Internal Medicine最新文献

Objective The HELT-E₂S₂ score is a novel risk assessment tool for ischemic stroke in patients with atrial fibrillation. We explored the prognostic impact of the HELT-E₂S₂ score on cardiovascular outcomes in patients with heart failure (HF), beyond its original scope. Methods We enrolled 997 patients hospitalized for acute decompensated HF (ADHF) (median age, 81 years; 44.3% female) from the Clue of Risk Stratification in the Elderly Patients with Heart Failure (CURE-HF) registry. We evaluated the relationship between the HELT-E₂S₂ score and all-cause death over a median follow-up of 2.7 years. Results The patients were categorized into four quartiles based on the HELT-E₂S₂ score: score 0 or 1 (group 1, n=234), score 2 (group 2, n=244), score 3 (group 3, n=255), and score ≥4 (group 4, n=264). Atrial fibrillation was present in 592 (59.4%) patients (paroxysmal, 15.0%; persistent, 44.3%). All-cause death was observed in 384 patients (14.7 per 100 patient-years). A Kaplan-Meier analysis showed that the higher score group was associated with an increased risk of all-cause death (log-rank p<0.001). After multivariable adjustment, the higher score groups had an elevated risk of all-cause death compared to group 1 [group 2; hazard ratio (HR): 1.56; 95% confidence interval (CI): 1.03-2.37; p=0.037, group 3; HR: 2.74; 95% CI: 1.85-4.07; p<0.001, group 4; HR: 3.32; 95% CI: 2.34-4.94; p<0.001]. Conclusion Higher HELT-E₂S₂ scores were associated with a higher risk of all-cause death in patients with ADHF.

Renal salt-wasting syndrome (RSWS) induced by cisplatin causes hyponatremia and dehydration. A 75-year-old woman with thymoma underwent cisplatin chemotherapy. She presented with hypovolemic shock, seizures, and impaired consciousness (Japan Coma Scale II-30) with a decreased serum sodium level of 116 mmol/L on day 9. In addition, the patient had hypokalemia, hypomagnesemia, hypocalcemia, and hypophosphatemia. We herein describe the first reported case of RSWS complicated by hypovolemic shock. This is the second reported case with multiple electrolyte abnormalities. Thus, we should recognize that severe RSWS with hypovolemic shock and multiple electrolyte abnormalities can occur in patients undergoing cisplatin treatment.

Mass-forming pancreatitis and lipodystrophy are rare immune-related adverse events (irAEs). A 71-year-old woman received 12 cycles of pembrolizumab for recurrent uterine endometrial cancer. The patient presented with mass-forming pancreatitis and lipodystrophy. A needle biopsy of the pancreatic tissue revealed lymphocytic infiltration and fibrosis. Simultaneously, the patient exhibited lipodystrophy. The recurrent tumors disappeared, so the patient discontinued immune checkpoint inhibitor treatment and was administered oral prednisolone. In addition, the pancreatic mass disappeared; however, the fat loss did not improve. Considering pancreatitis and lipodystrophy to be irAEs, prompt management is important.

Doublet chemotherapy with encorafenib and cetuximab has demonstrated a survival benefit for BRAF V600E mutation-positive advanced colorectal cancer, which generally has a poor prognosis, as shown in the BEACON CRC trial. We encountered a case of rectal cancer with this mutation, complicated by grade 3 pancreatitis, one month after starting this doublet therapy. Despite aggressive treatment efforts, the pancreatitis led to duodenal ulcer perforation and a fatal intra-abdominal abscess. This case highlights pancreatitis as a rare, but severe, side effect of combination chemotherapy.

Screening for colorectal cancer (CRC) in individuals with Li-Fraumeni syndrome (LFS) typically recommends initiating colonoscopy at 25 years old. We herein report a case of LFS with dual CRC and liver metastasis diagnosed before the recommended screening age. A 17-year-old boy with a history of sarcoma underwent colonoscopy, revealing 2 advanced CRCs: neuroendocrine carcinoma in the descending colon and adenocarcinoma in the rectum, each displaying distinct histological features. In addition, a TP53 missense mutation (p.His193Arg) was detected by a detailed genetic examination. LFS is associated with a heightened risk of rapid progression to invasive carcinomas due to TP53 variants. Therefore, earlier initiation of colonoscopy screening may be necessary for patients with LFS.

Amyloidosis is a rare cause of common bile duct (CBD) stricture that often presents with nonspecific symptoms. We herein report the case of a 61-year-old woman with CBD stricture caused by amyloidosis diagnosed through cholangioscopy and confirmed by a biopsy, with subsequent findings identifying it as AA-type amyloidosis. This condition poses diagnostic challenges owing to its rarity and non-specific manifestations. When common causes are excluded, amyloidosis should be considered in the differential diagnosis of CBD stricture. Advanced imaging and cholangioscopy with targeted biopsies are essential for making an accurate diagnosis. Documenting such cases and further research are vital to improve the understanding and management of amyloidosis-related biliary stricture.

The coexistence of sporadic Creutzfeldt-Jakob disease (sCJD) and intracerebral hemorrhaging (ICH) has rarely been reported, and the relationship between these conditions remains unclear. This report presents the case of a 49-year-old woman without any hemorrhagic risk factors who developed subcortical hemorrhaging in the early stages of sCJD. This case suggests that sCJD is associated with ICH, particularly in cases of subcortical hemorrhaging.

Patients with ulcerative colitis (UC) treated with tumor necrosis factor (TNF) inhibitors can sometimes develop articular manifestations, but rarely rheumatoid arthritis (RA). We herein report the case of a 70-year-old woman who developed seropositive RA during adalimumab therapy for UC diagnosed 11 years previously. A literature review, including 30 patients with both UC and RA, identified three patients (10%) who developed RA after their diagnosis of UC. Notably, the present study is the only case in which RA developed during TNF inhibitor therapy for UC. This result demonstrates that arthritis in patients with UC can be caused by RA despite TNF inhibitor administration.

A 51-year-old man was diagnosed with gastric mucosa-associated lymphoid tissue (MALT) lymphoma after presenting with fold convergence on upper gastrointestinal radiography and nausea. He tested positive for Helicobacter pylori, and eradication therapy decreased the size of the gastric MALT lymphoma. Eighteen years later, whitish subepithelial lesions were discovered in the middle thoracic esophagus which were diagnosed to be esophageal MALT lymphoma. Six months later, the left tonsillar swelling was identified as diffuse large B-cell lymphoma (DLBCL). Complete remission was achieved after treatment with rituximab and chemotherapy. To our knowledge, this is the first reported case of metachronous gastric and esophageal MALT lymphoma with tonsillar DLBCL.