial nerve palsies, a 73-year-old female patient with intractable epilepsy and intellectual disability was diagnosed with duplicated 15q11.1-11.2, in addition to a deletion of 17p12, causing hereditary neuropathy with liability to pressure palsies. CNVs in 15q11.1-11.2 have been reported in patients with schizophrenia and autism. Although CNVs are also sometimes seen in healthy individuals, duplicated 15q11.1-11.2 could be associated with CNS symptoms in this patient.

A 17-year-old Japanese woman diagnosed with granulomatosis with polyangiitis (GPA) and was treated with immunotherapy suddenly developed an impaired consciousness, left hemiplegia, and conjugate eye deviation to the right. Magnetic resonance imaging showed an acute cerebral infarction in the right striatum and right middle cerebral artery (MCA) occlusion. As her GPA had worsened recently, intravenous methylprednisolone (IVMP) was started. Immediately after IVMP was started, recanalization of the MCA was detected on repeat cerebral angiography. Aspirin and argatroban dissolved the residual thrombi. A combination of IVMP and antithrombotic therapy may be effective for large-vessel occlusions associated with GPA.

Screening for colorectal cancer (CRC) in individuals with Li-Fraumeni syndrome (LFS) typically recommends initiating colonoscopy at 25 years old. We herein report a case of LFS with dual CRC and liver metastasis diagnosed before the recommended screening age. A 17-year-old boy with a history of sarcoma underwent colonoscopy, revealing 2 advanced CRCs: neuroendocrine carcinoma in the descending colon and adenocarcinoma in the rectum, each displaying distinct histological features. In addition, a TP53 missense mutation (p.His193Arg) was detected by a detailed genetic examination. LFS is associated with a heightened risk of rapid progression to invasive carcinomas due to TP53 variants. Therefore, earlier initiation of colonoscopy screening may be necessary for patients with LFS.

Background Drug-induced interstitial lung disease (DI-ILD) is an adverse effect of the combination of gemcitabine and nab-paclitaxel (GnP) treatment that has raised concerns because the incidence rate of DI-ILD in the real world is higher than that reported in initial clinical trials. The present study assessed the cumulative incidence rate of DI-ILD among patients treated with GnP based on previously published studies and explored any potential bias in the results.

Methods We conducted a meta-analysis in accordance with the PRISMA guidelines. The MEDLINE, Scopus, and Cochrane Library databases were searched from 2013 to 2024, using specific keywords. Randomized controlled trials, prospective studies, retrospective studies, and case-control studies that reported the incidence of interstitial lung disease (ILD) among patients treated with GnP were included. Two reviewers independently extracted the data from the included studies.

Results Nine studies involving 1,980 patients were included in this analysis. Nine studies were conducted in Japan. The pooled incidence of DI-ILD was 5.9%. A subgroup analysis revealed that smaller studies reported higher incidence rates (≤200 vs. ≥201 cases: 9.4% vs. 4.1%). There was significant heterogeneity and publication bias, suggesting that the variability in incidence rates was due to the study size and potential biases.

Conclusion The pooled incidence of ILD among patients treated with GnP was 5.9%. However, the results should be interpreted with caution because of the heterogeneity and publication bias. Further global studies are required to determine the true incidence of ILD.

Background The controversy persists regarding whether the serum level of γ-glutamyltransferase (GGT), a marker of liver damage, is associated with hypertension irrespective of alcohol intake.

Methods We investigated the relationship between the GGT level and new-onset hypertension during a 10-year follow-up period in Japanese individuals who underwent annual health examinations (n=28,990). After excluding subjects without systolic blood pressure and GGT data and those with hypertension at baseline, a total of 18,618 subjects (men/women: 11,262/7,356, mean age: 44 years) were enrolled.

Results During the follow-up period, 2,753 men (24.4%) and 837 women (11.4%) developed hypertension. When the subjects were divided by quartiles of GGT at baseline (Q1-Q4), multivariable Cox proportional hazard model analyses after adjustment for age, sex, systolic blood pressure, body mass index, levels of uric acid, estimated glomerular filtration rate, family history of hypertension, habits of current smoking and alcohol drinking, and diagnosis of diabetes mellitus and dyslipidemia showed that hazard risks (HRs) for the development of hypertension were significantly higher in the Q2, Q3, and Q4 groups than in the Q1 group. A significant interaction was observed between alcohol drinking habits and the GGT level at baseline for the development of hypertension (p=0.022), and adjusted HRs were similarly significant in alcohol infrequent drinkers (≤5 days/week). However, the GGT level was not significantly associated with the development of hypertension in frequent alcohol drinkers (≥6 days/week).

Conclusions A high GGT level is an independent predictor of new-onset hypertension in infrequent alcohol drinkers but not in frequent drinkers.

We describe a case of immunological rejection occurring twice after cord blood transplantation (CBT) for mixed phenotype blast phase chronic myeloid leukemia that was successfully salvaged by haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with post-transplant cyclophosphamide (PT-Cy). Pre-engraftment immune reaction (PIR) and subsequent hemophagocytic lymphohistiocytosis (HLH), likely due to HLA mismatch in the graft-versus-host (GVH) direction, lead to poor graft function (PGF) and graft failure (GF). This case highlights the pathophysiology of PIR, HLH, PGF, and GF, collectively termed "post-transplant cytokine syndrome." PT-Cy haplo-PBSCT, with wide donor availability and reduced infection risk leading to HLH via rapid engraftment, may be a suitable salvage option for post-CBT cytokine syndrome-related GF.

A 60-year-old man with a history of radiation therapy 28 years ago for a benign disease (an aneurysmal bone cyst) was admitted with dyspnea and dysphagia. Computed tomography showed an 8-cm tumor invading the trachea and esophagus. His condition declined rapidly, and he died on day 27 of hospitalization. Autopsy revealed radiation-induced osteosarcoma. Radiation-induced sarcoma can develop even after radiotherapy for benign diseases, in which case the latency period might be longer. Furthermore, the prognosis depends on the location of the resectable tumor. Therefore, longer-term internal imaging follow-up should be performed after radiotherapy for benign diseases to detect early-stage sarcoma.

Objective Despite the recent development of various novel therapeutic approaches for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), optimal management of patients with R/R DLBCL who are elderly and/or unfit has not yet been established.

Methods and Patients We retrospectively analyzed the efficacy and safety of the R-mEPOCH regimen comprising rituximab, etoposide, vincristine, doxorubicin, carboplatin, and prednisolone in transplant-ineligible patients with R/R DLBCL.

Results In total, 22 patients were included in this study. The median patient age was 75 years old. The median number of prior lines of therapy was one (range, 1-5). The overall response rate was 68%, with 45% achieving complete response (CR) or unconfirmed CR and 23% achieving partial response. With a median follow-up of 27.8 months, the median progression-free survival and overall survival (OS) were 17.1 and 27.4 months, respectively. The 2- and 5-year OS rates were 50% and 28%, respectively. The most common grade ≥3 adverse events were neutropenia (n=18 [82%]), febrile neutropenia (n=16 [73%]), anemia (n=12 [55%]), and thrombocytopenia (n=8 [36%]). The median total lifetime cumulative dose of anthracyclines was 281 mg/m² (range, 69-536 mg/m²) in doxorubicin equivalents. One case of grade 1 bradycardia occurred, leading to the discontinuation of R-mEPOCH. No other cardiac adverse events of grade ≥3 and/or discontinuation of treatment were observed.

Conclusion Our study suggests that the R-mEPOCH regimen may be an effective and tolerable salvage regimen for transplant-ineligible R/R DLBCL patients.

We herein report a case of hepatitis B virus (HBV) reactivation in a female patient in her 70s with isolated anti-hepatitis B core (IAHBc) antibodies (HB surface antigen (HBsAg)-negative, HB surface antibody (HBsAb)-negative, and HB core antibody (HBcAb)-positive), receiving rituximab-based chemotherapy for follicular lymphoma. Her serum HBV DNA was negative. The patient was treated with rituximab for 21 months, and 33 months after completion of treatment, her HBV DNA level increased to 5.1 Log IU/mL, and the patient developed hepatic failure. Tenofovir alafenamide fumarate treatment was initiated for HBV reactivation, and DNA was not detected 9 months later.

Hughes-Stovin syndrome (HSS) is an exceedingly rare disease characterized by thrombotic phlebitis and pulmonary or bronchial artery aneurysms. A 68-year-old man presented with ischemic colitis, and angiography revealed occlusion of the inferior mesenteric vein and arteriovenous malformation in the inferior mesenteric artery region. Medical treatment was unsuccessful, and a left hemicolectomy was therefore performed following coil embolization. Subsequently, a pulmonary artery aneurysm was incidentally detected, and coil embolization was performed. However, the patient developed deep vein thrombosis and a pulmonary embolism, which led to a diagnosis of HSS. To our knowledge, this is the first report of ischemic colitis as a presenting feature of HSS.

Obinutuzumab-induced acute thrombocytopenia is characterized by a rapid decrease in the platelet count after administration. The underlying mechanisms remain unclear. However, we present novel laboratory findings related to its pathophysiology. A 65-year-old woman with follicular lymphoma developed acute thrombocytopenia within 24 hours after obinutuzumab administration. Laboratory results showed features resembling acute immune thrombocytopenic purpura, including an elevated immature platelet fraction, mildly increased thrombopoietin levels, elevated platelet-associated IgG, and refractory to platelet transfusion. Our case and her laboratory findings suggest that increased platelet consumption might be involved in the development of obinutuzumab-induced acute thrombocytopenia.

Objective White matter hyperintensity (WMH) is the most prominent magnetic resonance imaging (MRI) feature of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), clinically characterized by recurrent ischemic stroke. This study aimed to explore the association between WMH and symptomatic stroke in patients with CADASIL by quantifying the volume and features extracted from histogram-segmented WMH.

Methods Twenty-eight patients with CADASIL were retrospectively recruited. WMH was extracted from fluid-attenuated inversion recovery (FLAIR) images. A histogram analysis of WMH was performed using radiomics extension on a 3D slicer. We compared the histogram parameters between patients with and without symptomatic stroke.

Results Thirteen patients had no symptoms, while 15 had previous symptomatic stroke. Their characteristics were similar, except for a higher frequency of males among stroke patients (73.3 vs. 15.4%, respectively). Among the histogram features, the skewness of the FLAIR intensity histogram was significantly lower in patients with stroke than in those without stroke (-0.179 vs. 0.210, respectively, p=0.0287), but there was no significant difference regarding any other histogram features or the WMH volume. According to a multiple logistic regression analysis, sex and skewness remained significant (odds ratio: 40.870 and 0.0119, p=0.0136 and 0.0473, respectively).

Conclusion The skewness of the FLAIR WMH intensity histogram was significantly correlated with stroke in patients with CADASIL.

Objective According to the current guidelines, the use of non-dihydropyridine calcium-channel blockers for the rate control of atrial fibrillation (AF) is contraindicated in patients with heart failure (HF), especially in those with a reduced ejection fraction (EF). However, there is little data supporting this recommendation. This study aimed to investigate the use of intravenous verapamil in patients with AF.

Methods We retrospectively studied 223 consecutive patients with AF treated with intravenous verapamil. We evaluated the clinical data of these patients, including any adverse events that occurred within 7 days.

Results The median age of the patients was 75.9 (67.8-80.7) years. Before administration, 71 patients (31.8%) had HF, 112 patients (62.6%) had a high B-type natriuretic peptide (BNP) level, and 28 patients (13.6%) had a left ventricular (LV) EF less than 50%. The mean administered dose of verapamil was 5.4±1.6 mg. The median heart rate (HR) was significantly reduced after verapamil administration [HR:145 (130-160) bpm to 95 (82-105) bpm, p<0.001]. Twenty-eight patients (12.6%) suffered from hypotension. Two patients had bradyarrhythmias. Within 7 days, cardiovascular death occurred in three patients (1.3%). A multivariate analysis revealed that pre sBP and hemoglobin, but not LVEF or BNP, were independently associated with adverse events.

Conclusion The intravenous administration of verapamil appears to be effective and safe for controlling the heart rate in most patients with AF, except in critically ill patients. However, further research is required to assess the safety of verapamil in patients for whom its use is not currently recommended by the clinical guidelines.

Anifrolumab is a newly developed biological agent for patients with moderate-to-severe systemic lupus erythematosus (SLE). Anifrolumab neutralizes the signaling pathways mediated by type I interferons (IFNs), which are involved in viral clearance and anticancer immunity. Although susceptibility to viral infections has been reported in patients treated with anifrolumab, whether anifrolumab treatment increases the cancer risk in patients with SLE is unknown. We herin report a case of SLE that manifested as aggressive diffuse large B-cell lymphoma (DLBCL) after treatment with anifrolumab. The neutralization of type I IFNs by anifrolumab may promote the development of DLBCL owing to defective anticancer immunity.

Small-intestinal bacterial overgrowth (SIBO) causes gastrointestinal symptoms. Proton pump inhibitors (PPIs) are commonly used for acid peptic diseases; however, their long-term use can alter the gut microbiota, resulting in adverse effects. We herein report the case of a 26-year-old Japanese woman with SIBO caused by prolonged PPI use. After switching to a H2 receptor antagonist, her symptoms and blood test results improved. This case highlights the need to understand the pathogenesis of SIBO and also the risks associated with prolonged PPI use.

An association between coronavirus disease 2019 (COVID-19) and concomitant varicella-zoster virus (VZV) reactivation has been proposed. We herein report a case of severe VZV pneumonia in a 73-year-old man who underwent corticosteroid tapering after recovering from COVID-19 and presented with fever, vesicular rashes, and hypoxemia. Chest computed tomography (CT) revealed ground-glass opacities and multiple granular shadows. Varicella-zoster virus was detected in the skin and bronchoalveolar lavage fluid. The patient was diagnosed with disseminated VZV reactivation and thereafter successfully recovered with acyclovir treatment. Physicians should consider the possibility of VZV reactivation when ground-glass opacities or patchy nodular shadows appear during the course of patients with COVID-19.

This report presents two cases of esophageal mucosal damage following peroral endoscopic myotomy (POEM) for esophageal motility disorders. In the first case, delayed perforation and mediastinitis occurred on postoperative day 15 and the patient was treated with endoscopic clipping and antibiotics. In the second case, although no perforation was observed, extensive mucosal injury developed the day after POEM which was successfully managed by fasting and antibiotic therapy. These findings highlight the need for careful patient management to minimize the risks associated with POEM, while maximizing its therapeutic benefits.

A 66-year-old male ex-smoker presented with fatigue and non-productive cough, as well as a 2-year history of ground-glass opacities. Deterioration on chest radiography and increased KL-6 levels coincided with the progression of diffuse ground-glass opacities on high-resolution CT. Surgical lung biopsy revealed features consistent with desquamative interstitial pneumonia. Concurrent skin hardening and presence of anti-Scl-70 antibodies supported the diagnosis of systemic sclerosis. Treatment with oral corticosteroids proved to be effective, leading to radiographic improvement. The subsequent administration of cyclophosphamide and mycophenolate mofetil stabilized disease progression.

A 70-year-old male presented with infiltration, ground-glass opacities, and bronchiectasis on chest radiography, which indicated interstitial pneumonia. Clinical findings (thickening of the skin on the fingers, slight nail fold petechiae, and skin lesions resembling mechanic's hands) suggested early systemic sclerosis and/or polymyositis/dermatomyositis. However, anti-scl-70, anti-centromere, and anti-aminoacyl tRNA synthetase (anti-ARS) antibodies were negative. Exertion-related oxygenation gradually worsened. Since the multiplex protein array confirmed anti-Zo and anti-Ro52/SSA1 antibody positivity, anti-ARS antibody syndrome was diagnosed and treated with steroids and immunosuppressive drugs. The patient was concurrently diagnosed with advanced colorectal cancer. Treating interstitial pneumonia first allowed for the subsequent treatment of colorectal cancer without worsening the condition.

Dipeptidyl peptidase-4 inhibitors (DPP-4is) are shown to be associated with the development of bullous pemphigoid (BP). Immune checkpoint inhibitors (ICIs) can lead to BP development. Therefore, the combination of DPP-4is and ICIs may predispose an individual to developing BP; however, few reports have focused on this issue. We herein report two patients with non-small-cell lung cancer complicated by diabetes mellitus (DM) who developed BP while receiving DPP-4is and ICIs. The clinical course of these patients suggests that the combination of DPP-4is and ICIs may carry a potential risk of BP development.

Dyskeratosis congenita (DC) is a rare genetic disorder that is caused by abnormal telomere shortening. We herein report the case of a 40-year-old man with classic DC characterized by a mucocutaneous triad complicated by pulmonary fibrosis and myelodysplastic syndrome (MDS). The telomere length of lymphocytes was extremely short (-3.3 standard deviations). We identified the germline mutation c.C91A in DKC1 gene. We also identified a somatic mutation c.C101T in the U2AF1 gene of leukocytes, which may be associated with MDS development. Nintedanib was started, but the patient died of bilateral pneumothorax 6 months after diagnosis.

A 67-year-old man on intense immunosuppressive therapy after heart transplantation for end-stage hypertrophic cardiomyopathy 7 years ago developed severe dyspnea and was admitted to our hospital. His serum SARS-CoV-2 antigen test was positive, and he was diagnosed with COVID-19-related pneumonia. He was started on ventilatory management for severe respiratory failure and remdesivir for COVID-19, with careful adjustment of immunosuppressive drugs. However, unexpectedly prolonged muscle weakness necessitated transfer to a rehabilitation facility. Although the COVID-19 pandemic has subsided, it is still considered a risk in post-transplant cases. Infection control is considered critical in heart transplant recipients, especially in those receiving intensified immunosuppressive drugs.

Progress in the development of molecular targeted therapies in the field of inflammatory bowel disease has been remarkable. With the advent of molecular-targeted agents, treatment strategies have changed, and higher-level treatment goals have been set. In terms of the long-term prognosis of inflammatory bowel disease, there has been a clear decline in the rate of surgery since 2000 when anti-tumor necrosis factor antibody preparations were introduced. However, a large number of molecular-targeted agents with diverse modes of action have appeared, and their positioning has become complicated and often confusing for clinicians. Furthermore, these agents are expensive and therefore present economic challenges. The selection of therapeutic agents for inflammatory bowel disease based on the mode of action and prediction of treatment effects continues to be a major issue, and it is hoped that artificial intelligence and machine learning will help resolve these problems.

We herein report an autopsy case of multiple cerebral infarctions caused by varicella-zoster virus (VZV) vasculopathy. A 60-year-old man, previously diagnosed with VZV uveitis, subsequently developed cerebral infarction with multiple cerebral vessel stenoses. Based on the results of a polymerase chain reaction test of cerebrospinal fluid, the patient was diagnosed with VZV vasculopathy. Despite treatment with acyclovir and prednisolone, the vascular stenosis progressed and became complicated by extensive cerebral infarctions. Upon autopsy, inflammatory cell infiltration was pathologically observed in the vessel walls of the anterior and middle cerebral arteries, consistent with the magnetic resonance imaging findings.

We herein report a case of IgG4-related kidney disease (IgG4-RKD) with an atypical cystic renal mass in a 73-year-old man. Computed tomography (CT) revealed diffuse renal enlargement and a cystic mass in the left kidney. Blood tests revealed elevated IgG and IgG4 levels. A renal biopsy led to the IgG4-RKD diagnosis. The cystic mass was deemed to be benign based on the clinical, imaging, and ultrasonography findings. No malignancy or abscess formation was noted. Both the renal function and IgG4 levels improved after steroid treatment; moreover, the mass shrunk, suggesting an IgG4-RKD etiology. Cystic renal masses with capsule formation should be considered in patients presenting with IgG4-RKD.

Objective Immediate primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is closely associated with better clinical outcomes. However, the optimal timing of PCI for the culprit lesion in non-ST-elevation myocardial infarction (NSTEMI) is not fully understood. The aim of this study was to compare clinical outcomes between patients with early and delayed PCI and to investigate whether early PCI within 24 hours of admission can improve long-term clinical outcomes in patients with NSTEMI.

Methods This was a single-center, retrospective study. The primary endpoint was major adverse cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal MI, and re-admission for heart failure.

Results We included 816 patients with NSTEMI and divided them into an early PCI group (n=446) and a delayed PCI group (n=370). The median follow-up period was 856 days. The median age was lower in the early PCI group [73 (65-79) years] than in the delayed PCI group [76 (69-81)] (p<0.001). Shock at admission was more frequently observed in the early PCI group (11.9%) than in the delayed PCI group (3.2%) (p=0.001). The incidence of MACE in the delayed PCI group (40.8%) was higher than that in the early PCI group (28.5%) (P<0.001). However, a multivariate Cox hazard analysis revealed that early PCI was not associated with MACE after controlling for multiple confounding factors (HR 1.005, 95% CI 0.763-1.322, p=0.973).

Conclusion The timing of PCI may not be important in hemodynamically stable patients with NSTEMI, as long as primary PCI is performed.

This study aimed to clarify the current state of research on the effects of stretching exercises on the health of patients with type 2 diabetes mellitus (T2DM). A scoping review of the literature was conducted in December 2024, using four databases. Experimental and clinical studies were included if they compared stretching exercises with non-stretching exercises for T2DM-related health outcomes. The primary search terms used were "diabetes mellitus, type 2," "muscle stretching exercises," and "range of motion, articular.". Eleven studies met our inclusion criteria. Eight studies focused on blood glucose levels, one of which assessed the functional capacity. The remaining studies investigated plantar pressure, shoulder joint mobility/pain/disability, and fatigue, with one study addressing each outcome. This review indicates that stretching exercises may affect a variety of health parameters, including blood glucose regulation, in patients with T2DM but emphasizes the need for further high-quality research to determine their effectiveness.

Yellow nail syndrome (YNS), a rare condition characterized by thickened yellow nails, lymphedema, and respiratory manifestations, is rarely caused by bucillamine, an anti-rheumatic agent. Respiratory manifestations of YNS include chylothorax in 18.8%-22% of patients with pleural effusion. We herein report the first case of bucillamine-induced YNS with chylothorax. Lymphangiography revealed narrowing of the lymphatic vessels and stagnation of the lymphatic fluid, suggesting impaired lymphatic drainage. The chylothorax persisted despite the discontinuation of bucillamine. The present case illustrates that bucillamine can cause irreversible lymphatic impairment and chylothorax.

Nocardiosis typically affects immunocompromised patients; however, the clinical characteristics of idiopathic CD4 lymphocytopenia (ICL) remain poorly understood. A 64-year-old patient was diagnosed with ICL following disseminated nocardiosis, including bacteremia, pneumonia, knee arthritis, and brain abscess. The patient underwent trimethoprim-sulfamethoxazole therapy with frequent dose adjustments based on the renal function, ranging from 2 to 12 single-strength tablets daily over 5 months of hospitalization. While he had a 1-year uneventful course of lifelong prophylaxis, he experienced prolonged recovery in physical activity. A literature review highlighted the life-threatening nature of nocardiosis in ICL, underscoring the importance of a timely diagnosis and tailored management strategies.