Internal Medicine最新文献

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.

Relapsing polychondritis (RP) is a rare, progressive, immune-mediated systemic inflammatory disease of unknown etiology characterized by recurrent inflammation of cartilaginous structures. Approximately 30% of RP cases are associated with autoimmune disease. However, co-occurrence of RP and Crohn's disease (CD) has rarely been reported. We herein report a case of coexisting RP, CD, and pyoderma gangrenosum that was successfully treated with adalimumab in combination with methotrexate. We believe that this case and literature review will facilitate the accurate and prompt diagnosis and treatment of RP combined with CD and various other complications.

Objective The controversy persists regarding whether the serum level of γ-glutamyltransferase (GGT), a marker of liver damage, is associated with hypertension irrespective of alcohol intake. Methods We investigated the relationship between the GGT level and new-onset hypertension during a 10-year follow-up period in Japanese individuals who underwent annual health examinations (n=28,990). After excluding subjects without systolic blood pressure and GGT data and those with hypertension at baseline, a total of 18,618 subjects (men/women: 11,262/7,356, mean age: 44 years) were enrolled. Results During the follow-up period, 2,753 men (24.4%) and 837 women (11.4%) developed hypertension. When the subjects were divided by quartiles of GGT at baseline (Q1-Q4), multivariable Cox proportional hazard model analyses after adjustment for age, sex, systolic blood pressure, body mass index, levels of uric acid, estimated glomerular filtration rate, family history of hypertension, habits of current smoking and alcohol drinking, and diagnosis of diabetes mellitus and dyslipidemia showed that hazard ratios (HRs) for the development of hypertension were significantly higher in the Q2, Q3, and Q4 groups than in the Q1 group. A significant interaction was observed between alcohol drinking habits and the GGT level at baseline for the development of hypertension (p=0.022), and adjusted HRs were similarly significant in alcohol infrequent drinkers (≤5 days/week). However, the GGT level was not significantly associated with the development of hypertension in frequent alcohol drinkers (≥6 days/week). Conclusion A high GGT level is an independent predictor of new-onset hypertension in infrequent alcohol drinkers but not in frequent drinkers.

An association between coronavirus disease 2019 (COVID-19) and concomitant varicella-zoster virus (VZV) reactivation has been proposed. We herein report a case of severe VZV pneumonia in a 73-year-old man who underwent corticosteroid tapering after recovering from COVID-19 and presented with fever, vesicular rashes, and hypoxemia. Chest computed tomography revealed ground-glass opacities (GGOs) and multiple granular shadows. Varicella-zoster virus was detected in the skin and bronchoalveolar lavage fluid. The patient was diagnosed with disseminated VZV reactivation and thereafter successfully recovered with acyclovir treatment. Physicians should consider the possibility of VZV reactivation when GGOs or patchy nodular shadows appear during the course of patients with COVID-19.

Pseudomonas aeruginosa (P. aeruginosa) infection, often diagnosed in immunocompromised patients, is a chronic disease. However, peritonsillar and deep cervical abscesses caused by P. aeruginosa are rare. We herein present the rare case of a 70-year-old male patient with a 5-day history of sore throat and difficult oral intake. The oral cavity was filled with pus and the left palatine tonsil was destroyed. A peritonsillar abscess caused by P. aeruginosa was diagnosed using a pus culture. Emergency incisions were made for tonsil drainage, tracheostomy, and antibacterial drug treatment. Despite infection resolution in 20 days, recovery from swallowing dysfunction required one year of rehabilitation.

Objective Drug-induced interstitial lung disease (DI-ILD) is an adverse effect of the combination of gemcitabine and nab-paclitaxel (GnP) treatment that has raised concerns because the incidence rate of DI-ILD in the real world is higher than that reported in initial clinical trials. The present study assessed the cumulative incidence rate of DI-ILD among patients treated with GnP based on previously published studies and explored any potential bias in the results. Methods We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. The MEDLINE, Scopus, and Cochrane Library databases were searched from 2013 to 2024, using specific keywords. Randomized controlled trials, prospective studies, retrospective studies, and case-control studies that reported the incidence of interstitial lung disease (ILD) among patients treated with GnP were included. Two reviewers independently extracted the data from the included studies. Results Nine studies involving 1,980 patients were included in this analysis. Nine studies were conducted in Japan. The pooled incidence of DI-ILD was 5.9%. A subgroup analysis revealed that smaller studies reported higher incidence rates (≤200 vs. ≥201 cases: 9.4% vs. 4.1%). There was significant heterogeneity and publication bias, suggesting that the variability in incidence rates was due to the study size and potential biases. Conclusion The pooled incidence of ILD among patients treated with GnP was 5.9%. However, the results should be interpreted with caution because of the heterogeneity and publication bias. Further global studies are required to determine the true incidence of ILD.

Objective Bacteria in the airways are reportedly involved in the pathogenesis of chronic obstructive pulmonary disease (COPD) and asthma. In addition, oral bacteria are thought to contribute to respiratory diseases by migrating to the airway. Therefore, we investigated whether or not the number of oral bacteria influences COPD, asthma, and asthma and COPD overlap (ACO). Methods We analyzed the correlations between the number of oral bacteria and clinical variables, such as pulmonary function tests, in patients with COPD, asthma, and ACO whose condition was stable and who visited our center from August 2019 to December 2020. The number of oral bacteria was assessed using the dielectrophoretic impedance measurement method. Results In patients with COPD (n=50), the number of oral bacteria was significantly negatively correlated with the percentage predicted forced expiratory volume in one second (%FEV₁), percentage peak expiratory flow, and percentage forced vital capacity but was not correlated with the COPD Assessment Test. In patients with asthma (n=32), it was significantly negatively correlated with the FEV₁ percentage and with the increase in FEV₁ in the reversibility test but not with fractional exhaled nitric oxide. In patients with ACO (n=39), we found no significant correlation between the number of oral bacteria and any clinical variable. Conclusion The results suggest that the number of oral bacteria is associated with both lung capacity and airflow obstruction in patients with COPD and with airflow obstruction in patients with asthma.

Objective Although chronic kidney disease (CKD) is independently associated with hypertension or hyperglycemia, there is no consensus on the thresholds of obesity, dyslipidemia, or visceral fat accumulation to predict CKD onset and progression. Methods We performed a multivariable logistic regression analysis for the association of the subsequent rate of estimated glomerular filtration rate (eGFR) decline with body mass index (BMI), blood high-density lipoprotein (HDL) cholesterol and triglycerides (TG) levels on 308,174 subjects who underwent health examinations conducted by the Public Health Research Center Foundation from 2015 to 2022. In addition, a Poisson regression analysis was used to evaluate the association between the appearance of urinary protein in participants without baseline urinary protein levels and eGFR decline. Results The median age of the subjects was 46 years old, and the median observation period was approximately 3 years. An eGFR decline rate of ≥5%/year was significantly associated with low HDL-cholesterol levels (<40 mg/dL), independent of the BMI and TG levels. A high baseline BMI (≥25 kg/m²) or waist circumference (≥85 cm for men and ≥90 cm for women), high TG levels (≥150 mg/dL), and low HDL-cholesterol levels were significantly associated with new-onset proteinuria. Furthermore, the higher the baseline BMI, the higher the incidence rate ratio of new-onset proteinuria. Conclusion Independent of hyperglycemia and hypertension, dyslipidemia according to the Japanese metabolic syndrome criteria and an elevated BMI were associated with a high risk of new-onset proteinuria, and a low HDL-cholesterol level was significantly associated with a rapid eGFR decline.