Successful Treatment with a High-dose Rifampin-containing Regimen for Pulmonary Tuberculosis with a Disputed rpoB Mutation.
Authors: Jeong DH, Kang YW, Kim JY, Han JS, Jo KW, Shim TS Abstract Mutations in the rpoB gene of Mycobacterium tuberculosis can result in resistance to rifampin. Among various mutations in the rpoB gene, some known as disputed rpoB mutations can cause low-level rifampin resistance. It has been suggested that a high-dose rifampin (20 mg/kg)-based regimen might be effective in treating tuberculosis (TB) caused by M. tuberculosis with disputed rpoB mutations exhibiting low-level resistance. We herein report the first two cases of pulmonary TB caused by M. tuberculosis with a disputed rpoB mutation (CTG511CCG) that sh...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Acute Kidney Injury by Renal Hemosiderosis Secondary to Primary Cold Agglutinin Disease Associated with an Excessive Alcohol Intake.
Authors: Imafuku A, Yamamoto G, Takemura K, Hasegawa E, Sawa N, Kawada M, Sekine A, Hoshino J, Takaichi K, Fujii T, Ohashi K, Ubara Y Abstract Renal hemosiderosis occurs in the context of severe intravascular hemolysis, with the most common cause being paroxysmal nocturnal hematuria. Patients with cold agglutinin disease (CAD) have relatively mild hemolysis, and acute kidney injury (AKI) due to renal hemosiderosis has not been reported. We encountered a patient with CAD caused by lymphoplasmacytic lymphoma who developed AKI secondary to renal hemosiderosis after an excessive alcohol intake. PMID: 29984743 [PubM...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Very Late Relapse of Acute Promyelocytic Leukemia 17 Years after Continuous Remission.
Authors: Sakurai M, Watanuki S, Kato J, Hashida R, Yamane Y, Karigane D, Mitsuhashi T, Murata M, Ueno H, Nakazto T, Okamoto S, Mori T Abstract The prognosis of acute promyelocytic leukemia (APL) has been improved by the combination of all-trans retinoic acid (ATRA) with chemotherapy. Nonetheless, relapse occurs in a certain proportion of patients, mostly within three to four years after treatment. We herein report a patient treated with ATRA and chemotherapy achieving remission who relapsed approximately 17 years after the treatment. A literature review identified 5 additional reported cases of APL relapse after mo...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Systemic Disseminated Angiosarcoma Showing Thin-walled Cystic Nodules in the Lungs.
Authors: Wada Y, Ito H, Yokoi E, Masaki M PMID: 29984745 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Combined Coagulopathy can Induce both Hemorrhagic and Thrombotic Complications in Multiple Myeloma.
Authors: Kawashima I, Takano K, Kumagai T, Koshiishi M, Oishi S, Sueki Y, Nakajima K, Mitsumori T, Kirito K Abstract Coagulation abnormalities are a rare but critical complication associated with plasma cell diseases. We herein present a case of multiple myeloma (MM) with complicated coagulopathy. Initially, the patient showed severe bleeding tendency due to concomitant acquired hemophilia A and acquired von Willebrand syndrome. Interestingly, the patient also exhibited hyperactivation of factor IX. During treatment for MM, the bleeding complications were ameliorated; however, the patient had central retinal vein o...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Improvement of Alveolar Hemorrhaging in an Elderly and Renally Impaired Patient with Relapsing Anti-neutrophil Cytoplasmic Autoantibody-associated Vasculitis by Single Infusion of Rituximab: A Case Report.
Authors: Oda K, Ishikawa E, Ito T, Mizoguchi S, Hirabayashi Y, Suzuki Y, Haruki A, Fujimoto M, Murata T, Katayama K, Onishi T, Ito M Abstract Rituximab (RTX) has become a therapeutic option for inducing remission of anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV). However, the optimum dosage of RTX to induce remission of AAV and reduce adverse events, such as infection, remains unclear. We herein report an elderly and renally impaired patient with alveolar hemorrhaging due to refractory AAV who was successfully treated with single infusion of RTX. Single infusion of RTX may be a therapeutic opt...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hereditary Pancreatitis Showing Numerous Cysts with Pancreatic Cancer.
Authors: Masui Y, Kikuyama M, Kawaguchi S, Kanemoto H PMID: 29984748 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Standard and Novel Additional (Optional) Therapy for Lung Abscess by Drainage Using Bronchoscopic Endobronchial Ultrasonography with a Guide Sheath (EBUS-GS).
Authors: Miki M PMID: 29984749 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Stiff-person Syndrome with Waldenstr öm Macroglobulinemia: A Case Report.
Stiff-person Syndrome with Waldenström Macroglobulinemia: A Case Report. Intern Med. 2018 Jul 06;: Authors: Horiuchi K, Maruo Y, Matsuoka S Abstract We herein report the case of stiff-person syndrome in a 73-year-old woman. She experienced episodes of painful muscle spasms and was admitted to another hospital. She was diagnosed with Waldenström macroglobulinemia. She showed improvement in muscle spasms post-chemotherapy, which was discontinued due to pancytopenia. Six months later, she was admitted to our hospital for repeated whole-body muscle spasms, at which point she was diagnosed with st...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Clival Osteomyelitis with Cavernous Sinus Thrombosis Due to Fusobacterium nucleatum and Campylobacter rectusInduced by Tooth Extraction.
Authors: Oka K, Nakano Y, Sazumi Y, Michitani T, Horiguchi S, Ocho K, Iwamuro M, Otsuka F Abstract A 70-year-old woman who had suffered from aseptic meningitis complained of chronic headache after dental treatment including tooth extraction. She developed a fever and respiratory failure. Based on chest computed tomography and head magnetic resonance imaging (MRI), she was diagnosed with osteomyelitis in the clivus accompanying moderate pituitary involvement, cavernous sinus thrombosis and septic pulmonary embolism. Both of the causal bacteria, Fusobacterium nucleatum and Campylobacter rectus, were isolated from her...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Central Nervous System Lymphoma Harboring the JAK2 V617F Mutation that Developed after a 20-year History of Polycythemia Vera.
Authors: Kajikawa N, Seki Y, Fujio T, Okoshi Y, Hori M, Saito H, Iijima T, Kojima H Abstract A 78-year-old man who had a 20-year history of polycythemia vera (PV) with a JAK2 V617F mutation presented with gradually progressive disturbance of consciousness. Hyper-intense lesions in the peri-lateral ventricular area and left cerebellar hemisphere were observed by T2-weighted and fluid-attenuated inversion recovery magnetic resonance imaging. Cytologic and genetic analyses of the lymphoma cells obtained from his cerebrospinal fluid established the diagnosis of B-cell lymphoma. No lesions outside of the brain were reco...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Anti-MDA5 Antibody-positive Dermatomyositis Complicated by Autoimmune-associated Hemophagocytic Syndrome that was Successfully Treated with Immunosuppressive Therapy and Plasmapheresis.
Authors: Fujita Y, Fukui S, Suzuki T, Ishida M, Endo Y, Tsuji S, Takatani A, Igawa T, Shimizu T, Umeda M, Sumiyoshi R, Nishino A, Koga T, Kawashiri SY, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Abe K, Kawakami A Abstract A 56-year-old Japanese woman with muscle weakness, increased creatine kinase and aldolase levels, and characteristic cutaneous lesions was diagnosed with anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 antibody)-positive dermatomyositis. She also had interstitial lung disease (ILD). After corticosteroid and tacrolimus combination therapy was started, pancytopenia a...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Cardiac Variant of Fabry Disease Diagnosed with Chance Urinary Mulberry Cells.
Authors: Onishi R, Kanaoka K, Sugiura J, Tokunaga M, Takemoto Y, Onoue K, Yamamoto Y, Horii M, Saito Y Abstract Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A and is classified into two types: classical and variant. The classical type exhibits classic manifestations, but the variant type does not and is therefore difficult to identify sometimes. A 73-year-old woman with a first episode of heart failure was admitted to our hospital. Her left ventricular wall motion was mildly reduced without hypertrophy. Urine sediment revealed mulberry cells, leading to the...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Falling after Starting Running in a Case of Myoclonus Epilepsy Associated with Ragged-red Fibers with a 8344A > G mtDNA Mutation.
Falling after Starting Running in a Case of Myoclonus Epilepsy Associated with Ragged-red Fibers with a 8344A>G mtDNA Mutation. Intern Med. 2018 Jul 06;: Authors: Miyaue N, Yamanishi Y, Tada S, Ando R, Nagai M, Nomoto M Abstract Myoclonus epilepsy associated with ragged-red fibers (MERRF) is traditionally characterized by myoclonus, generalized epilepsy and ragged-red fibers. We herein report a 42-year-old man who complained of falling after starting running, symptoms resembling those of paroxysmal kinesigenic dyskinesia. He showed only slight muscle weakness of the right quadriceps femoris. Muscle ...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Two Cases of Paroxysmal Atrial Fibrillation in Patients Successfully Treated by Radiofrequency Catheter Ablation with Severely Compression, Lateral Displacement, and Clockwise Rotation of Their Hearts Due to Severe Pectus Excavatum.
Authors: Tanaka A, Takemoto M, Kang H, Aoki R, Antoku Y, Mito T, Kinoshita S, Matsuo A, Hida S, Okazaki T, Tayama KI, Kosuga KI Abstract Two cases with severe pectus excavatum and symptomatic atrial fibrillation (AF) underwent radiofrequency catheter ablation (RFCA). Their chest X-ray and computed tomography (CT) findings revealed lateral displacement and clockwise rotation of their hearts, and severe right atrial and mild right ventricular compression against the sternum, but no left atrium compression against the spinal column. The procedure was therefore carefully performed under guidance with CT, intra-cardiac ...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Pharmacokinetics of Isoniazid-induced Rhabdomyolysis in a Girl.
Authors: Kurane K, Goto M, Sano K, Noguchi K, Tamura D, Yamagata T PMID: 29984757 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

The Transbronchial Drainage of a Lung Abscess Using Endobronchial Ultrasonography with a Modified Guide Sheath.
Authors: Takaki M, Tsuyama N, Ikeda E, Sano M, Matsui K, Ito H, Kakiuchi S, Yamashita Y, Tanaka T, Ariyoshi K, Morimoto K Abstract Lung abscess is usually treated with long-term antibiotic therapy. Due to the lack of a safe and easy drainage technique, drainage is only applied in refractory cases. We herein describe three cases in which drainage was successfully performed by endobronchial ultrasonography using a modified guide sheath. This procedure may have advantages in the detection of causative pathogens and early infection source control, and may therefore lead to the appropriate selection of antibiotics and r...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Successful Stenting for Bronchial Stenosis Resulting from Blunt Airway Trauma.
Authors: Roh JY, Kim I, Eom JS, Lee G, Ahn HY, Lee MK Abstract Blunt airway trauma is rare but life threatening. Injuries to other vital organs accompany this type of injury in most cases; therefore, conservative treatment may be considered first. In cases of delayed fibrotic airway stenosis after conservative treatment, surgical treatment or bronchoscopic intervention are therapeutic options. We herein report a case of delayed airway stenosis after a blunt traumatic airway injury that was successfully managed by silicone stenting. PMID: 29984759 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hypopituitarism and Central Diabetes Insipidus Caused by Central Nervous System Lymphoma.
Authors: Zenimaru Y, Yamada M, Suzuki J, Konoshita T PMID: 29984760 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Irreversible Electroporation for Nonthermal Tumor Ablation in Patients with Locally Advanced Pancreatic Cancer: Initial Clinical Experience in Japan.
CONCLUSIONS: Percutaneous and open IRE may be acceptable for patients with LAPC (despite some major adverse events) and may represent a useful new therapeutic option. PMID: 29984761 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Severe Maxillary Medication-related Osteonecrosis of the Jaw.
Authors: Kitajima S, Mizuno S, Kogiso R, Tsuji C PMID: 29984762 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Trigeminal Root Entry Zone Lesions in Non-multiple Sclerosis.
Authors: Matsumoto A, Hisanaga K, Nagano I PMID: 29984763 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Pulmonary Tuberculosis Complicated with Severe Thrombocytopenia with Diffuse Alveolar Hemorrhaging during Anti-tuberculosis Chemotherapy: An Autopsy Report.
We describe the case of an 82-year-old man with pulmonary tuberculosis and tuberculous pleurisy. He underwent anti-tuberculosis chemotherapy; during tuberculosis treatment, he experienced DAH due to fulminant thrombocytopenia. Thrombocytopenia is a common finding in patients with pulmonary tuberculosis, but the laboratory findings should be carefully evaluated. Thrombocytopenia during anti-tuberculosis chemotherapy can cause life-threatening DAH. PMID: 29984764 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Perigraft Abscess Subsequent to Aortoesophageal Fistula.
Authors: Takei N, Kunieda T, Kumada Y, Murayama M Abstract A 79-year-old man with appetite loss and nausea for 1 month was admitted to our hospital. His thoracic aortic aneurysm had gradually increased in size due to perigraft endoleak after the previous aneurysm repair surgery. Although he showed no hematemesis, melena, or a fever, gastrointestinal endoscopy and contrast-enhanced computed tomography (CT) revealed an aortoesophageal fistula (AEF). He developed septic shock due to a perigraft abscess and eventually died, although aortic graft replacement and esophageal transection were performed. Clinical suspicion ...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Ovarian Metastases from ALK-rearranged Lung Adenocarcinoma: A Case Report and Literature Review.
Authors: Sasano H, Sekine A, Hirata T, Iwamoto K, Itou Y, Itani H, Kondou S, Tokui T, Tanigawa M Abstract We herein report a 37-year-old woman with lung adenocarcinoma with brain metastases and an asymptomatic ovarian tumor. Immunohistochemistry and a fluorescent in situ hybridization analysis of the biopsied lung tumor revealed ALK gene rearrangement. Although the origin of the ovarian tumor remained unclear, alectinib administration was initiated, and radiological responses were observed in all lesions, which confirmed that the ovarian tumor was a metastasis from lung cancer. Although differentiating the origin o...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Imported Tungiasis in a Non-endemic Country.
Authors: Adachi E, Miharu Y, Suzuki M, Yotsuyanagi H PMID: 29984767 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Monocular Oculomotor Nerve Disorder Manifesting as Cranial Neuropathy in Systemic Lupus Erythematosus: A Case Report.
Authors: Nakamagoe K, Yanagiha H, Miyake Z, Kondo Y, Hiyama T, Ishii A, Kaji Y, Oshika T, Sumida T, Tamaoka A Abstract We herein report the case of a patient who developed peripheral neuropathy of the bilateral lower legs that later became complicated with isolated oculomotor nerve disorder and was finally diagnosed as systemic lupus erythematosus (SLE). Based on the findings for oculomotor nerve paralysis and contrast-enhanced magnetic resonance imaging findings for the oculomotor nerve in the prepontine cistern, the isolated oculomotor nerve disorder was considered to be a manifestation of peripheral neuropathy. ...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Cervical Cord Infarction Caused by Dissection of the Intracranial Segment of the Vertebral Artery.
Authors: Suzuki H, Kitagawa T, Gotoh M, Mitsueda-Ono T, Matsui M Abstract Cervical cord infarction is uncommon but has been increasingly reported as a complication of vertebral artery dissection (VAD). A 54-year-old woman presented with neck pain and neurological deficit following sudden neck movement. Radiological findings suggested cervical cord infarction in the anterior spinal artery territory at the C5-C6 vertebral level and dissection of the intracranial segment of the right vertebral artery. Cervical cord infarction due to VAD is usually caused by dissection of its extracranial segment. The present case indi...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Widespread Cardiac and Vasomotor Autonomic Dysfunction in Non-Val30Met Hereditary Transthyretin Amyloidosis.
Conclusion Cardiac and peripheral vasomotor autonomic dysfunctions were prevalent in non-Val30Met patients, irrespective of their phenotype, suggesting a common pathology of autonomic involvement. However, the vasoconstrictor function was preserved, even in a patient with advanced neuropathy. PMID: 29984770 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Progressive Encephalomyelitis with Rigidity and Myoclonus Resolving after Thymectomy with Subsequent Anasarca: An Autopsy Case.
Authors: Ozaki K, Ohkubo T, Yamada T, Yoshioka K, Ichijo M, Majima T, Kudo S, Akashi T, Honda K, Ito E, Watanabe M, Sekine M, Hamagaki M, Eishi Y, Sanjo N, Ishibashi S, Mizusawa H, Yokota T Abstract Progressive encephalomyelitis with rigidity and myoclonus (PERM) is an autoimmune disorder involving the brainstem and spinal cord and is sometimes associated with thymoma. We encountered a 75-year-old woman with typical PERM features, glycine receptor antibody, and thymoma. Her neurologic symptoms improved after thymectomy, but she unexpectedly developed anasarca with massive pleural effusions and hypoalbuminemia and f...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Sudden-onset C8 Radiculopathy due to a Plexiform Schwannoma of the Cervical Nerve Root: A Case Report.
Authors: Komatsu K, Toda H, Matsumoto S Abstract Plexiform schwannoma is a rare variant of schwannomas and usually presents with chronic symptoms. We herein report a case of cervical nerve plexiform schwannoma that presented with unusually sudden severe left radiculopathy of the eighth cervical nerve after physical exercise. Coronal short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) revealed a multinodular tumor along the eighth cervical nerve. The tumor was partially resected. A pathological analysis revealed that the tumor was a schwannoma, and we diagnosed the case as a plexiform schwannoma. Th...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Subacute Sensorimotor Neuropathy Accompanied by Anti-ganglioside GM1 Antibody in a Patient with Lung Cancer.
Authors: Kanaji N, Kume K, Mizoguchi H, Inoue T, Watanabe N, Nishiyama N, Kadowaki N, Ishii T Abstract A 66-year-old man presented with subacute sensorimotor neuropathy in association with small cell lung cancer. Tests for the anti-ganglioside antibody GM1-IgM were positive. Chemotherapy and intravenous immunoglobulin treatment led to a slight improvement in neurological symptoms. Four additional cases of neuropathy accompanied by anti-ganglioside antibody and lung cancer have been reported. The most commonly reported pattern was subacute sensorimotor neuropathy. Patients died from cancer progression after 5 to 18 ...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Case of Lung Cancer with a Small Cell Carcinoma Component Diagnosed from Pleural Effusion and a Squamous Cell Carcinoma Component Diagnosed from the Tumor.
Authors: Zaizen Y, Tokito T, Masuda K, Azuma K, Naito Y, Tsuneyoshi S, Sakzaki Y, Matsuo N, Ishii H, Yamada K, Akiba J, Hoshino T Abstract There have been few reports on the accuracy of the diagnosis of small-cell carcinoma based on a cytological examination of malignant pleural effusion, so whether or not such a diagnosis is possible using this approach alone remains unclear. We herein report a 76-year-old Japanese man in whom small-cell carcinoma was diagnosed cytopathologically from pleural effusion and squamous cell carcinoma was diagnosed histopathologically from a transbronchial biopsy. Tumor shrinkage was ac...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

SIADH with Severe Hyponatremia in an Elderly Man with Herpes Zoster Infection: A causal or Casual Association?
Authors: Foppiani L Abstract Syndrome of inappropriate antidiuretic hormone (SIADH) secretion is the most common cause of hypotonic hyponatremia in hospitalized patients. An elderly man with severe symptomatic hyponatremia (109 mEq/L) was diagnosed with SIADH that was likely secondary to large cutaneous herpes zoster (HZ) infection. Hypertonic saline and tolvaptan improved the patient's sodium levels and clinical condition. A one month after discharge, tolvaptan was withdrawn, due to inadequate prescription criteria, after which hyponatremia relapsed several times and was properly treated; eventually fever and sopo...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Small Cell Lung Cancer with Bizarre Radiographic Findings.
Authors: Yamasaki M, Taniwaki M, Deguchi N, Hattori N PMID: 29984776 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Successful Empiric Therapy for Postsplenectomy Sepsis with Campylobacter fetus in an Abattoir Worker with Follicular Lymphoma.
Authors: Nakazawa H, Nishina S, Sakai H, Ito T, Ishida F, Kitano K Abstract Asplenia may yield an increased risk of fulminant sepsis with various pathogens. Human infection with Campylobacter fetus is rare, but it often presents with non-gastrointestinal tract infection among immunocompromised individuals. A 55-year-old abattoir worker presented with a fever. He had had splenectomy for follicular lymphoma and rituximab maintenance therapy by four months before the presentation. Blood cultures yielded C. fetus, and the administration of meropenem dissolved the bacteremia. Further maintenance therapy was withheld, an...
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Renal Papillary Necrosis with Diabetes and Urinary Tract Infection.
Authors: Kawaguchi Y, Mori H, Izumi Y, Ito M PMID: 29984778 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

The Relationship between the Intrarenal Dopamine System and Intrarenal Renin-angiotensin System Depending on the Renal Function.
Conclusion The negative correlation between the intrarenal dopamine system and intrarenal RAS in CKD patients may be affected by the renal function. PMID: 29984779 [PubMed - as supplied by publisher] (Source: Internal Medicine)
Source: Internal Medicine - July 10, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Renal-limited Cryoglobulinemic Vasculitis: Two Case Reports.
Authors: Toriu N, Sawa N, Oguro M, Mizuno H, Oshima Y, Hasegawa E, Sumida K, Suwabe T, Kawada M, Ueno T, Hayami N, Sekine A, Hiramatsu R, Yamanouchi M, Hoshino J, Takaichi K, Ohashi K, Fujii T, Yanagita M, Ubara Y Abstract Cryoglobulinemic vasculitis (CV) presents with systemic manifestations, including renal disease, arthritis, peripheral neuropathy, and muscle weakness. We encountered two patients who developed severe nephrotic range proteinuria; however, extrarenal manifestations were not noted during the clinical course. A renal biopsy revealed typical membranoproliferative glomerulonephritis (MPGN) with huge t...
Source: Internal Medicine - July 3, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Hormone-replacement Therapy for Hepatopulmonary Syndrome and NASH Associated with Hypopituitarism.
Authors: Torii N, Ichihara A, Mizuguchi Y, Seki Y, Hashimoto E, Tokushige K Abstract The patient was a 23-year-old man who was diagnosed with severe hypoxemia and liver dysfunction after suffering from sudden difficulty breathing. At 2 years of age, he had been diagnosed with hypopituitarism, and had received hormone-replacement until he was 18 years of age. Echocardiography using micro bubbles and pulmonary scintigraphy indicated intrapulmonary shunt and a liver biopsy showed steatohepatitis. He was diagnosed with hepatopulmonary syndrome associated with nonalcoholic steatohepatitis. Hormone-replacement therapy wa...
Source: Internal Medicine - June 20, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Takotsubo Cardiomyopathy in a Patient with Previously Undiagnosed Hypertrophic Cardiomyopathy with Latent Obstruction.
Authors: Arakawa K, Gondo T, Matsushita K, Himeno H, Kimura K, Tamura K Abstract A 62-year-old woman with takotsubo cardiomyopathy (TCM) accompanied by cardiogenic shock due to the obstruction of left ventricular outflow tract (LVOT) and massive mitral regurgitation (MR) was admitted to the emergency department. After successful treatment with intensive care, dobutamine stress-echocardiography (DSE) was performed, which showed a dynamic LVOT gradient, severe MR and cardiogenic shock. A histological examination obtained from the right ventricular septum demonstrated hypertrophied and bizarre myocytes, with myocyte d...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Complete Atrioventricular Block Associated with Pembrolizumab-induced Acute Myocarditis: The Need for Close Cardiac Monitoring.
Authors: Katsume Y, Isawa T, Toi Y, Fukuda R, Kondo Y, Sugawara S, Ootomo T Abstract Pembrolizumab, a humanized monoclonal IgG4 antibody directed against programmed death-1, is an immune checkpoint inhibitor that has been introduced for the treatment of non-small-cell lung cancer. However, immune checkpoint inhibitors may cause severe immune-related adverse events. We herein present a case of lung cancer with complete atrioventricular block associated with acute myocarditis, which developed 16 days after the administration of pembrolizumab. The clinical course of this case suggested a strong need for close cardiac ...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Peripartum Serial Echocardiographic Findings in a Patient with Life-threatening Peripartum Cardiomyopathy.
Authors: Aoyama D, Hamatani Y, Kamiya C, Ohta-Ogo K, Amaki M, Kawakami S, Okada A, Takahama H, Hasegawa T, Sugano Y, Kanzaki H, Ishibashi-Ueda H, Yasuda S, Anzai T Abstract A 35-year-old woman was referred to our hospital for the management of acutely decompensated heart failure due to peripartum cardiomyopathy (PPCM). Generally, cardiac examinations are performed after the manifestation of heart failure in patients with PPCM. Thus, reports of serial cardiac examinations before the onset of PPCM are scarce. In this case, we were able to document the serial echocardiographic findings before the onset of life-threate...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

The Effect of Everolimus on Refractory Hypoglycemia in a Patient with Inoperable Metastatic Insulinoma Evaluated by Continuous Glucose Monitoring.
Authors: Yanagiya S, Cho KY, Nakamura A, Nomoto H, Kawamoto Y, Kawakubo K, Komatsu Y, Mitsuhashi T, Miyoshi H, Atsumi T Abstract An 84-year-old Japanese woman with metastatic insulinoma suffered from frequent hypoglycemic events. Continuous glucose monitoring (CGM) confirmed severe and frequent symptomatic/asymptomatic hypoglycemia. After the initiation of everolimus treatment, the hypoglycemic events were rapidly eliminated. CGM revealed that her blood glucose levels were maintained without hypoglycemia throughout the day. Furthermore, everolimus reduced the duration of time above the upper limit (>180 mg/dL) a...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Recovery of Pure Red Cell Aplasia Following Hematopoietic Stem Cell Transplantation Associated with IL-6 Elevation Caused by Odontogenic Infection.
Authors: Nakamura N, Ninomiya S, Matsumoto T, Nakamura H, Kitagawa J, Hara T, Shimizu M, Tsurumi H Abstract We herein report a case of long-lasting pure red cell aplasia (PRCA) after major ABO-incompatible allogeneic stem cell transplantation (SCT) for acute lymphoblastic leukemia. The patient needed red blood cell (RBC) transfusion every week after SCT. On day 236, he was diagnosed with odontogenic infection, and the serum levels of IL-6 were elevated to 12.1 pg/ml. After that, the numbers of reticulocyte rapidly began to increase, and RBC support was not needed from day 251. No standard care for PRCA following SC...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Aspergillus Sternomyelitis Developed from Chronic Pulmonary Aspergillosis as a Late Complication to Lobectomy for Lung Cancer.
Authors: Uehara Y, Kasai H, Nakajima T, Tanabe N, Tatsumi K, Yoshino I Abstract Progressive fibrobullous changes in the residual lobes are sometimes observed after lobectomy. Aspergillus osteomyelitis is an uncommon infection that rarely occurs sternally. A 70-year-old man who had undergone lobectomy 12 years earlier was admitted to our hospital for chest pain. He was diagnosed with Aspergillus sternomyelitis based on sternal bone culture after an ultrasound-guided percutaneous needle biopsy. The fibrosis and right residual lung apex volume loss had gradually progressed over 12 years, and therefore, chronic pulmona...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Ceritinib Treatment for Carcinomatous Meningitis with a Secondary Mutation at I1171T in Anaplastic Lymphoma Kinase.
Authors: Ashinuma H, Shingyoji M, Hasegawa Y, Yokoi S, Yoshida Y Abstract The mechanisms underlying anaplastic lymphoma kinase (ALK) resistance have not been well investigated in clinical practice. We herein report the case of a lung cancer patient with carcinomatous meningitis who had an ALK I1171T resistance mutation revealed by direct DNA sequencing of the cerebrospinal fluid after treatment with cytotoxic chemotherapy, crizotinib, and alectinib. I1171T is considered to be sensitive to ceritinib. Although ceritinib was not effective initially, we chose ceritinib again after whole-brain radiotherapy and ventricul...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Valacyclovir-induced Neurotoxicity in a Patient with a Preserved Renal Function.
Authors: Yoshimura T, Kawasaki T, Shirota A, Saeki M, Okada Y, Okada H Abstract Valacyclovir, a prodrug of acyclovir, is the first-line treatment for herpes zoster, but the renal function must be monitored, because acyclovir is metabolized by the kidneys. We herein report a case of valacyclovir-induced neurotoxicity with no preceding renal impairment. An 88-year-old man was admitted because of an impaired consciousness after the administration of valacyclovir at 3,000 mg daily for herpes zoster on the chest. His consciousness level gradually improved with hydration and valacyclovir withdrawal. It was later confirme...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

A Young Man with Non-alcoholic Steatohepatitis and Serum Anti-mitochondrial Antibody Positivity: A Case Report.
Authors: Seike T, Komura T, Shimizu Y, Omura H, Kumai T, Kagaya T, Ohta H, Kawashima A, Harada K, Kaneko S, Unoura M Abstract A 37-year-old obese man who was a social drinker was admitted to our hospital to undergo a detailed examination for liver injury with anti-mitochondrial antibody positivity. Abdominal ultrasonography revealed moderate fatty liver. A histological analysis showed steatosis of approximately 30% of the hepatocytes, focal necrosis, a few ballooning hepatocytes and lobular inflammation suggestive of steatohepatitis, epithelioid granuloma and irregularity of the sequence of the bile duct epithelium...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Efficacy of Corticosteroid Treatment for Refractory Multivessel Vasospastic Coronary Angina with Hypereosinophilia.
Authors: Takano T, Ozaki K, Tanaka K, Yanagawa T, Ozawa T, Minamino T Abstract A 43-year-old man was diagnosed with acute myocardial infarction (AMI) due to multivessel coronary vasospasm. Accordingly, two coronary vasodilators were administered, and he was discharged without an angina attack. However, from the following day, he reported frequent chest pain and was re-hospitalized. Despite adding multiple coronary vasodilators, it was difficult to completely suppress the angina attack. He also demonstrated hypereosinophilia from the onset of AMI, and his eosinophil count gradually increased up to 6,238 /μL. Afte...
Source: Internal Medicine - June 9, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research