Journal of General and Family Medicine最新文献

We present a 23-year-old woman with depression and long COVID in whom a diagnosis of idiopathic ventricular tachycardia (VT) was made. Although the relationship between idiopathic VT and long COVID remains unknown, this is the first report of idiopathic VT detected in a patient with long COVID.

A 78-year-old woman visited the outpatient clinic with a 4-week history of low-grade fever of unknown origin. One week after fever onset, she visited the dental clinic because of upper left toothache and left jaw claudication, and she was scheduled to have a mouthpiece made. No dental caries was observed. Since the cause of fever was not clear, the patient visited our clinic. On presentation, she was alert, and her vital signs were normal. Physical examination revealed a slightly enlarged left temporal artery without pulsation and tenderness (Figure 1A). She did not complain of pain and morning stiffness about the shoulders, neck, hip girdle, and proximal thighs. There were no complications of polymyalgia rheumatica. Her C-reactive protein level was 4.8 mg/dL (reference: 0–0.3 mg/dL), and erythrocyte sedimentation rate was 85 mm/h (reference: 0–10 mm/h). Ultrasonography revealed thickened walls in both the temporal artery frontal branches (Figure 1B; left temporal artery). Giant-cell arteritis (GCA) was considered likely.¹ Left temporal artery biopsy was performed, which revealed a highly narrowed lumen. Lymphocytes, neutrophil infiltration, and granulation tissue formation were observed in the blood vessel wall, and multinucleated giant cells were also observed. The biopsy results confirmed the diagnosis, and 40 mg prednisolone (1 mg/kg body weight) was orally administered daily.¹ Symptoms resolved within a week.

Giant-cell arteritis is a vasculitis that often affects medium- and large-sized arteries and shows a variety of clinical manifestations (Table 1). Headache is present in over 80% of cases in a report.² Our patient complained of toothache, but she had no problems with her teeth. Giant-cell arteritis can also cause serious risks, such as blindness,³ and requires prompt diagnosis. Giant-cell arteritis occurs less often in Japan, Korea, and other Asian countries than in Western countries; the reason for this discrepancy remains unclear. In Asian countries, GCA is one of the cause of fever of unknown origin. In primary care settings, the possibility of GCA should be considered in elderly Asian patients suffering from fever and pain in the temple; ultrasonography should be performed to detect wall thickening in the temporal artery frontal branches. This easy method is very useful for the diagnosis of this emergent disease.

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No potential conflict of interest relevant to this article was reported.

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We obtained informed consent from the patient for this case report.

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Eppikajutsuto (EPTJ) is used to reduce redundant body fluids and suppress inflammation. We observed that EPTJ shortened the duration of treatment in an elderly patient with burn injuries. A 96-year-old man suffered superficial partial-thickness burns on the dorsum of his right hand and left knee. The injuries showed early improvement with the use of EPTJ. This suggests that EPTJ could contribute to shortening the duration of healing for superficial partial-thickness burns in elderly patients who may experience slow wound healing and have a high mortality rate. Eppikajutsuto needs to be considered as a treatment for burns in primary care.

A 38-year-old pathologist developed multiple evanescent white dot syndrome (MEWDS). He documented his visual impairment in detail utilizing a light microscope for pathological diagnosis. Notably, the subjective defects illustrated by the patient were in good spatiotemporal agreement with diagnostic outcomes. The present report enhances the understanding of visual impairment associated with MEWDS through a comparative analysis of subjective experiences and objective clinical findings.