Baloxavir marboxil (BM), a newly approved drug for influenza treatment, is prescribed for pediatric patients less frequently than for adults. The purpose of this study was to evaluate the non-inferiority of the clinical effects of BM to oseltamivir for children aged ＜6 years and that of BM to laninamivir for children aged ≥ 6 years. We enrolled 201 influenza patients aged 1 to 15 years from December 2018 through October 2019. The participants were divided according to age (age ＜ 6 years or age ≥ 6 years), and then randomly assigned to the BM or neuraminidase inhibitors (NAIs) group. The primary outcome was the time to fever resolution after treatment. In the age group ＜ 6 years, the median time for the BM and oseltamivir groups was 24.0 h vs. 32.0 h. In the age group ≥ 6 years, the median time of the BM and laninamivir groups was 29.8 h vs. 32.5 h. These results met criteria for non-inferiority. The type and frequency of side effects were almost the same between the BM and NAIs groups. In conclusion, BM would be an effective therapeutic option for children as well as adults.

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[Introduction] Clinical manifestations of infectious enterocolitis vary depending on the causative microorganism, providing clues in the search for the cause. However, studies on the simple clinical differentiation between bacterial enterocolitis (BE) and viral enterocolitis (VE) are scarce. we performed a post hoc analysis to examine the clinical differentiation between BE and VE. [Methods] We performed a post hoc analysis using a previously performed study on hospitalized patients with infectious diarrhea. BE was defined as cases in which a specific causative organism was definitely detected from stool culture, and VE was defined as cases with a positive rapid stool antigen testing for virus. We compared the clinical characteristics of BE and VE. [Results] The data of 44 BE patients and 26 VE patients showed that the BE patients were younger and had a higher prevalence of fever, longer onset-visit interval, and higher serum CRP level. Unexpectedly, hematochezia was prevalent in VE. Higher serum CRP level for BE (odds ratio：1.30) and older age for VE (odds ratio：0.96) were significant in the logistic regression analysis. [Conclusions] Our study suggests that serum CRP is useful for diagnosing BE in adults and that VE cases with hematochezia may include cases with “viral diarrhea-induced ischemic colitis”.

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Polymyalgia rheumatica (PMR), a common inflammatory rheumatic disease, typically affects elderly individuals and has been known to respond well to low dosages of corticosteroids. The aim of this study is to evaluate predictive factors that correspond to subsequent remission of PMR. Twenty-four patients with PMR were treated with prednisolone. After 2 years, patients were divided into prednisolone-free remission and no remission groups for comparison of clinical factors. Ten patients (41.7%) had achieved prednisolone-free remission at 2 years. The level of initial CRP was not significantly different between the groups. Significantly short duration from the treatment start to negative CRP was observed in patients with prednisolone-free remission when compared in those with no remission. The percentage of patients who showed negative CRP after 8 weeks was significantly higher in the prednisolone-free remission group than in the no remission group. The prednisolone dosage at 1 year was significantly less in prednisolonefree remission group than in the no remission group. This study suggests that, even if the initial CRP levels are high, negative CRP early in the treatment results in a subsequent prednisolonefree remission.

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A 68-year-old man presented with fever and swelling of the thigh and calf after a COVID-19 vaccination. The lower leg MRI showed inflammation of the calf, and the patient was diagnosed with post-vaccination myositis. After introducing prednisolone 60 mg/day, the inflammation improved. COVID-19 vaccine can cause inflammatory myositis as a presentation of systemic immune-mediated reactogenicity.

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[Introduction] During the coronavirus disease (COVID-19) pandemic, some patients erroneously suspected of having COVID-19 were later diagnosed with other diseases. This type of diagnostic error, known as COVID blindness, can be corrected by COVID-19 test negativity. However, diagnostic errors related to COVID-19 test positivity have rarely been discussed. [Case Description] An 82-year-old man presented to our emergency department with suddenonset nausea, vomiting, and gait disturbance. Based on the results of a COVID-19 test and chest computed tomography, he was diagnosed with COVID-19 pneumonia. After treatment for pneumonia, brain magnetic resonance imaging revealed left lateral medullary infarction. [Discussion] When a screening test for COVID-19 is positive and patients are diagnosed with COVID-19, the possibility of other diseases may be ignored, leading to delayed diagnosis, as illustrated in this case. Complications of atherosclerotic disease, which are common, especially in patients with COVID-19, should be cautiously ruled out. [Conclusions] COVID-19 test positivity may not always be a definitive diagnosis.

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A 72-year-old man was admitted to our hospital on an emergency basis on the seventh day after the onset of fever and cough. A PCR test for COVID-19 was positive. Computed tomography (CT) scan of his chest showed bilateral pneumonia；hence, favipiravir and ciclesonide were administered. However, the patient continued to have fever with worsening respiratory condition；hence, oxygen therapy was started. Because the second CT revealed worsening of the pneumonia, the treatment was switched to remdesivir and dexamethasone. The initial oxygen therapy that required a maximum of 4 L/min was eventually reduced to 1 L/min. However, his blood oxygen saturation (SpO2) was less than 90% during exertion, and the respiratory status did not improve in the first month after COVID-19 onset. Combination therapy with additional steroids and respiratory rehabilitation was suggested, and the patient was started on 30 mg/day prednisolone. His respiratory status improved drastically on the seventh day of this treatment, and he was weaned completely off oxygen therapy. We report that additional steroid therapy is an important new treatment strategy that is effective for residual pulmonary lesions in patients with COVID-19 pneumonia.

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IgG4-related disease (IgG4-RD) is an autoimmune disorder in which lymphocytes and IgG4- positive plasma cells infiltrate organs and tissues throughout the body that may occur asynchronously, presenting various clinical symptoms. Steroid therapy is known to be effective. Vascular lesions in IgG4-RD include periaortitis/arteritis and aneurysms. We encountered a case of IgG4-RD-related autoimmune pancreatitis (AIP) and interstitial nephritis complicated by periaortitis in the abdominal aorta and periarteritis in the coronary artery. Steroid therapy improved the AIP and interstitial nephritis, and IgG4 levels showed gradual improvement to normal. But, abdominal periaortitis was only slightly improved on periodic ultrasound examinations (US). Furthermore, when it came to the coronary arteries, the patient eventually developed unstable angina despite multidisciplinary treatment. Therefore, steroid therapy may be limited in the treatment of IgG4-RD-related periaortitis/periarteritis, and it is important that extensive, careful follow-up be done with periodic evaluation of periaortitis/periarteritis, even if amelioration is seen in other organs.

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[Introduction] Patients on maintenance hemodialysis are at a high risk of complication and death following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Vaccination is a critical step in fighting the disease；however, evidence on the reactogenicity of COVID-19 vaccines in hemodialysis patients is limited. [Methods] We chronologically determined antibody titers against the spike protein of SARS-CoV-2 in hemodialysis patients (N=34) and health care workers (N=166). We also assessed the solicited systemic reactions induced by BNT162b2 vaccine using a selfreported questionnaire survey and examined whether the immunological responses of dialysis patients differ from those of controls. [Results] Antibody titers were significantly lower in maintenance hemodialysis patients than in controls at two and six months after vaccination (p＜0. 001). Both groups had increased antibody titers at two months, then a decrease to six months after the first vaccination. The frequency of systemic adverse events after the second dose decreased in dialysis patients. [Conclusions] In patients undergoing chronic dialysis, the humoral response to BNT162b2 vaccination was significantly lower and the risk of breakthrough infection is suspected to be higher than that of healthy controls. The safety of vaccination was confirmed.

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