Okayama Igakkai Zasshi (Journal of Okayama Medical Association)

　Japan experienced four major epidemic periods (i.e., the 3rd-6th waves) of COVID-19 from January 2020 to March 2022. A different strain predominated in each period: the wild-type strain, an Alpha variant, a Delta variant, and an Omicron variant were predominant in waves 3, 4, 5, and 6, respectively. In this study, we conducted a descriptive analysis to investigate the differences in symptoms and severity during each epidemic period. We analyzed a total of 31,037 patients with COVID-19 who were reported to the Okayama City Public Health Center between February 1, 2020 and March 31, 2022. We described and compared the proportion of symptoms, the number and proportion of severe COVID-19 cases, and the number and proportion of deaths for each epidemic period. We also compared the proportion of severe COVID-19 cases depending on the number of vaccinations for the 5th and 6th waves.
　Differences in symptoms and severity were observed in each epidemic period. In the 5th and 6th waves, the results suggested that vaccination had a preventive effect against severe COVID-19.

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　A Japanese woman was diagnosed with rheumatoid arthritis at the age of 41. At the age of 56, her rheumatoid arthritis worsened and a subcutaneous injection of tocilizumab and oral prednisolone was administered, which led to an improvement of arthritis. At the age of 57, right lower abdominal pain and vomiting suddenly appeared. Abdominal computed tomography showed a parapapillary diverticulum in the descending duodenum. The diverticulum was filled with residue, and an inflammation of the surrounding adipose tissue was observed; no free air was found. The patient was diagnosed with duodenal diverticulitis and treated with antibiotics, which resulted in an uneventful recovery. The maximum value of CRP was 1.88㎎/dL on the third day of hospitalization. Esophagogastroduodenoscopy performed on the 8th day of hospitalization revealed a parapapillary diverticulum with adhesion of pus and redness of the mucosa at the opening of the diverticulum, consistent with diverticulitis. This case highlights that diverticulitis in infrequent areas such as the duodenum may occur in patients who are treated with tocilizumab. In addition, inflammation of diverticulitis may be underestimated because abnormal laboratory values such as those induced by inflammatory reactions are less likely to occur during tocilizumab treatment.

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　During a pandemic like the novel coronavirus infection 2019 (COVID-19), the availability of inpatient beds is always a major issue. Thus, it is extremely important to release patients from isolation efficiently in order to maintain stable bed operations. However, in clinical practice, patients may develop fever again, before or after the timing specified by the Ministry of Health, Labor and Welfare (MHLW) for lifting isolation, and hence it may be difficult to determine whether the fever is due to a delay in recovery or due to relapse. The diagnosis of relapse is based primarily on the recurrence of symptoms consistent with COVID-19 and a positive PCR result, but few reports have focused on comparing the patterns of variation in two or more blood test findings over the course of the disease. In the present study, we study a case of relapse in an elderly patient on immunosuppressive drugs.
　Understanding the unique patterns of variability between baseline blood test values and acute infection test values in each individual patient may serve as an adjunctive tool to help diagnose COVID-19 relapse.

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