Aim : To clarify a long-term preventive effect of corticosteroid therapy for the recurrence of cerebral amyloid angiopathy (CAA)-related hemorrhages. Subjects and methods : Cases consisted of one male and two females, being consistent with the diagnosis of G3 to G4 in Boston validation criteria of CAA. To detect cerebral Aβ amyloidosis, they underwent positron emission tomography combined with a novel amyloid specific tracer, BF-227, all showing positive brain shadow. A 66-year-old man (case 1) with a diagnosis of G3 was given an initial dose of prednisolone at 50mg/day. The dose was gradually reduced and was tapered off 6 months later, but after the next 6 months cerebral hemorrhage recurred. He again received similar corticosteroid therapy. A 69-year-old woman (case 2) with a diagnosis of G3 was given dexamethasone 16mg/day after suffering recurrent cerebral hemorrhages. A week later dexamethasone was switched to prednisolone 30mg/day and the dose of this corticosteroid was gradually reduced, until being kept at 8mg/day. Another 75-year-old woman (case 3) with a diagnosis of G4 was given an initial dose of prednisolone at 30mg/day and the dose of this corticosteroid was gradually reduced and has been kept at 8mg/day. During the observation periods they were evaluated by clinical manifestations and T2* MR images : the total area of microbleeds was assessed by computer-assisted morphometry. After treatment two cases received a second PET scan and the regional standard uptake value ratio (SUVR) of BF-227 at the occipital lobe was compared with the previous one. Results : Case 1 suffered a small hemorrhage in the left frontal lobe at 20 months after receiving the corticosteroid therapy and steroid pulse therapy was added. During the remaining 33 months he has been free of cerebral hemorrhages. SUVR in his PET scan showed 2.0 to 2.2 in a 14- month follow-up period and the total area of microbleeds extended from 410.2 to 445.5mm2 during the 48-month observation period. Case 2 showed two simultaneous small hemorrhages at 29 months after starting the corticosteroid therapy and herdose of prednisolone was temporally increased. During the remaining 17 months she has not had any strokes and SUVR in her PET showed 1.5 to 1.4 in an 18-month follow-up period. The total area of microbleeds extended from 512.5 to 560.8mm2 during the 27-month observation period. Case 3 has been free of cerebral hemorrhages for 22 months after this corticosteroid therapy and the total area of microbleeds ranged from 152.5 to 154.1mm2 during the 13-month observation period. Conclusions : Corticosteroid therapy seems to be clinically effective for the long-term prevention of recurrences of CAA-related hemorrhages but current brain image data are inadequate to lead to this conclusion. This is the first report showing that domestically developed BF227 PET scan is useful in visualizing CAA lesions.
We report here a case of a 70-year-old male with myelodysplastic/myeloproliferative neoplasms (MDS/MPN) having hepatosplenomegaly, mild monocytosis, and normal karyotypes without JAK2 mutation. The patient developed an acute transformation and during the intensive therapy with daunorubicin and cytarabin, diffuse alveolar hemorrhage appeared due to disseminated intravascular coagulopathy. After induction, bone marrow blasts reduced to 5.1%, and the patient received two courses of azacitidine therapy. During these courses, blasts in the peripheral blood were not observed. Intensive chemotherapy consisting of daunorubicin and cytarabin followed by azacitidine therapy might be effective for acute transformation in MDS/MPN.
The applicable age for BCG vaccination was lowered from less than 4 years old to 6 months old in April 2005. Since then, the incidence of BCG osteomyelitis has increased, and 2-9 cases per year have been reported since 2006. A previously healthy 16-month-old girl was taken to a local clinic because she had become unable to raise her right arm. This did not change for 1 month, so she was brought to the outpatient clinic of our hospital. MRI suggested a bone tumor at the proximal metaphysis of the right humerus, and curettage and biopsy of the bone were performed. The pathological analysis of the biopsy specimen revealed the formation of granuloma, but polymerase chain reaction analysis showed that the curetted tissue was negative for acid-fast bacteria. However, 5 weeks later, M. tuberculosis complex was detected on a culture test for acid-fast bacteria. Gene analysis revealed M. bovis BCG (Tokyo 172). Finally, a diagnosis of BCG osteomyelitis was made. During medication-free follow-up until definitive diagnosis, osteomyelitis recurred. Additional surgery was conducted 4 months after the initial surgery and the administration of anti-tubercular agents were started. Our findings suggest that it is difficult to cure BCG osteomyelitis only with bone curettage even if there are no clinical symptoms. When infection with acid-fast bacteria is suspected based on pathological results of a biopsy specimen, the administration of anti-tubercular agents should be started. Subsequently, de-escalation should be considered after definitive diagnosis of BCG osteomyelitis.
A 70-year-old man was referred to our hospital because of epigastralgia. Abdomal CT revealed an omental abscess. A polypoid lesion was recognized in the gastric body on upper gastrointestinal endoscopy, which was performed to investigate the cause of the abscess. Histopathology of the biopsy of the lesion showed granulation tissue. We decided that conservative treatment wouled be ineffective and performed resection of the omental abscess. Follicular lymphoma was suspected from the histopthological findings of the specimen of the abscess. After operation, biopsy of the gastric lesion was performed again. Histopathology showed infiltration of CD10 and Bcl-2 positive lymphocytes. FDG-PET revealed an abnormal accumulation in the stomach and regional lymph nodes. From the overall findings, gastric malignant lymphoma (follicular lymphoma) was diagnosed. We reported a case of gastric malignant lymphoma with omental abscess with a review of the literature.