Internal Medicine最新文献

A 70-year-old male presented with infiltration, ground-glass opacities, and bronchiectasis on chest radiography, which indicated interstitial pneumonia. Clinical findings (thickening of the skin on the fingers, slight nail fold petechiae, and skin lesions resembling mechanic's hands) suggested early systemic sclerosis and/or polymyositis/dermatomyositis. However, anti-Scl-70, anti-centromere, and anti-aminoacyl tRNA synthetase (anti-ARS) antibodies were negative. Exertion-related oxygenation gradually worsened. Since the multiplex protein array confirmed anti-Zo and anti-Ro52/SSA1 antibody positivity, anti-ARS antibody syndrome was diagnosed and treated with steroids and immunosuppressive drugs. The patient was concurrently diagnosed with advanced colorectal cancer. Treating interstitial pneumonia first allowed for the subsequent treatment of colorectal cancer without worsening the condition.

Objective Despite the recent development of various novel therapeutic approaches for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), optimal management of patients with R/R DLBCL who are elderly and/or unfit has not yet been established. Methods We retrospectively analyzed the efficacy and safety of the R-mEPOCH regimen comprising rituximab, etoposide, vincristine, doxorubicin, carboplatin, and prednisolone in transplant-ineligible patients with R/R DLBCL. Results In total, 22 patients were included in this study. The median patient age was 75 years old. The median number of prior lines of therapy was one (range, 1-5). The overall response rate was 68%, with 45% achieving complete response (CR) or unconfirmed CR and 23% achieving partial response. With a median follow-up of 27.8 months, the median progression-free survival and overall survival (OS) were 17.1 and 27.4 months, respectively. The 2- and 5-year OS rates were 50% and 28%, respectively. The most common grade ≥3 adverse events were neutropenia [n=18 (82%)], febrile neutropenia [n=16 (73%)], anemia [n=12 (55%)], and thrombocytopenia [n=8 (36%)]. The median total lifetime cumulative dose of anthracyclines was 281 mg/m² (range, 69-536 mg/m²) in doxorubicin equivalents. One case of grade 1 bradycardia occurred, leading to the discontinuation of R-mEPOCH. No other cardiac adverse events of grade ≥3 and/or discontinuation of treatment were observed. Conclusion Our study suggests that the R-mEPOCH regimen may be an effective and tolerable salvage regimen for transplant-ineligible R/R DLBCL patients.

A 66-year-old male ex-smoker presented with fatigue and non-productive cough, as well as a 2-year history of ground-glass opacities. Deterioration on chest radiography and increased Krebs von den Lungen-6 levels coincided with the progression of diffuse ground-glass opacities on high-resolution computed tomography. Surgical lung biopsy revealed features consistent with desquamative interstitial pneumonia. Concurrent skin hardening and presence of anti-Scl-70 antibodies supported the diagnosis of systemic sclerosis. Treatment with oral corticosteroids proved to be effective, leading to radiographic improvement. The subsequent administration of cyclophosphamide and mycophenolate mofetil stabilized disease progression.

We herein report a case of hepatitis B virus (HBV) reactivation in a female patient in her 70s with isolated anti-hepatitis B core (IAHBc) antibodies [HB surface antigen (HBsAg)-negative, HB surface antibody (HBsAb)-negative, and HB core antibody (HBcAb)-positive], receiving rituximab-based chemotherapy for follicular lymphoma. Her serum HBV DNA was negative. The patient was treated with rituximab for 21 months, and 33 months after completion of treatment, her HBV DNA level increased to 5.1 Log IU/mL, and the patient developed hepatic failure. Tenofovir alafenamide fumarate treatment was initiated for HBV reactivation, and DNA was not detected 9 months later.

Anifrolumab is a newly developed biological agent for patients with moderate-to-severe systemic lupus erythematosus (SLE). Anifrolumab neutralizes the signaling pathways mediated by type I interferons (IFNs), which are involved in viral clearance and anticancer immunity. Although susceptibility to viral infections has been reported in patients treated with anifrolumab, whether anifrolumab treatment increases the cancer risk in patients with SLE is unknown. We herin report a case of SLE that manifested as aggressive diffuse large B-cell lymphoma (DLBCL) after treatment with anifrolumab. The neutralization of type I IFNs by anifrolumab may promote the development of DLBCL owing to defective anticancer immunity.

A 17-year-old Japanese woman diagnosed with granulomatosis with polyangiitis (GPA) and was treated with immunotherapy suddenly developed an impaired consciousness, left hemiplegia, and conjugate eye deviation to the right. Magnetic resonance imaging showed an acute cerebral infarction in the right striatum and right middle cerebral artery (MCA) occlusion. As her GPA had worsened recently, intravenous methylprednisolone (IVMP) was started. Immediately after IVMP was started, recanalization of the MCA was detected on repeat cerebral angiography. Aspirin and argatroban dissolved the residual thrombi. A combination of IVMP and antithrombotic therapy may be effective for large-vessel occlusions associated with GPA.

Dyskeratosis congenita (DC) is a rare genetic disorder that is caused by abnormal telomere shortening. We herein report the case of a 40-year-old man with classic DC characterized by a mucocutaneous triad complicated by pulmonary fibrosis and myelodysplastic syndrome (MDS). The telomere length of lymphocytes was extremely short (-3.3 standard deviations). We identified the germline mutation c.C91A in DKC1 gene. We also identified a somatic mutation c.C101T in the U2AF1 gene of leukocytes, which may be associated with MDS development. Nintedanib was started, but the patient died of bilateral pneumothorax 6 months after diagnosis.

A 60-year-old man with a history of radiation therapy 28 years ago for a benign disease (an aneurysmal bone cyst) was admitted with dyspnea and dysphagia. Computed tomography showed an 8-cm tumor invading the trachea and esophagus. His condition declined rapidly, and he died on day 27 of hospitalization. Autopsy revealed radiation-induced osteosarcoma. Radiation-induced sarcoma can develop even after radiotherapy for benign diseases, in which case the latency period might be longer. Furthermore, the prognosis depends on the location of the resectable tumor. Therefore, longer-term internal imaging follow-up should be performed after radiotherapy for benign diseases to detect early-stage sarcoma.