Internal Medicine最新文献

A 45-year-old woman with Mycobacterium abscessus pulmonary disease was treated with multidrug therapy, including clofazimine, at Fukujuji Hospital. Six months after clofazimine initiation, the treatment was discontinued at the patient's request due to hyperpigmentation. Pigmentation is a critical side effect of clofazimine. We quantified clofazimine-induced pigmentation on her face using NeoVoirI^® and measured the serum concentration of clofazimine during the administration period. The patient's skin tone score closely correlated with the serum concentration of clofazimine. However, 14 months after the discontinuation of clofazimine, clofazimine-induced pigmentation was still not completely resolved.

Objectives Thymus and activation-regulated chemokine (TARC) can predict severe disease in patients with coronavirus disease 2019 (COVID-19). However, no reports have addressed the predictive value of TARC with the widespread use of vaccines and medications for COVID-19 during the Omicron variant period of the pandemic. Methods This single-center prospective cohort study enrolled COVID-19 patients admitted to our institution between December 1, 2021, and August 15, 2022. Patients with respiratory failure due to diseases other than COVID-19 were also excluded. We measured the serum TARC levels of patients at admission. Results We enrolled 157 patients, with 89 in the severe group and 68 in the non-severe group. The severe group was more likely than the non-severe group to include older patients, those with no or one dose of vaccine, and those with interstitial lung disease (ILD). The cutoff level of TARC derived from a receiver operator characteristic curve analysis to predict severe disease was 174.0 pg/mL. The sensitivity, specificity, positive predictive value, and negative predictive value were 72.1%, 69.7%, 64.5%, and 76.5%, respectively. The area under the curve was 0.722 (95% confidence interval: 0.635-0.809). A multivariate analysis showed that 2 vaccination doses were associated with non-severe disease, and TARC ≤174 pg/mL was associated with severe disease. Conclusion TARC was a predictive factor for severe disease, but its cutoff value was higher and its predictive accuracy lower than those in previous reports. We surmised that during the Omicron variant period of the pandemic, the widespread use of vaccines and medications for COVID-19 decreased the predictive accuracy of TARC.

Objective To evaluate the influence of sample collection time during esophagogastroduodenoscopy (EGD) on the accuracy of a newly approved point-of-care test (POCT)-based polymerase chain reaction kit for detecting Helicobacter pylori and clarithromycin susceptibility in gastric wash fluid. Methods Intragastric fluid was collected at three time points: Collection Time 1 (start of EGD), Collection Time 2 (during EGD), and Collection Time 3 (after indigo carmine spraying). POCT-based quantitative PCR (qPCR) targeting 23S rRNA domain V (2142/2143) was used to quantify H. pylori DNA in the collected fluid at all three time points and compared with qPCR targeting 16S rRNA. Patients Fifty patients with suspected H. pylori infection were consecutively enrolled in this study over a three-month period and underwent EGD. Results In 9 out of 50 EGD cases that were H. pylori-positive, no significant differences in H. pylori DNA content, quantified using POCT-based qPCR targeting 23S rRNA, were observed between the three collection times: 1 vs. 2, p=0.81; 2 vs. 3, p=0.59; 1 vs. 3. Collection Time 2 had the strongest inverse correlation with the urea breath test (r=-0.80, p=0.01) and was the only time-point at which POCT-based qPCR could detect H. pylori in case 15. Conclusion This study suggests that the optimal collection timing for the H. pylori detection POCT kit (within 60 min) using intragastric fluid (with no biopsy) may be during EGD (Collection Time 2). However, our study had a limited sample size, so the findings must be verified through large-scale, multicenter collaboration studies.

Nodal Epstein-Barr virus-positive T/NK-cell lymphoma (EB-nTNKL) is an extremely rare disease characterized by an aggressive clinical course and poor prognosis, for which treatment strategies have not yet been established. We herein report a young man with EB-nTNKL. Although initial chemotherapies, including L-asparaginase, failed to produce a good response, subsequent myeloablative allogeneic hematopoietic stem cell transplantation (alloHSCT) resulted in favorable disease control and a long-term disease-free survival. The prompt performance of alloHSCT using an available donor source at that time, regardless of whether or not the initial chemotherapy was effective, could be critical to saving patients with this otherwise fatal disease.

Pseudomonas otitidis bacteremia is rare. We herein report a case of bacteremia caused by P. otitidis in a patient with advanced appendiceal cancer. A 79-year-old Japanese man developed infection when he was admitted to our hospital for palliative care. Blood culture revealed the presence of Pseudomonas spp. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify the organism accurately. The patient was treated with a two-week course of piperacillin/tazobactam, and the bacteremia was successfully controlled. Clinicians should be aware that P. otitidis can cause bacteremia, particularly in immunocompromised patients.

Up to one-third of lymphoma cases involve the nervous system. Miller-Fisher syndrome (MFS) associated with lymphoma is extremely rare. We herein report a case of primary central nervous system lymphoma initially mimicking MFS in a 70-year-old man who presented with subacute unsteady gait and diplopia. A neurological examination revealed unilateral ophthalmoplegia, ataxia, and areflexia. The patient tested positive for anti-GQ1b antibodies, so MFS was initially suspected. However, the progression extended over one month. Subsequently, disturbance of consciousness was observed. Cranial magnetic resonance imaging revealed lesions in the periventricular fourth ventricle, and a brain biopsy indicated diffuse large B-cell lymphoma.

Background Nursing home residents with a high risk of multidrug-resistant organism infection pose a complex challenge to broad-spectrum empirical antimicrobial therapy, particularly those infected with extended-spectrum β-lactamase-producing Enterobacteriaceae. The present study compared the efficacy of piperacillin-tazobactam and carbapenems as empirical antimicrobial treatments for patients with sepsis from nursing homes. Patients and Methods Using a nationwide inpatient database in Japan, we identified patients diagnosed with sepsis within two days of admission from nursing homes between 2018 and 2021. We selected patients who received intravenous piperacillin-tazobactam or carbapenems within two days of admission. In-hospital mortality was compared between the piperacillin-tazobactam and carbapenem groups using inverse probability of treatment weighting. Result We identified 8,025 eligible patients. Of these, 3,391 (42%) received piperacillin-tazobactam, and 4,634 (58%) received carbapenems within 2 days of admission. The inverse probability of treatment weighting analysis showed no significant difference in in-hospital mortality between the groups (31.6% in the piperacillin-tazobactam group and 32.8% in the carbapenem group; risk difference, 1.2%; 95% confidence interval, -3.2% to 0.9%). Conclusions Carbapenems and piperacillin-tazobactam as empirical antimicrobial therapy in patients with sepsis from nursing homes were associated with comparable in-hospital mortality rates. These findings highlight the importance of making decisions regarding broad-spectrum empirical antimicrobial therapy.

There are high expectations regarding heart regeneration for refractory heart failure (HF). Transplantation of human pluripotent stem cell (hPSC)-derived cardiomyocytes (CMs) is expected to replace CMs lost due to HF, and various studies have been conducted to apply this therapy clinically. Though issues such as arrhythmias and immune rejection remain, the mass production of purified hPSC-derived CMs, their efficient transplantation, and methods to improve their engraftment pushed up the transplantation of hPSC-derived CMs to the clinical stage. In contrast, a direct cardiac reprogramming method has been developed, where cardiac fibroblasts are directly converted into CM-like cells without undergoing PSCs by overexpressing reprogramming factors. Although many challenges still remain in the clinical application of direct cardiac reprogramming, this can be a novel treatment which overcomes issues of transplantation of hPSC-derived CMs.

Amiodarone is an antiarrhythmic drug that is widely used for atrial fibrillation and other refractory arrhythmias. Although beneficial, its long-term administration is associated with adverse effects on various organs. One patient presented with amiodarone-induced liver injury, which led to liver failure. Computed tomography revealed a gradual increase in hepatic density over a long period following the initiation of amiodarone. Despite the discontinuation of the drug, the patient developed hepatic encephalopathy and subsequently died. This outcome highlights the drug's extended half-life, which caused persistent end-organ damage even after its withdrawal. Drug titration to the lowest effective dose and careful monitoring of annual liver function tests are important.