Internal Medicine最新文献

Post-transplant lymphoproliferative disorder (PTLD) affects from 0.8-2.5% of kidney transplant patients, with peaks in incidence within 1 year and 10-14 years post-transplant. Very late-onset PTLD (VL-PTLD) can occur over 10 years post-transplant, reportedly up to 30 years, but its characteristics remain unclear. A 61-year-old man developed PTLD 45 years after kidney transplant, presenting with fever and shortness of breath. Computed tomography revealed lung and liver masses and biopsy-confirmed stage IVB monomorphic PTLD. Despite obtaining an initial improvement, the patient died on day 66. VL-PTLD may differ from early- or late-onset PTLD, thus necessitating further research on both the associated risks and management.

The causes of hypercalcemia vary. There are high-calcium-containing preparations in Chinese herbal medicine, which may contribute to drug-induced hypercalcemia. We encountered a case of hypercalcemia following the simultaneous administration of an active vitamin D3 preparation and several Chinese herbal medicines. The patient had been treated at several medical institutions, with one institution administering eldecalcitol and another institution administering Keishikaryukotsuboreito, Borei powder, and Goreisan. The patient presented with drug-induced hypercalcemia due to an unexpected synergistic effect. Confirmation of prescriptions for patients with multiple medical visits and recognition of the components and side effects of Chinese herbal medicines is thus considered to be extremely important.

We present the case of a patient with lung cancer who developed brachial plexitis following treatment with immunochemotherapy, which included atezolizumab and palliative radiotherapy for a metastatic cervical spine tumor. This case highlights the importance of considering immune-related adverse events (irAEs) when initiating immune checkpoint inhibitor therapy, in addition to other recognized causes such as radiation, tumor compression and invasion, and paraneoplastic syndromes. While brachial plexitis has been reported as an irAE associated with programmed cell death 1 (PD-1) antibodies, this is the first report associated with the administration of programmed cell death ligand 1 (PD-L1) antibodies.

A 45-year-old woman with Basedow's disease, who was later diagnosed with slowly progressive type 1 diabetes mellitus (SPIDDM), developed iron deficiency anemia. Despite normal vitamin B12 levels, the endoscopic findings of the residual fundic glands and severe atrophy predominantly in the body of the stomach and fundus, along with serological tests, confirmed a diagnosis of autoimmune gastritis (AIG). This case highlights the significance of an early AIG diagnosis in non-elderly patients with type 1 diabetes mellitus (T1DM) and autoimmune thyroid disease (AITD) because of the risk of developing pernicious anemia and gastric neoplasms. Key words:slowly progressive type 1 diabetes mellitus (SPIDDM); latent autoimmune diabetes in adults (LADA); Basedow's (Graves) disease; autoimmune gastritis (AIG); thyrogastric disease; autoimmune polyglandular syndrome (APS) type 3.

Esophageal cell tumors are rare. Esophagogastroduodenoscopy performed on a 48-year-old woman revealed an elevated esophageal lesion and the presence of long-segment Barrett's esophagus. Endoscopic ultrasonography showed a 15 mm homogeneous hypoechoic tumor extending from the lamina propria mucosa to the submucosa. Pathological examination of the biopsy tissue revealed a sheet-like cluster of histiocytoid cells with an abundant eosinophilic granular cytoplasm. Immunohistochemical examination revealed S-100(+) and CD68(+), thus suggesting the diagnosis of a granular cell tumor. The tumor was resected by endoscopic submucosal dissection. Pathologically, the background mucosa was Barrett's mucosa. This is the first reported case of an esophageal granular cell tumor in long-segment Barrett's esophagus.

A 74-year-old Japanese man was admitted to our hospital for catheter ablation of paroxysmal atrial fibrillation. Transthoracic echocardiography revealed basal interventricular septal hypertrophy without apical sparing. Cardiac magnetic resonance imaging revealed late gadolinium enhancement in the hypertrophic lesions. The Kumamoto criteria was one point, and the patient had no carpal tunnel syndrome. However, technetium-99m pyrophosphate scintigraphy revealed an accumulation in the basal region of the left ventricle. A skin biopsy revealed transthyretin (TTR) amyloid deposition. A TTR gene examination revealed no variants. This case suggests that amyloid deposition in TTR may occur in the basal area of the interventricular septum.

Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody-positive dermatomyositis is associated with rapidly progressive interstitial lung disease (RP-ILD). We encountered a man in his 40s who presented with a history of a fever and dry cough. Based on laboratory tests and computed tomography scans of his chest, he was diagnosed with anti-MDA-5 antibody-positive dermatomyositis with RP-ILD refractory to antimicrobial agents. Although the patient was treated with glucocorticoids, calcineurin inhibitors, intravenous cyclophosphamide, and plasma exchange, ventilatory management was still required. The patient survived additional therapy with tofacitinib; however, he developed a catheter-related pulmonary embolism as a complication.