This case report describes vasospastic angina diagnosed after percutaneous coronary intervention (PCI). A 69-year-old man was admitted to our institution because of chest pain at rest and reduced vigor. Coronary angiography revealed focal stenosis in the proximal and distal segment of right coronary artery. PCI was performed and treated by implantation of an everolimus-eluting stent (EES). He again presented to our institution six months later because of chest pain at rest in the morning. There was no significant elevation of myocardial damage markers and no significant change in electrocardiogram on this admission. Coronary angiography showed no in-stent restenosis or new lesion of significant stenosis. Coronary artery spasm provocation test by intracoronary acetylcholine injection was performed. Severe diffuse vasospasm with chest pain was induced in the right coronary artery despite the stents. Vasospastic angina must always be kept in mind as a potential cause of chest pain at rest. It is unclear if the incidence of new onset vasospasm occurs after EES implantation. When a patient without coronary artery stenosis who has chest pain at rest is referred, it is necessary to perform a spasm provocation test for the diagnosis of vasospastic angina, even after stenting, and to prescribe medicine to prevent coronary artery spasm.

View full abstract

A 50-year-old man presented to the emergency department with disturbed consciousness. On arrival, his vital signs were: GCS, E2V2M5; BP, 109/76 m mHg; and SpO2, 98% (under ambient air). His past medical history included alcoholic liver cirrhosis and he had previously attended a hepatology clinic; therefore, hepatic encephalopathy was suspected. However, laboratory examinations revealed normal blood ammonia levels (82 μg/dL). On a second physical examination, turquoise-blue vomit was observed in his oral cavity, and an ECG showed a prolonged QT interval (QTc, 611 ms) due to heavy drinking. Flunitrazepam overdose was suspected; therefore, flumazenil was injected intravenously as a diagnostic treatment. One minute after the injection, the patient’s consciousness became lucid, and he was diagnosed with a flunitrazepam overdose. Physicians should suspect flunitrazepam addiction whenever turquoiseblue vomit is observed.

View full abstract

The patient was a 27-year-old woman who had pain in her posterior cervical region. After experiencing flu-like symptoms, shortness of breath, and a gradual worsening and persistent pain, she visited a primary care physician. With no improvement, she visited our Division of Neurosurgery and Neurology. The neurological findings were normal; however, she had difficulty flexing and rotating her neck because of pain. Computed tomography (CT) and blood testing were conducted, but no diagnosis was reached, so outpatient care was planned. However, the patient experienced cardiopulmonary arrest the following day. CPR was performed, but the patient died. The cause of death could not be identified by autopsy imaging CT; therefore, a pathalogical autopsy was performed. Enlargement of both ventricles and atria was evident, with histological images revealing extensive degeneration and necrosis of the myocardial cells and infiltration of the inflammatory cells, compatible with lymphocytic myocarditis. Acute myocarditis related to viral infection was diagnosed. As no other cause was found, we consider the neck pain in this case to have been associated with myocarditis. Acute myocarditis should be considered as a rare cause of the symptoms of patients complaining of neck pain.

View full abstract

Fever of unknown origin (FUO), a medical condition caused by a wide variety of diseases, is often encountered in daily practice. In Japan, several studies have reported the situation of FUO. Here, we review the current trends of its causes and prognosis and the usefulness of inflammatory markers and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). We hope that this review will serve as a catalyst for the promotion of FUO research in Japan.

View full abstract