Small Insulinoma Followed-up as an Indolent Pancreatic Tumor: A Case Report
Intern Med. 2024 Mar 4. doi: 10.2169/internalmedicine.3194-23. Online ahead of print.ABSTRACTA woman in her 60s presented with a small pancreatic head tumor. Imaging studies revealed a 13-mm well-defined pancreatic head tumor. A neuroendocrine neoplasm was suspected, and the patient opted for observation at that time. After 8 months, the patient began experiencing sweating while fasting, and blood tests during regular follow-up visits showed hypoglycemia. Hypoglycemia was induced during fasting test. The tumor exhibited clear features of an insulinoma during follow-up observation. While small neuroendocrine neoplasms are o...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Hiroki Sato Shozaburo Fujii Tetsuhiro Okada Hidemasa Kawabata Yuki Kamikokura Mikihiro Fujiya Source Type: research

Severe Anemia from Multiple Gastric Hyperplastic Polyps in a Hemodialysis Patient after Long-term Use of a Proton-pump Inhibitor
Intern Med. 2024;63(5):649-657. doi: 10.2169/internalmedicine.2091-23.ABSTRACTA 90-year-old man on maintenance hemodialysis was admitted due to severe symptomatic anemia. Biopsies under esophagogastroduodenoscopy demonstrated that the cause of anemia was intermittent blood oozing from multiple gastric hyperplastic polyps. Even after successful eradication of Helicobacter pylori, he showed hypergastrinemia (480 pg/mL) owing to esomeprazole (proton-pump inhibitor) therapy for the past 4.5 years to treat reflux esophagitis. Seven months after we switched esomeprazole to famotidine (H2-receptor antagonist), those gastric polyp...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Shiyo Ikeda Toshiya Takahashi Toshitsugu Tandoh Kaori Ushiyama Yujiro Kida Source Type: research

Successful Management of a Pregnant Patient with Danon Cardiomyopathy
Intern Med. 2024;63(5):681-686. doi: 10.2169/internalmedicine.1673-23.ABSTRACTA 25-year-old woman with left ventricular (LV) dysfunction became pregnant during the diagnostic period. Decompensated heart failure with frequent ventricular arrhythmias necessitated hospitalization in the 21st week of pregnancy. Under careful monitoring, diuretics and sotalol were added to her ongoing treatment of carvedilol and spironolactone due to the risk of hemodynamic collapse. An emergency cesarean section was performed in the 32nd week after the detection of rapid nonsustained ventricular tachycardia. Subsequent genetic testing revealed...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Wataru Inoue Hirohiko Motoki Koji Yoshie Koichiro Kuwahara Source Type: research

Japanese 17q12 Deletion Syndrome with Complex Clinical Manifestations
Intern Med. 2024;63(5):687-692. doi: 10.2169/internalmedicine.1660-23.ABSTRACT17q12 deletion syndrome is a rare chromosomal anomaly with variable phenotypes, caused by the heterozygous deletion of chromosome 17q12. We herein report a 35-year-old Japanese patient with chromosomal 17q12 deletion syndrome identified by de novo deletion of the 1.46 Mb segment at the 17q12 band by genetic analyses. He exhibited a wide range of phenotypes, such as maturity-onset diabetes of the young (MODY) type 5, structural or functional abnormalities of the kidney, liver, and pancreas; facial dysmorphic features, electrolyte disorders; kerato...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Yutaka Hasegawa Yoshihiko Takahashi Kan Nagasawa Hirofumi Kinno Tomoyasu Oda Mari Hangai Yoshimi Odashima Yoko Suzuki Jun Shimizu Toshihiko Ando Isao Egawa Kouhei Hashizume Koji Nata Daisuke Yabe Yukio Horikawa Yasushi Ishigaki Source Type: research

Anti-contactin 1 Antibody-associated Membranous Nephropathy in Chronic Inflammatory Demyelinating Polyneuropathy with Several Autoantibodies
Intern Med. 2024;63(5):699-705. doi: 10.2169/internalmedicine.2126-23.ABSTRACTA 50-year-old man diagnosed with anti-contactin 1 (CNTN1) antibody-associated chronic inflammatory demyelinating polyneuropathy (CIDP) was referred to our department for the evaluation of proteinuria. A kidney biopsy revealed membranous nephropathy (MN). Immunohistochemistry for CNTN1 revealed positive granular staining along the glomerular basement membrane, confirming anti-CNTN1 antibody-associated MN. Immunofluorescence showed a full-house pattern, and several autoantibodies, such as anti-nuclear antibody, anti-double-strand DNA antibody, and ...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Ryutaro Shida Takamasa Iwakura Naro Ohashi Chiemi Ema Taro Aoki Takeshi Tashiro Sayaka Ishigaki Shinsuke Isobe Tomoyuki Fujikura Akihiko Kato Tomohiko Nakamura Yoshihide Fujigaki Akira Shimizu Hideo Yasuda Source Type: research

Severe acute interstitial nephritis induced by α-glucosidase inhibitor miglitol in an elderly patient with type 2 diabetic nephropathy
Intern Med. 2024 Mar 4. doi: 10.2169/internalmedicine.3156-23. Online ahead of print.ABSTRACTA 79-year-old male patient with type 2 diabetic nephropathy and hypertension was admitted to our hospital because of acute kidney injury with significantly elevated serum creatinine (8.12 mg/dL) and urinary β2-microglobulin (β2MG, 31,748 μg/L) levels. α-Glucosidase inhibitor (α-GI) miglitol, started two weeks prior to presentation, was discontinued because drug-induced acute interstitial nephritis (AIN) was suspected. Renal biopsy revealed AIN and diabetic nephropathy. The drug-induced lymphocyte stimulation test for miglitol ...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Kazutoshi Ono Takahiro Masuda Yuko Ono Erika Hishida Hiromichi Yoshizawa Toshimi Imai Hiroshi Satonaka Tetsu Akimoto Daisuke Nagata Source Type: research

Intramural Esophageal Hematoma
Intern Med. 2024 Mar 4. doi: 10.2169/internalmedicine.3117-23. Online ahead of print.NO ABSTRACTPMID:38432958 | DOI:10.2169/internalmedicine.3117-23 (Source: Internal Medicine)
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Yasuhiko Hamada Takumi Aota Hayato Nakagawa Source Type: research

Cytokine Release Syndrome with Relative Adrenal Insufficiency Induced by Ipilimumab and Nivolumab Combination Therapy for Clear Cell Renal Cell Carcinoma
Intern Med. 2024 Mar 4. doi: 10.2169/internalmedicine.3115-23. Online ahead of print.ABSTRACTCombination therapy with ipilimumab and nivolumab is indicated for many types of cancers; however, several patients experience immune-related adverse events (irAEs). We herein report a case of cytokine release syndrome (CRS) in a 63-year-old woman with stage IV left clear cell renal cell carcinoma. Our patient developed CRS while taking prednisolone, 43 days after the start of ipilimumab and nivolumab administration. The patient was treated with steroid pulse therapy, which improved the symptoms of shock and respiratory failure. In...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Kohei Yamamoto Shinsuke Shiotsu Misaki Sasakura Shunya Tanaka Shiho Goda Taisuke Tsuji Tatsuya Yuba Chieko Takumi Noriya Hiraoka Source Type: research

An Autopsy Case of COVID-19 with New Diffuse Pulmonary Ossification
We present the case of a 61-year-old man who developed Coronavirus disease 2019 (COVID-19) and died during treatment for relapsing polychondritis. The patient was intubated and treated with steroid pulse therapy, remdecivir, antibacterial agents, baricitinib, and tocilizumab. However, his respiratory condition worsened, and he died 108 days after disease onset. An autopsy revealed diffuse alveolar damage in the fibrotic phase in all lung lobes, diffuse pulmonary ossification, and cytomegalovirus-infected cells in the middle lobe of the right lung. We herein discuss the clinical features and pathological findings of COVID-1...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Taisuke Nakagawa Yasuaki Kotetsu Katsumi Takizawa Michihiro Yoshimi Isamu Okamoto Shohei Takata Source Type: research

Sporadic Late-onset Nemaline Myopathy Associated with Sj ögren's Syndrome: A Case Report
We report the case of a 46-year-old female patient who developed a subacute progression of axial and proximal muscle weakness. Laboratory findings revealed mildly elevated serum creatine kinase levels. No monoclonal gammopathy was detected. A muscle biopsy revealed that she had nemaline myopathy. Serological tests and a lip biopsy revealed Sjögren's syndrome (SjS). We diagnosed her as having sporadic late-onset nemaline myopathy without monoclonal gammopathy of undetermined significance associated with SjS. Her symptoms improved after methylprednisolone pulse therapy followed by intravenous immunoglobulin therapy. A good ...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Tsuyoshi Hamaguchi Ichizo Nishino Yasuki Hirano Nobuaki Uchida Michiyo Fujita-Nakata Megumi Nakanishi Tomoyuki Sakai Masato Asahina Source Type: research

Evidence of tosufloxacin deposition in the kidneys of a patient presenting with crystal nephropathy
Intern Med. 2024 Mar 4. doi: 10.2169/internalmedicine.3082-23. Online ahead of print.ABSTRACTTosufloxacin tosilate is classified as a new quinolone antibacterial agent, which has been reported to cause crystal nephropathy. However, the origin of these crystal deposits has not yet been elucidated. We encountered a case of renal failure that progressed slowly owing to crystal-forming interstitial nephritis after long-term exposure to tosufloxacin. Mass spectrometry of the renal specimens revealed that tosufloxacin was deposited in the kidneys. The patient's renal function improved slowly with the withdrawal of tosufloxacin a...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Yuuki Ito Noriko Mori Ken Matsuo Satoshi Tanaka Kiyoshi Mori Nao Kobayashi Hajime Mizuno Kenichiro Todoroki Kojiro Nagai Source Type: research

Vibrio fluvialis Bacteremia in an Immunocompetent Patient with Acute Cholangitis
We report a case of V. fluvialis bacteremia due to cholangitis in an immunocompetent adult who was exposed to seawater regularly as a sushi chef. The increased risk of V. fluvialis entry into the body resulting from frequent consumption of raw fish and regular exposure to seawater, bile outflow impairment caused by transient inflammation of the bile duct, and the presence of multiple bile acid resistance-related genes in V. fluvialis may lead to the development of acute cholangitis and subsequent bacteremia in immunocompetent patients.PMID:38432963 | DOI:10.2169/internalmedicine.3078-23 (Source: Internal Medicine)
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Tomoko Takezawa Naohisa Matsunaga Atsushi Miki Toshihiko Arizumi Atsushi Tanaka Fuyu Ito Shoji Kawachi Source Type: research

A Case of Unresectable Combined Hepatocellular-cholangiocarcinoma Treated with Combination Therapy Consisting of Durvalumab Plus Tremelimumab
Intern Med. 2024 Mar 4. doi: 10.2169/internalmedicine.3071-23. Online ahead of print.ABSTRACTCombined hepatocellular cholangiocarcinoma is a rare and challenging primary liver malignancy that lacks any established standard treatments for unresectable cases. We herein present the first known case of a 49-year-old woman diagnosed with unresectable combined hepatocellular-cholangiocarcinoma, who underwent novel chemotherapy involving durvalumab plus tremelimumab combination therapy. The treatment was temporarily discontinued owing to immune-related adverse events, such as rash, and the patient was subsequently managed with sy...
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Shinji Unome Kenji Imai Takao Miwa Tatsunori Hanai Atsushi Suetsugu Koji Takai Natsuko Suzui Tatsuhiko Miyazaki Masahito Shimizu Source Type: research

Association between an early revascularization strategy and major cardiac events based on left ventricular dyssynchrony in patients at intermediate risk of major cardiac events using the J-ACCESS risk model
Conclusion The combination of the J-ACCESS risk model and the SPBW is thus considered to be an optimal treatment strategy for patients at intermediate risk of MCE, and early revascularization may lead to an improved prognosis in intermediate-risk patients with an abnormal SPBW.PMID:38432965 | DOI:10.2169/internalmedicine.3039-23 (Source: Internal Medicine)
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Yudai Tanaka Shunichi Yoda Katsunori Fukumoto Takumi Hatta Keiichiro Kuronuma Yasuyuki Suzuki Naoya Matsumoto Yasuo Okumura Source Type: research

A Reduction in the Number of Hospitalized Cases of Acute Meningitis during the COVID-19 Pandemic in Japan
Conclusion The number of hospitalized cases of acute meningitis clearly decreased during the COVID-19 pandemic, especially for viral and bacterial meningitis in younger populations aged <50 years.PMID:38432966 | DOI:10.2169/internalmedicine.3022-23 (Source: Internal Medicine)
Source: Internal Medicine - March 3, 2024 Category: Internal Medicine Authors: Tetsuya Akaishi Kunio Tarasawa Kiyohide Fushimi Chiharu Ota Sumireko Sekiguchi Tetsuji Aoyagi Nobuo Yaegashi Masashi Aoki Kenji Fujimori Source Type: research