Risk of Rebleeding in Patients with Small Bowel Vascular Lesions
Conclusions Gastrointestinal rebleeding is not a rare condition among patients with SBVLs. Patients with poor general health may therefore have a higher risk of rebleeding.PMID:34120996 | DOI:10.2169/internalmedicine.6341-20 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Akira Harada Takehiro Torisu Shin Fujioka Yuichiro Yoshida Yasuharu Okamoto Yuta Fuyuno Atsushi Hirano Junji Umeno Kumiko Torisu Tomohiko Moriyama Motohiro Esaki Takanari Kitazono Source Type: research

Pseudo-thrombotic Microangiopathy Caused by Acquired Cobalamin Deficiency Due to Unintentional Neglect: A Case Report
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6660-20. Online ahead of print.ABSTRACTAcquired vitamin B12 (VB12) deficiency is a rare cause of thrombotic microangiopathy (TMA). We experienced an 86-year-old Japanese woman who presented with coma, renal dysfunction, and microangiopathic hemolytic anemia. Although we initially considered thrombotic thrombocytopenic purpura, we eventually diagnosed her to have VB12 deficiency due to inappropriate dietary care based on her low serum VB12 level, social history, and negative parietal cell finding and the presence of intrinsic factor antibody. Because similar cases are e...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Tomoyuki Shigeta Yosuke Sasaki Tadashi Maeda Erika Hanji Yoshihisa Urita Source Type: research

Capnocytophaga Sputigena Sepsis in a Severe Aplastic Anemia Patient
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6665-20. Online ahead of print.NO ABSTRACTPMID:34120998 | DOI:10.2169/internalmedicine.6665-20 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Nobuki Iwamoto Yosuke Matsumoto Kentaro Tochitani Hitoji Uchiyama Source Type: research

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6765-20. Online ahead of print.ABSTRACTAn 82-year-old woman with a history of bladder cancer presented with dyspnea and loss of consciousness. Contrast-enhanced computed tomography revealed pulmonary embolism, and emergency thrombus aspiration therapy was performed, but the thrombus was not aspirated. Echocardiography showed mobile masses in the heart and a right-to-left shunt due to a patent foramen ovale (PFO). Magnetic resonance imaging showed multiple cerebral infarctions. Surgical thrombectomy and PFO closure were performed, and the patient was diagnosed with intr...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Masamitsu Kamakura Ayako Okazaki Kazuki Ito Fumihiko Kin Keisuke Miyajima Yasuyo Takashima Tomoyuki Watanabe Yoshitaka Kawaguchi Yasushi Wakabayashi Mitsuru Asano Yuichiro Maekawa Source Type: research

Indications and Limitations Associated with the Patency Capsule Prior to Capsule Endoscopy
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6823-20. Online ahead of print.ABSTRACTThe retention of the capsule used during small bowel capsule endoscopy (SBCE) is a serious complication that can occur in patients with known or suspected small bowel stenosis, and a prior evaluation of the patency of the gastrointestinal (GI) tract is therefore essential. Patency capsule (PC) is a non-diagnostic capsule the same size as the diagnostic SBCE. To date, there are no clear guidelines regarding the contraindications for undergoing a PC evaluation prior to SBCE. Each small bowel disorder has specific occasions to inhibi...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Masanao Nakamura Hiroki Kawashima Masatoshi Ishigami Mitsuhiro Fujishiro Source Type: research

Prognostic Significance of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology for the Prediction of Major Cardiac Events after Revascularization
Conclusion Evaluating the SPBW before revascularization may help predict future MCEs in patients with CAD who intended to undergo treatment.PMID:34121001 | DOI:10.2169/internalmedicine.6995-20 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Hidesato Fujito Shunichi Yoda Takumi Hatta Yusuke Hori Misa Hayase Masatsugu Miyagawa Yasuyuki Suzuki Naoya Matsumoto Yasuo Okumura Source Type: research

Oral Ulcers Associated with Scrub Typhus
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7037-21. Online ahead of print.NO ABSTRACTPMID:34121002 | DOI:10.2169/internalmedicine.7037-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Shotaro Suzuki Lisa Hirahara Source Type: research

Abdominal Subcutaneous Hematoma
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7040-21. Online ahead of print.NO ABSTRACTPMID:34121003 | DOI:10.2169/internalmedicine.7040-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Naoki Yamamoto Masahiro Fujinaga Akihiro Dejima Kenkou Hasatani Source Type: research

A Solitary Necrotizing Sarcoid Granulomatosis-like Pulmonary Lesion Possibly Associated with Propionibacterium Acnes and Mycobacterium Avium
We report a case of a pulmonary necrotizing sarcoid granulomatosis (NSG)-like lesion possibly associated with coinfection of Mycobacterium avium and Propionibacterium acnes. A solitary nodule in the right middle lobe of the lung was notable for coagulative necrosis with aggregates of sarcoid-like epithelioid granulomas. Small arteries were damaged by granulomas. Both M. avium and P. acnes were detected in the lesion. Furthermore, more P. acnes genomes were detected in the granulomas than in the non-lesion lung. These findings blur the pathophysiologic boundaries among NSG, sarcoidosis, and mycobacteriosis, and suggest that...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Keigo Murakami Shuko Hata Naoya Ishibashi Motoki Kubota Yoshinobu Eishi Keisuke Uchida Toshiharu Tabata Yasuhiro Nakamura Kazuhiro Murakami Source Type: research

Persistent Hemichorea as a Preceding Symptom of Cerebral Infarction due to Middle Cerebral Artery Stenosis
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7191-21. Online ahead of print.ABSTRACTWe herein report an 84-year-old woman with right middle cerebral artery (MCA) stenosis who presented with persistent left hemichorea preceding cerebral infarction. She visited our hospital on day 9 after the hemichorea onset. Magnetic resonance imaging (MRI) showed no acute cerebral infarction. Magnetic resonance angiography revealed right MCA stenosis. Her hemichorea persisted for 19 days and subsequently disappeared. On day 21, she developed left hemiplegia. Repeat MRI revealed a cerebral infarction in the right putamen. MCA ste...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Yuki Ueta Haruhisa Kato Makiko Naito Takeshi Taguchi Hiroo Terashi Hitoshi Aizawa Source Type: research

High-grade Primary Central Nervous System Lymphomatoid Granulomatosis: Successful Rituximab Monotherapy
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7232-21. Online ahead of print.ABSTRACTThe primary central nervous system (CNS) presentation of lymphomatoid granulomatosis (LYG) is rare, and no standard therapy for LYG with primary CNS symptoms exists. CNS-LYG patients usually survive for only less than a year from diagnosis. This is the first report of high-grade primary CNS-LYG with monoclonality that was successfully treated with rituximab monotherapy, resulting in a durable remission for more than 1year in a 66-year-old woman with pemphigus vulgaris who was also on immunosuppressive therapy.PMID:34121006 | DOI:1...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Sakiko Harada Jun Ando Miki Ando Hideaki Nitta Tadaaki Inano Yusuke Hirasawa Yoshiki Furukawa Shintaro Kinoshita Akihide Kondo Koichi Ohshima Norio Komatsu Source Type: research

Impact of the Concomitant Use of Immunomodulator and a Lower Week 8 Partial Mayo Score on the Persistence of Adalimumab in Refractory Ulcerative Colitis
Conclusion ADA was effective for inducing and maintaining both a clinical response and remission in patients with refractory UC. It remains possible that the concomitant use of IM and a week 8 partial Mayo score of ≤2 may predict the long-term response of ADA.PMID:34121007 | DOI:10.2169/internalmedicine.7279-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Shinsuke Kumei Toshihiro Sakurai Suketo So Soichi Itaba Hirotada Akiho Shigeo Nakamura Hyonji Kim Masahiro Yamasaki Noritaka Takatsu Ryuichiro Maekawa Ryosuke Sakemi Tatsuyuki Watanabe Michihiko Shibata Keiichiro Kume Ichiro Yoshikawa Yasuhiro Takaki Masa Source Type: research

Possible Neoangiogenesis in Achilles Tendon Xanthoma with Familial Hypercholesterolemia: A Novel Approach to Achilles Tendon Xanthoma
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7326-21. Online ahead of print.ABSTRACTAchilles tendon xanthoma (ATX) is one of the typical features of familial hypercholesterolemia (FH). The morphological evaluation of ATX by X-ray radiography is widely recognized; however, the utility of other imaging modalities remains unclear. We herein report two cases of FH in which Doppler ultrasound imaging demonstrated a microvascular flow in ATX that only rarely could be observed in normal Achilles tendons. Neoangiogenesis accompanies chronic inflammation and it may play an important role in the deposition of cholesterol c...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Tetsu Tanaka Kazuyuki Yahagi Osamu Wada Kai Ninomiya Yu Horiuchi Masahiko Asami Hitomi Yuzawa Kota Komiyama Jun Tanaka Jiro Aoki Akitake Suzuki Kazuho Ishizaki Kengo Tanabe Source Type: research

Myelin Oligodendrocyte Glycoprotein-antibody-associated Disorder Presenting with Corticomeningeal Encephalitis prior to the Onset of Optic Neuritis
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7357-21. Online ahead of print.ABSTRACTWe herein report a case of myelin oligodendrocyte glycoprotein-antibody-associated disorder (MOG-AD) presenting with corticomeningeal encephalitis. The patient exhibited oral ulceration, a mild impairment of consciousness, fever, nausea, nuchal rigidity, positivity for human leukocyte antigen type B51, and neutrophil-dominant pleocytosis and interleukin-6 level in cerebrospinal fluid (CSF). Magnetic resonance imaging (MRI) revealed a right temporal lesion with leptomeningeal gadolinium enhancement. The initial diagnosis was neuro-...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Takuya Ataka Noriyuki Kimura Etsuro Matsubara Source Type: research

A Case of Fatal Immune Checkpoint Inhibitor-related Pancreatitis
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7366-21. Online ahead of print.ABSTRACTWe herein report a case of fatal pancreatitis induced by an immune checkpoint inhibitor. A 62-year-old man with cancer of unknown primary was treated with pembrolizumab. After 12 cycles, immune-related pneumonitis developed and was treated with prednisolone. Three months later, pancreatitis developed, which was successfully treated with hydration and protease inhibitors. Eight months later, another attack of pancreatitis occurred, which did not respond to therapy, including high-dose corticosteroids, and he eventually died. This i...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Masayuki Ueno Yoshihisa Tsuji Toshihide Yokoyama Takashi Koyama Yosuke Uenishi Etsuji Ishida Motowo Mizuno Source Type: research

Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay without Spasticity
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7401-21. Online ahead of print.ABSTRACTAutosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare progressive neurodegenerative disease caused by either homozygous or compound heterozygous mutations in the SACS gene. The original ARSACS cases found in Quebec showed very homogenous phenotypes characterized by cerebellar ataxia, spasticity, and polyneuropathy. However, many cases with atypical phenotypes have been found in other regions and ethnic groups. We herein present a Japanese patient with atypical ARSACS who showed cerebellar ataxia and polyneur...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Izumi Aida Tetsuo Ozawa Hidehiko Fujinaka Kiyoe Goto Kentaro Ohta Takashi Nakajima Source Type: research

A Case of Myasthenia Gravis Presenting with Myasthenic Crisis Mimicking Status Asthmatics
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7426-21. Online ahead of print.ABSTRACTA 23-year-old woman was transferred to our hospital due to exacerbating dyspnea with wheeze. After admission, we started mechanical ventilation immediately, and she was diagnosed with status asthmatics. On the following day, she was able to be weaned from the ventilator. However, she required re-intubation because of an unstable respiratory condition just after extubation. Detailed neurological investigations identified blepharoptosis and muscle weakness with easy fatigability. An edrophonium test was positive. Anti-acetylcholine ...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Hitoshi Kubo Tomoya Katsuta Norihiko Nakanishi Koji Inoue Kensho Okamoto Source Type: research

A Case of Acquired Coagulation Factor V Inhibitor that Was Successfully Treated with Oral Corticosteroid Therapy
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7453-21. Online ahead of print.ABSTRACTAcquired coagulation factor V (FV) inhibitors are rare disorders in which antibodies against FV develop under various conditions. We herein report the case of a 71-year-old woman with FV inhibitor during radiochemotherapy for pancreatic cancer. Multiple purpuras suddenly appeared on her bilateral upper limbs with prolonged coagulation data (APTT 97.3 seconds). The FV activity was less than 3% and the FV inhibitor was positive (1.7 B.U./mL). Oral prednisolone induced a rapid normalization of the coagulation data and FV activity and...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Yoshihiro Yokota Osamu Inatomi Minami Nakagawa Kazuki Kakuda Kousuke Hiroe Shigeki Sakai Rie Osaki Masaki Iwasa Masahiro Kawahara Katsuyuki Kito Akira Andoh Hiromichi Bamba Source Type: research

MFN2-related Charcot-Marie-Tooth Disease with Atypical Ocular Manifestations
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7463-21. Online ahead of print.ABSTRACTWe herein describe a Charcot-Marie-Tooth disease (CMT) family with a MFN2 mutation with atypical ocular manifestations. The proband, his mother, his third daughter, and his deceased maternal grandfather all had symptoms of CMT and a visual impairment (either cataracts or severe astigmatism). On whole-exome sequencing for the proband having CMT and congenital cataracts, we identified a c.314C>T (p.Thr105Met) mutation in MFN2, but no mutation in the causative genes associated with cataracts. This missense mutation in MFN2 co-segr...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Haitian Nan Takanori Hata Toko Fukao Toshimichi Fukao Wanjing Chen Takafumi Kurita Takahiro Natori Yoshihisa Takiyama Source Type: research

Acquired Hemophilia A Presenting with Infectious Aortic Aneurysms Due to an Underlying Helicobacter Cinaedi Infection: A Case Report
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7517-21. Online ahead of print.ABSTRACTAcquired hemophilia A (AHA) is a bleeding disorder caused by the acquired appearance of inhibitor for factor VIII. Approximately half of all patients with AHA have some type of underlying disease. We herein report the case of a 72-year-old Japanese man with AHA who presented with infectious aortic aneurysms due to an underlying Helicobacter cinaedi infection. To our knowledge, this is the first report of AHA triggered by a bacterial infection; however, there may be similar cases that remain undiagnosed because this pathogen is dif...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Anna Matsuoka Yuya Sasaki Ai Kubodeta Kiyohito Hayashi Ryo Shimizu Akira Toriihara Akira Nakamura Keiichi Furukawa Hiroaki Tanaka Source Type: research

Primary Lymphoma of the Pericardium
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7643-21. Online ahead of print.NO ABSTRACTPMID:34121016 | DOI:10.2169/internalmedicine.7643-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Shintaro Kinoshita Jun Ando Miki Ando Norio Komatsu Source Type: research

Risk of Rebleeding in Patients with Small Bowel Vascular Lesions
Conclusions Gastrointestinal rebleeding is not a rare condition among patients with SBVLs. Patients with poor general health may therefore have a higher risk of rebleeding.PMID:34120996 | DOI:10.2169/internalmedicine.6341-20 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Akira Harada Takehiro Torisu Shin Fujioka Yuichiro Yoshida Yasuharu Okamoto Yuta Fuyuno Atsushi Hirano Junji Umeno Kumiko Torisu Tomohiko Moriyama Motohiro Esaki Takanari Kitazono Source Type: research

Pseudo-thrombotic Microangiopathy Caused by Acquired Cobalamin Deficiency Due to Unintentional Neglect: A Case Report
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6660-20. Online ahead of print.ABSTRACTAcquired vitamin B12 (VB12) deficiency is a rare cause of thrombotic microangiopathy (TMA). We experienced an 86-year-old Japanese woman who presented with coma, renal dysfunction, and microangiopathic hemolytic anemia. Although we initially considered thrombotic thrombocytopenic purpura, we eventually diagnosed her to have VB12 deficiency due to inappropriate dietary care based on her low serum VB12 level, social history, and negative parietal cell finding and the presence of intrinsic factor antibody. Because similar cases are e...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Tomoyuki Shigeta Yosuke Sasaki Tadashi Maeda Erika Hanji Yoshihisa Urita Source Type: research

Capnocytophaga Sputigena Sepsis in a Severe Aplastic Anemia Patient
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6665-20. Online ahead of print.NO ABSTRACTPMID:34120998 | DOI:10.2169/internalmedicine.6665-20 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Nobuki Iwamoto Yosuke Matsumoto Kentaro Tochitani Hitoji Uchiyama Source Type: research

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6765-20. Online ahead of print.ABSTRACTAn 82-year-old woman with a history of bladder cancer presented with dyspnea and loss of consciousness. Contrast-enhanced computed tomography revealed pulmonary embolism, and emergency thrombus aspiration therapy was performed, but the thrombus was not aspirated. Echocardiography showed mobile masses in the heart and a right-to-left shunt due to a patent foramen ovale (PFO). Magnetic resonance imaging showed multiple cerebral infarctions. Surgical thrombectomy and PFO closure were performed, and the patient was diagnosed with intr...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Masamitsu Kamakura Ayako Okazaki Kazuki Ito Fumihiko Kin Keisuke Miyajima Yasuyo Takashima Tomoyuki Watanabe Yoshitaka Kawaguchi Yasushi Wakabayashi Mitsuru Asano Yuichiro Maekawa Source Type: research

Indications and Limitations Associated with the Patency Capsule Prior to Capsule Endoscopy
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.6823-20. Online ahead of print.ABSTRACTThe retention of the capsule used during small bowel capsule endoscopy (SBCE) is a serious complication that can occur in patients with known or suspected small bowel stenosis, and a prior evaluation of the patency of the gastrointestinal (GI) tract is therefore essential. Patency capsule (PC) is a non-diagnostic capsule the same size as the diagnostic SBCE. To date, there are no clear guidelines regarding the contraindications for undergoing a PC evaluation prior to SBCE. Each small bowel disorder has specific occasions to inhibi...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Masanao Nakamura Hiroki Kawashima Masatoshi Ishigami Mitsuhiro Fujishiro Source Type: research

Prognostic Significance of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology for the Prediction of Major Cardiac Events after Revascularization
Conclusion Evaluating the SPBW before revascularization may help predict future MCEs in patients with CAD who intended to undergo treatment.PMID:34121001 | DOI:10.2169/internalmedicine.6995-20 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Hidesato Fujito Shunichi Yoda Takumi Hatta Yusuke Hori Misa Hayase Masatsugu Miyagawa Yasuyuki Suzuki Naoya Matsumoto Yasuo Okumura Source Type: research

Oral Ulcers Associated with Scrub Typhus
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7037-21. Online ahead of print.NO ABSTRACTPMID:34121002 | DOI:10.2169/internalmedicine.7037-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Shotaro Suzuki Lisa Hirahara Source Type: research

Abdominal Subcutaneous Hematoma
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7040-21. Online ahead of print.NO ABSTRACTPMID:34121003 | DOI:10.2169/internalmedicine.7040-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Naoki Yamamoto Masahiro Fujinaga Akihiro Dejima Kenkou Hasatani Source Type: research

A Solitary Necrotizing Sarcoid Granulomatosis-like Pulmonary Lesion Possibly Associated with Propionibacterium Acnes and Mycobacterium Avium
We report a case of a pulmonary necrotizing sarcoid granulomatosis (NSG)-like lesion possibly associated with coinfection of Mycobacterium avium and Propionibacterium acnes. A solitary nodule in the right middle lobe of the lung was notable for coagulative necrosis with aggregates of sarcoid-like epithelioid granulomas. Small arteries were damaged by granulomas. Both M. avium and P. acnes were detected in the lesion. Furthermore, more P. acnes genomes were detected in the granulomas than in the non-lesion lung. These findings blur the pathophysiologic boundaries among NSG, sarcoidosis, and mycobacteriosis, and suggest that...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Keigo Murakami Shuko Hata Naoya Ishibashi Motoki Kubota Yoshinobu Eishi Keisuke Uchida Toshiharu Tabata Yasuhiro Nakamura Kazuhiro Murakami Source Type: research

Persistent Hemichorea as a Preceding Symptom of Cerebral Infarction due to Middle Cerebral Artery Stenosis
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7191-21. Online ahead of print.ABSTRACTWe herein report an 84-year-old woman with right middle cerebral artery (MCA) stenosis who presented with persistent left hemichorea preceding cerebral infarction. She visited our hospital on day 9 after the hemichorea onset. Magnetic resonance imaging (MRI) showed no acute cerebral infarction. Magnetic resonance angiography revealed right MCA stenosis. Her hemichorea persisted for 19 days and subsequently disappeared. On day 21, she developed left hemiplegia. Repeat MRI revealed a cerebral infarction in the right putamen. MCA ste...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Yuki Ueta Haruhisa Kato Makiko Naito Takeshi Taguchi Hiroo Terashi Hitoshi Aizawa Source Type: research

High-grade Primary Central Nervous System Lymphomatoid Granulomatosis: Successful Rituximab Monotherapy
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7232-21. Online ahead of print.ABSTRACTThe primary central nervous system (CNS) presentation of lymphomatoid granulomatosis (LYG) is rare, and no standard therapy for LYG with primary CNS symptoms exists. CNS-LYG patients usually survive for only less than a year from diagnosis. This is the first report of high-grade primary CNS-LYG with monoclonality that was successfully treated with rituximab monotherapy, resulting in a durable remission for more than 1year in a 66-year-old woman with pemphigus vulgaris who was also on immunosuppressive therapy.PMID:34121006 | DOI:1...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Sakiko Harada Jun Ando Miki Ando Hideaki Nitta Tadaaki Inano Yusuke Hirasawa Yoshiki Furukawa Shintaro Kinoshita Akihide Kondo Koichi Ohshima Norio Komatsu Source Type: research

Impact of the Concomitant Use of Immunomodulator and a Lower Week 8 Partial Mayo Score on the Persistence of Adalimumab in Refractory Ulcerative Colitis
Conclusion ADA was effective for inducing and maintaining both a clinical response and remission in patients with refractory UC. It remains possible that the concomitant use of IM and a week 8 partial Mayo score of ≤2 may predict the long-term response of ADA.PMID:34121007 | DOI:10.2169/internalmedicine.7279-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Shinsuke Kumei Toshihiro Sakurai Suketo So Soichi Itaba Hirotada Akiho Shigeo Nakamura Hyonji Kim Masahiro Yamasaki Noritaka Takatsu Ryuichiro Maekawa Ryosuke Sakemi Tatsuyuki Watanabe Michihiko Shibata Keiichiro Kume Ichiro Yoshikawa Yasuhiro Takaki Masa Source Type: research

Possible Neoangiogenesis in Achilles Tendon Xanthoma with Familial Hypercholesterolemia: A Novel Approach to Achilles Tendon Xanthoma
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7326-21. Online ahead of print.ABSTRACTAchilles tendon xanthoma (ATX) is one of the typical features of familial hypercholesterolemia (FH). The morphological evaluation of ATX by X-ray radiography is widely recognized; however, the utility of other imaging modalities remains unclear. We herein report two cases of FH in which Doppler ultrasound imaging demonstrated a microvascular flow in ATX that only rarely could be observed in normal Achilles tendons. Neoangiogenesis accompanies chronic inflammation and it may play an important role in the deposition of cholesterol c...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Tetsu Tanaka Kazuyuki Yahagi Osamu Wada Kai Ninomiya Yu Horiuchi Masahiko Asami Hitomi Yuzawa Kota Komiyama Jun Tanaka Jiro Aoki Akitake Suzuki Kazuho Ishizaki Kengo Tanabe Source Type: research

Myelin Oligodendrocyte Glycoprotein-antibody-associated Disorder Presenting with Corticomeningeal Encephalitis prior to the Onset of Optic Neuritis
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7357-21. Online ahead of print.ABSTRACTWe herein report a case of myelin oligodendrocyte glycoprotein-antibody-associated disorder (MOG-AD) presenting with corticomeningeal encephalitis. The patient exhibited oral ulceration, a mild impairment of consciousness, fever, nausea, nuchal rigidity, positivity for human leukocyte antigen type B51, and neutrophil-dominant pleocytosis and interleukin-6 level in cerebrospinal fluid (CSF). Magnetic resonance imaging (MRI) revealed a right temporal lesion with leptomeningeal gadolinium enhancement. The initial diagnosis was neuro-...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Takuya Ataka Noriyuki Kimura Etsuro Matsubara Source Type: research

A Case of Fatal Immune Checkpoint Inhibitor-related Pancreatitis
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7366-21. Online ahead of print.ABSTRACTWe herein report a case of fatal pancreatitis induced by an immune checkpoint inhibitor. A 62-year-old man with cancer of unknown primary was treated with pembrolizumab. After 12 cycles, immune-related pneumonitis developed and was treated with prednisolone. Three months later, pancreatitis developed, which was successfully treated with hydration and protease inhibitors. Eight months later, another attack of pancreatitis occurred, which did not respond to therapy, including high-dose corticosteroids, and he eventually died. This i...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Masayuki Ueno Yoshihisa Tsuji Toshihide Yokoyama Takashi Koyama Yosuke Uenishi Etsuji Ishida Motowo Mizuno Source Type: research

Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay without Spasticity
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7401-21. Online ahead of print.ABSTRACTAutosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare progressive neurodegenerative disease caused by either homozygous or compound heterozygous mutations in the SACS gene. The original ARSACS cases found in Quebec showed very homogenous phenotypes characterized by cerebellar ataxia, spasticity, and polyneuropathy. However, many cases with atypical phenotypes have been found in other regions and ethnic groups. We herein present a Japanese patient with atypical ARSACS who showed cerebellar ataxia and polyneur...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Izumi Aida Tetsuo Ozawa Hidehiko Fujinaka Kiyoe Goto Kentaro Ohta Takashi Nakajima Source Type: research

A Case of Myasthenia Gravis Presenting with Myasthenic Crisis Mimicking Status Asthmatics
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7426-21. Online ahead of print.ABSTRACTA 23-year-old woman was transferred to our hospital due to exacerbating dyspnea with wheeze. After admission, we started mechanical ventilation immediately, and she was diagnosed with status asthmatics. On the following day, she was able to be weaned from the ventilator. However, she required re-intubation because of an unstable respiratory condition just after extubation. Detailed neurological investigations identified blepharoptosis and muscle weakness with easy fatigability. An edrophonium test was positive. Anti-acetylcholine ...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Hitoshi Kubo Tomoya Katsuta Norihiko Nakanishi Koji Inoue Kensho Okamoto Source Type: research

A Case of Acquired Coagulation Factor V Inhibitor that Was Successfully Treated with Oral Corticosteroid Therapy
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7453-21. Online ahead of print.ABSTRACTAcquired coagulation factor V (FV) inhibitors are rare disorders in which antibodies against FV develop under various conditions. We herein report the case of a 71-year-old woman with FV inhibitor during radiochemotherapy for pancreatic cancer. Multiple purpuras suddenly appeared on her bilateral upper limbs with prolonged coagulation data (APTT 97.3 seconds). The FV activity was less than 3% and the FV inhibitor was positive (1.7 B.U./mL). Oral prednisolone induced a rapid normalization of the coagulation data and FV activity and...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Yoshihiro Yokota Osamu Inatomi Minami Nakagawa Kazuki Kakuda Kousuke Hiroe Shigeki Sakai Rie Osaki Masaki Iwasa Masahiro Kawahara Katsuyuki Kito Akira Andoh Hiromichi Bamba Source Type: research

MFN2-related Charcot-Marie-Tooth Disease with Atypical Ocular Manifestations
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7463-21. Online ahead of print.ABSTRACTWe herein describe a Charcot-Marie-Tooth disease (CMT) family with a MFN2 mutation with atypical ocular manifestations. The proband, his mother, his third daughter, and his deceased maternal grandfather all had symptoms of CMT and a visual impairment (either cataracts or severe astigmatism). On whole-exome sequencing for the proband having CMT and congenital cataracts, we identified a c.314C>T (p.Thr105Met) mutation in MFN2, but no mutation in the causative genes associated with cataracts. This missense mutation in MFN2 co-segr...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Haitian Nan Takanori Hata Toko Fukao Toshimichi Fukao Wanjing Chen Takafumi Kurita Takahiro Natori Yoshihisa Takiyama Source Type: research

Acquired Hemophilia A Presenting with Infectious Aortic Aneurysms Due to an Underlying Helicobacter Cinaedi Infection: A Case Report
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7517-21. Online ahead of print.ABSTRACTAcquired hemophilia A (AHA) is a bleeding disorder caused by the acquired appearance of inhibitor for factor VIII. Approximately half of all patients with AHA have some type of underlying disease. We herein report the case of a 72-year-old Japanese man with AHA who presented with infectious aortic aneurysms due to an underlying Helicobacter cinaedi infection. To our knowledge, this is the first report of AHA triggered by a bacterial infection; however, there may be similar cases that remain undiagnosed because this pathogen is dif...
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Anna Matsuoka Yuya Sasaki Ai Kubodeta Kiyohito Hayashi Ryo Shimizu Akira Toriihara Akira Nakamura Keiichi Furukawa Hiroaki Tanaka Source Type: research

Primary Lymphoma of the Pericardium
Intern Med. 2021 Jun 12. doi: 10.2169/internalmedicine.7643-21. Online ahead of print.NO ABSTRACTPMID:34121016 | DOI:10.2169/internalmedicine.7643-21 (Source: Internal Medicine)
Source: Internal Medicine - June 14, 2021 Category: Internal Medicine Authors: Shintaro Kinoshita Jun Ando Miki Ando Norio Komatsu Source Type: research

Nivolumab-induced Vogt-Koyanagi-Harada-like Syndrome and Adrenocortical Insufficiency with Long-term Survival in a Patient with Non-small-cell Lung Cancer: A Case Report
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.6410-20. Online ahead of print.ABSTRACTA 58-year-old man was diagnosed with lung adenocarcinoma with a tumor proportion score of 10%. After six cycles of second-line chemotherapy with nivolumab, he achieved a complete response (CR) but developed uveitis and sensorineural hearing disorder, which were consistent with Vogt-Koyanagi-Harada (VKH)-like syndrome. Simultaneously, pituitary adrenocortical insufficiency was identified. Nivolumab discontinuation and systemic corticosteroid administration resolved these immune-related adverse events (irAEs). The patient has maintai...
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Ryota Ushio Masaki Yamamoto Atsushi Miyasaka Muraoka Tatshuya Hiromi Kanaoka Hironori Tamura Ayami Kaneko Ami Izawa Nobuyuki Hirama Shuhei Teranishi Saki Manabe Tatsuya Inoue Kunihiko Shibata Yasuyuki Sugiura Makoto Kudo Takeshi Kaneko Source Type: research

A Case of Yellow Nail Syndrome in Which Intranodal Lymphangiography Contributed to the Diagnosis
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.6499-20. Online ahead of print.ABSTRACTYellow nail syndrome (YNS) is a rare disease comprising the clinical triad of yellow nail discoloration, pleural effusion, and lower limb lymphedema. We encountered a difficult-to-treat case of YNS in which the diagnosis was finally made based on intranodal lymphangiography. An 84-year-old man was admitted to our hospital with pleural effusion and yellow-green discoloration of the nails, accompanied by onychomycosis and limb lymphedema. Intranodal lymphangiography revealed a slow contrast flow and narrowing of the thoracic duct, su...
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Takahiro Uchida Yoshitaka Uchida Masao Takahashi Kenji Masaki Hideaki Sato Hidetoshi Iemura Shun Shinomiya Hidetoshi Nakamura Makoto Nagata Source Type: research

Acute Lymphangitis after a Land Leech Bite
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.6759-20. Online ahead of print.NO ABSTRACTPMID:34092727 | DOI:10.2169/internalmedicine.6759-20 (Source: Internal Medicine)
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Shiro Ono Kiyomi Yoshimoto Kenji Nishio Source Type: research

Association between Changes in the Systolic Blood Pressure from Evening to the Next Morning and Night Glucose Variability in Heart Disease Patients
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.6784-20. Online ahead of print.ABSTRACTAims To assess the impact of glycemic variability on blood pressure in hospitalized patients with cardiac disease. Methods In 40 patients with cardiovascular disease, the glucose levels were monitored by flash continuous glucose monitoring (FGM; Free-Style Libre™ or Free-Style Libre Pro; Abbott, Witney, Oxfordshire, UK) and self-monitoring blood glucose (SMBG) for 14 days. Blood pressure measurements were performed twice daily (morning and evening) at the same time as the glucose level measurement using SMBG. Results The dete...
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Tomohiro Shimizu Hiroyasu Uzui Yusuke Sato Machiko Miyoshi Yuichiro Shiomi Kanae Hasegawa Hiroyuki Ikeda Naoto Tama Yoshitomo Fukuoka Tetsuji Morishita Kentaro Ishida Shinsuke Miyazaki Hiroshi Tada Source Type: research

An Autopsy Case of Multicentric Castleman Disease Presenting with Severe Jaundice
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.6835-20. Online ahead of print.ABSTRACTA 70-year-old man with multicentric Castleman disease (MCD) was admitted to our hospital with jaundice and ascites. Elevations in his bilirubin and interleukin-6 levels were noted, and computed tomography revealed hepatic atrophy and portal vein and bile duct disorders. Steroid therapy was started for MCD, but he died of hepatic failure. An autopsy revealed that the MCD activity was mild, but advanced fibrosis and cholestasis were observed in the liver. Mild infiltration of IL-6-positive plasma cells was noted in the highly fibroti...
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Yuichi Yamazaki Yuka Yoshida Megumi Shimizu Takeshi Kobayashi Hiroki Tojima Ken Sato Satoru Kakizaki Hiroshi Handa Hideaki Yokoo Toshio Uraoka Source Type: research

Acute Exacerbation of Idiopathic Interstitial Pneumonia Triggered by Cardiac Ablation: The First Case Report
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.7016-21. Online ahead of print.ABSTRACTAcute exacerbation of idiopathic interstitial pneumonia (AE-IIP) is associated with invasive procedures and respiratory infections. However, there have been no reports of AE-IIP triggered by catheter ablation. We herein report a case of AE-IIP after catheter ablation for atrial fibrillation in an 82-year-old man who was diagnosed with IIP. Cardiac ablation has become an increasingly common procedure for managing patients with arrhythmias. Considering that catheter ablation causes AE-IIP, a detailed clinical interview, physical exam...
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Kaho Akimoto Kuniaki Hirai Tetsuya Homma Shintaro Suzuki Akihiko Tanaka Hironori Sagara Source Type: research

A Case of Eosinophilic Granulomatosis with Polyangiitis Presenting with Central Retinal Artery Occlusion During Treatment with Anti-interleukin-5 Receptor Monoclonal Antibody
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.7027-21. Online ahead of print.ABSTRACTEosinophilic granulomatosis with polyangiitis (EGPA) is an anti-neutrophilic cytoplasm antibody (ANCA)-associated vasculitis characterized by asthma and eosinophilia. Although EGPA involves multiple organs, ocular involvement is infrequent and often carries a poor visual prognosis. We herein report a rare case of EGPA presenting with central retinal artery occlusion (CRAO) in which visual loss developed during treatment with anti-interleukin (IL)-5 receptor monoclonal antibody, and improvement in visual outcomes was attained after ...
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Hirono Nishiyama Tomoko Tajiri Toru Yamabe Tsutomu Yasukawa Norihisa Takeda Kensuke Fukumitsu Satoshi Fukuda Yoshihiro Kanemitsu Takehiro Uemura Hirotsugu Ohkubo Masaya Takemura Ken Maeno Yutaka Ito Tetsuya Oguri Taio Naniwa Akio Niimi Source Type: research

Subpleural Curvilinear Shadows Associated with COVID-19
Intern Med. 2021 Jun 5. doi: 10.2169/internalmedicine.7183-21. Online ahead of print.NO ABSTRACTPMID:34092732 | DOI:10.2169/internalmedicine.7183-21 (Source: Internal Medicine)
Source: Internal Medicine - June 7, 2021 Category: Internal Medicine Authors: Jiro Fujita Hideta Nakamura Kazuya Miyagi Masao Tateyama Source Type: research