Internal Medicine最新文献

A 72-year-old Japanese woman presented to our hospital with progressive hearing loss and dysphagia. Blood tests revealed elevated C-reactive protein and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). Contrast-enhanced magnetic resonance imaging of the head showed hypertrophic pachymeningitis of the left middle cranial fossa with compression of the cranial nerves, including the trigeminal (V), facial (VII), glossopharyngeal (IX), and vagal (X) nerves, resulting in cranial nerve palsy. She was diagnosed with Garcin syndrome associated with otitis media with ANCA-associated vasculitis (OMAAV) and treated with high-dose glucocorticoid therapy followed by intravenous cyclophosphamide and rituximab. Therefore, OMAAV should be considered in the differential diagnosis of refractory otitis media with unilateral cranial nerve involvement.

We herein report a case of IgG4-related autoimmune hepatitis (AIH) in a patient with a history of type 1 autoimmune pancreatitis. A 56-year-old man presented with fatigue and jaundice at our hospital. A blood biochemistry analysis revealed significant liver dysfunction, positive results for antinuclear antibodies, and high serum IgG4 levels. A histopathological examination revealed interface hepatitis marked by IgG4-positive plasma cell infiltration in the portal area, leading to liver cell depletion and necrosis. Based on the diagnosis of IgG4-related AIH, prednisolone treatment was initiated, which led to the rapid resolution of liver dysfunction and jaundice. An accurate diagnosis of IgG4-related AIH is crucial to prevent secondary manifestations.

An anomalous systemic arterial supply to the basal segment of the lung (ABLL) is a rare congenital vascular anomaly. We herein report a case of ABLL in a 26-year-old pregnant woman with hemoptysis. Contrast-enhanced chest computed tomography (CT) revealed an abnormal vessel branching directly from the descending aorta and circulating to the left lower lobe while showing a normal bronchial anatomy. The patient was therefore diagnosed with ABLL. Maternal safety was a priority, and the patient underwent thoracoscopic left lower lobectomy at 19 weeks' gestation. We concluded that the hemoptysis had been caused by an increased circulating plasma volume during pregnancy.

Thymic carcinoma (TC) is a rare malignancy with limited treatment options. Lenvatinib, a novel multitarget kinase inhibitor, has recently been used to treat advanced or metastatic thymic carcinoma that cannot be surgically removed. To date, there have been no reports of lenvatinib being used as induction chemotherapy prior to radiotherapy in cases of localized, unresectable thymic carcinoma. We herein report an 85-year-old Japanese woman with localized unresectable thymic carcinoma who was treated with lenvatinib as induction chemotherapy before undergoing radiotherapy. Our findings suggest that lenvatinib may be a viable option for induction chemotherapy in similar clinical scenarios.

Objective To investigate the clinical course of ulcerative colitis (UC) during pregnancy, focusing on their mutual influence. Methods We retrospectively reviewed the medical records of 58 patients with UC who had 73 pregnancies and 3 patients with newly developed UC during pregnancy. We recorded the rate of relapse of UC; the relationship between medication use and UC relapse during pregnancy; treatment for relapse; and the incidence of pregnancy, childbirth, and newborn abnormalities. Results UC was in remission at conception in 78% of the patients. The relapse rate during pregnancy was 27.3%, with most relapses occurring during the second and third trimesters. The relapse rate in patients in whom any UC drug had been discontinued was 50%, a rate significantly higher than the 20.5% of patients for whom all medications were continued (p = 0.016). Thiopurine was discontinued in 60% (6/10) of patients at conception, and the disease relapsed in 50% (3/6) of the patients. Most relapses were successfully treated with 5-aminosalicylic acid or corticosteroids. UC relapse occurred in 26.1% (18/70) of the patients after delivery, mostly within 2 months. Pregnancy, delivery, or neonatal abnormalities occurred in 23.3% (17/73) of patients. In two of the three patients with new-onset UC, UC was severe and required intensive care; however, the pregnancies continued uneventfully. Conclusion Although the progress of pregnancies complicated by UC was mostly uneventful, discontinuing medication carries the risk of UC relapse. Thus, appropriate management of medical treatments for UC during pregnancy is important.

Hepatic undifferentiated pleomorphic sarcoma (UPS) is a rare malignant mesenchymal tumor with unclear cancer-related genetic mutations. In a 60-year-old Japanese woman with a rapidly growing, inoperable hepatic UPS, a genetic mutation analysis revealed KRAS and TP53 mutations. Despite initiating hepatic arterial infusion chemotherapy, the tumor continued to grow, and the patient's poor performance status complicated the transition to a phase I KRAS mutation drug trial, leading to death eight months after the symptom onset. A timely genetic mutation analysis may facilitate effective treatment transitions in hepatic UPS despite the lack of established treatments.

A 75-year-old man presented with cognitive decline, headaches, and ataxic gait. Magnetic resonance imaging (MRI) revealed acute infarcts in multiple brain regions, and vessel wall MRI (VW-MRI) demonstrated concentric arterial wall thickening and enhancement in some intracranial arteries, initially suggesting primary central nervous system vasculitis (PCNSV). Despite immunosuppressive therapy, the patient developed further infarction. A skin biopsy revealed intravascular large B-cell lymphoma (IVLBCL), and autopsy revealed tumor cells in the arterial walls corresponding to the VW-MRI findings. This case highlights the risk of a misdiagnosis of PCNSV based solely on imaging findings and underscores the need for histological confirmation.

Objective Seasonal influenza affects healthcare demand. However, the efficacy of anti-influenza drugs, particularly among young patients at a low risk of complications, has rarely been evaluated. Therefore, we evaluated the efficacy of anti-influenza drugs against seasonal influenza in healthy young and middle-aged adults. Methods A systematic review and network meta-analysis were conducted. The Cochrane Central Register of Controlled Trials and Medical Literature Analysis and Retrieval System Online were searched for original articles reporting double-blind, randomized controlled trials published up to the end of July 2023. Clinical trials that tested the efficacy of anti-influenza drugs in young and middle-aged patients with seasonal influenza were also included. The primary outcome was time to fever alleviation. The efficacy and adverse effects of these treatments were estimated using a Bayesian hierarchical random-effects model and a Markov chain Monte Carlo simulation. Results In total, 24 articles with 34 treatments and 8,949 individuals were included. Oseltamivir (300 mg/day for 5 days) showed the largest reduction in time to fever alleviation by -19.1 [95% confidence interval (CI): -29.4, -10.7] h compared with a placebo. Baloxavir marboxil (40 mg/day) reduced the time to symptom alleviation by -28.2 (95% CI: -42.7, -13.7) h, and peramivir (300 mg/day) administered by intravenous infusion for 1 day reduced the time to resumption of usual activities by -43.5 (95% CI: -72.8, -14.2) h. Conclusion Several pharmaceutical treatments were able to reduce the recovery time for fever and symptom alleviation and resumption of usual activities in young and middle-aged adults with seasonal influenza without increasing the risk of complications.