Pub Date : 2022-04-23DOI: 10.2169/internalmedicine.9433-22
Hideki Nakamura, Yosuke Nagasawa, H. Kobayashi, M. Tsukamoto, T. Takayama, N. Kitamura
We herein report a 60-year-old woman who experienced severe flare of rheumatoid arthritis (RA) and Epstein-Barr virus (EBV) positivity following administration of the messenger ribonucleic acid (mRNA)-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Since 40 years old, she had been in long-term remission of anti-citrullinated protein antibody-positive RA. Ten days after SARS-CoV-2 vaccination, she presented with a high fever and polyarthritis, active synovitis on joint ultrasound, a clinical disease activity index of 35, and positivity for anti-early antigen, diffuse type and restricted type (EA DR) IgG and EBV deoxyribonucleic acid (EBV-DNA). Tocilizumab was introduced to treat RA. The RA disease activity disappeared, and anti-EA DR IgG and EBV-DNA became negative.
我们在此报告一位60岁的女性，在注射信使核糖核酸(mRNA)型严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)疫苗后出现严重的类风湿性关节炎(RA)和eb病毒(EBV)阳性。自40岁起，抗瓜氨酸蛋白抗体阳性RA长期缓解。接种SARS-CoV-2 10 d后，患者出现高热、多发性关节炎，关节超声显示活动性滑膜炎，临床疾病活动性指数35，抗早期抗原、弥漫性和限制性(EA DR) IgG和EBV脱氧核糖核酸(EBV- dna)阳性。Tocilizumab被引入治疗RA。RA疾病活动消失，抗ea DR IgG和EBV-DNA呈阴性。
{"title":"Successful Treatment of SARS-CoV-2 Vaccination-related Activation of Rheumatoid Arthritis with Positive Findings for Epstein-Barr Virus","authors":"Hideki Nakamura, Yosuke Nagasawa, H. Kobayashi, M. Tsukamoto, T. Takayama, N. Kitamura","doi":"10.2169/internalmedicine.9433-22","DOIUrl":"https://doi.org/10.2169/internalmedicine.9433-22","url":null,"abstract":"We herein report a 60-year-old woman who experienced severe flare of rheumatoid arthritis (RA) and Epstein-Barr virus (EBV) positivity following administration of the messenger ribonucleic acid (mRNA)-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Since 40 years old, she had been in long-term remission of anti-citrullinated protein antibody-positive RA. Ten days after SARS-CoV-2 vaccination, she presented with a high fever and polyarthritis, active synovitis on joint ultrasound, a clinical disease activity index of 35, and positivity for anti-early antigen, diffuse type and restricted type (EA DR) IgG and EBV deoxyribonucleic acid (EBV-DNA). Tocilizumab was introduced to treat RA. The RA disease activity disappeared, and anti-EA DR IgG and EBV-DNA became negative.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"2073 - 2076"},"PeriodicalIF":0.0,"publicationDate":"2022-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48367405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-23DOI: 10.2169/internalmedicine.9223-21
K. Sugihara, R. Wakiya, H. Shimada, T. Kameda, S. Nakashima, Mikiya Kato, T. Miyagi, M. Mizusaki, R. Mino, Yumi Nomura, M. Inoo, N. Kadowaki, H. Dobashi
Objective To investigate the serum total antibody (immunoglobulin M and immunoglobulin G) titre against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein receptor-binding domain following BNT162b2 messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination in Japanese rheumatic disease patients undergoing immunosuppressive therapy. Methods The serum antibody titre against SARS-CoV-2 spike protein was analysed in 123 outpatients with rheumatic diseases at Kagawa University Hospital and 43 healthy volunteers who had received 2 doses of the BNT162b2 mRNA vaccine with at least 14 days elapsing since the second dose. Results The antibody titre in rheumatic disease patients was significantly lower than that in healthy subjects (p<0.0001). The antibody titres of the 41 patients who received biologics or Janus kinase inhibitors and the 47 patients who received conventional immunosuppressive agents were significantly lower than those of the 35 patients who did not receive immunosuppressive agents (p<0.0001 and p<0.0001, respectively). In addition, the mean antibody titre of the 43 patients on methotrexate was significantly lower than that of the 80 patients not on methotrexate (p=0.0017). Conclusion Immunogenicity to the BNT162b2 mRNA COVID-19 vaccine in rheumatic disease patients was found to be reduced under immunosuppressive treatment. In particular, methotrexate seems to be associated with a decreased antibody response.
{"title":"Immunogenicity against the BNT162b2 mRNA COVID-19 Vaccine in Rheumatic Disease Patients Receiving Immunosuppressive Therapy","authors":"K. Sugihara, R. Wakiya, H. Shimada, T. Kameda, S. Nakashima, Mikiya Kato, T. Miyagi, M. Mizusaki, R. Mino, Yumi Nomura, M. Inoo, N. Kadowaki, H. Dobashi","doi":"10.2169/internalmedicine.9223-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.9223-21","url":null,"abstract":"Objective To investigate the serum total antibody (immunoglobulin M and immunoglobulin G) titre against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein receptor-binding domain following BNT162b2 messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination in Japanese rheumatic disease patients undergoing immunosuppressive therapy. Methods The serum antibody titre against SARS-CoV-2 spike protein was analysed in 123 outpatients with rheumatic diseases at Kagawa University Hospital and 43 healthy volunteers who had received 2 doses of the BNT162b2 mRNA vaccine with at least 14 days elapsing since the second dose. Results The antibody titre in rheumatic disease patients was significantly lower than that in healthy subjects (p<0.0001). The antibody titres of the 41 patients who received biologics or Janus kinase inhibitors and the 47 patients who received conventional immunosuppressive agents were significantly lower than those of the 35 patients who did not receive immunosuppressive agents (p<0.0001 and p<0.0001, respectively). In addition, the mean antibody titre of the 43 patients on methotrexate was significantly lower than that of the 80 patients not on methotrexate (p=0.0017). Conclusion Immunogenicity to the BNT162b2 mRNA COVID-19 vaccine in rheumatic disease patients was found to be reduced under immunosuppressive treatment. In particular, methotrexate seems to be associated with a decreased antibody response.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1953 - 1958"},"PeriodicalIF":0.0,"publicationDate":"2022-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48463783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-16DOI: 10.2169/internalmedicine.9341-22
N. Ishikawa, Kenya Kamimura, Saori Endo, Soichi Ishii, Kazuya Ogawa, Norihiro Sakai, H. Abe, Masayoshi Ko, Osamu Shibata, Youhei Koseki, J. Yokoyama, A. Sakamaki, S. Terai
Regarding the prognosis of cases with advanced-stage hepatocellular carcinoma (HCC), a recent clinical study showed that the immune checkpoint inhibitors atezolizumab plus bevacizumab have superior efficacy to sorafenib. However, only a few reports have focused on their effects on extrahepatic metastases. We herein report a case of HCC in a 59-year-old man with intrahepatic lesions treated successfully by hepatic arterial chemoembolization, radiotherapy, and sorafenib; the extrahepatic lesion in the adrenal gland was treated by atezolizumab plus bevacizumab. The patient showed a tumor-free condition for one year. We have summarized the clinical course and reviewed the literature to underscore the efficacy of atezolizumab plus bevacizumab for treating extrahepatic lesions of HCC.
{"title":"Effects of Atezolizumab and Bevacizumab on Adrenal Gland Metastasis of Hepatocellular Carcinoma: A Case Report and Review of Literature","authors":"N. Ishikawa, Kenya Kamimura, Saori Endo, Soichi Ishii, Kazuya Ogawa, Norihiro Sakai, H. Abe, Masayoshi Ko, Osamu Shibata, Youhei Koseki, J. Yokoyama, A. Sakamaki, S. Terai","doi":"10.2169/internalmedicine.9341-22","DOIUrl":"https://doi.org/10.2169/internalmedicine.9341-22","url":null,"abstract":"Regarding the prognosis of cases with advanced-stage hepatocellular carcinoma (HCC), a recent clinical study showed that the immune checkpoint inhibitors atezolizumab plus bevacizumab have superior efficacy to sorafenib. However, only a few reports have focused on their effects on extrahepatic metastases. We herein report a case of HCC in a 59-year-old man with intrahepatic lesions treated successfully by hepatic arterial chemoembolization, radiotherapy, and sorafenib; the extrahepatic lesion in the adrenal gland was treated by atezolizumab plus bevacizumab. The patient showed a tumor-free condition for one year. We have summarized the clinical course and reviewed the literature to underscore the efficacy of atezolizumab plus bevacizumab for treating extrahepatic lesions of HCC.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"3233 - 3237"},"PeriodicalIF":0.0,"publicationDate":"2022-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47808735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-16DOI: 10.2169/internalmedicine.9544-22
Sho Katayama, Mitsuhito Ota
A previously healthy 60-year-old woman presented with a 3-day history of pruritic eruption on the elbows. She had received the second dose of the BNT162b2 vaccine three days before the onset. An examination showed round edematous erythemas with central concavity symmetrically on the elbows (Picture 1). She had no mucosal lesions. These findings along with the histology (Picture 2) resulted in a diagnosis of erythema multiforme (EM). There were no other clinically identifiable causes, such as herpes simplex virus (HSV) or Mycoplasma pneumoniae infection. The lesions resolved with topical corticosteroid administration after a week. EM is an acute mucocutaneous hypersensitivity reaction that presents as multiform eruptions, including erythema, papules, bullous and erosive lesions, and characteristically, target lesions. The most common trigger (>90% of cases) is infection, especially of HSV or M. pneumoniae (1). Regarding COVID-19, a relationship between EM and COVID-19 infection has been established (2). Therefore, the host immune response to SARS-CoV-2 that induces EM may be replicated by vaccination.
{"title":"Erythema Multiforme after BNT162b2 Vaccination","authors":"Sho Katayama, Mitsuhito Ota","doi":"10.2169/internalmedicine.9544-22","DOIUrl":"https://doi.org/10.2169/internalmedicine.9544-22","url":null,"abstract":"A previously healthy 60-year-old woman presented with a 3-day history of pruritic eruption on the elbows. She had received the second dose of the BNT162b2 vaccine three days before the onset. An examination showed round edematous erythemas with central concavity symmetrically on the elbows (Picture 1). She had no mucosal lesions. These findings along with the histology (Picture 2) resulted in a diagnosis of erythema multiforme (EM). There were no other clinically identifiable causes, such as herpes simplex virus (HSV) or Mycoplasma pneumoniae infection. The lesions resolved with topical corticosteroid administration after a week. EM is an acute mucocutaneous hypersensitivity reaction that presents as multiform eruptions, including erythema, papules, bullous and erosive lesions, and characteristically, target lesions. The most common trigger (>90% of cases) is infection, especially of HSV or M. pneumoniae (1). Regarding COVID-19, a relationship between EM and COVID-19 infection has been established (2). Therefore, the host immune response to SARS-CoV-2 that induces EM may be replicated by vaccination.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1929 - 1929"},"PeriodicalIF":0.0,"publicationDate":"2022-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45519469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-15DOI: 10.2169/internalmedicine.7266-21
Seizaburo Masuda, K. Ota, Rei Okazaki, Ryoko Ishii, K. Cho, Yuki Hiramatsu, Yuko Adachi, Sayo Koseki, Eri Ueda, Isao Minami, Tetsuya Yamada, Takayuki Watanabe
Objective This study analyzed the clinical and laboratory parameters that might influence the clinical outcomes of patients with type 2 diabetes who develop diabetic ketoacidosis (DKA), which has not been well investigated. Methods We reviewed the clinical and laboratory data of 158 patients who were hospitalized due to DKA between January 2006 and June 2019 and compared the data of patients stratified by the type of diabetes. In addition, the patients with type 2 diabetes were subdivided according to age, and their clinical and laboratory findings were evaluated. Results Patients with type 2 diabetes had a longer symptom duration associated with DKA, higher body mass index (BMI), and higher C-peptide levels than those with type 1 diabetes (p＜0.05). Among patients with type 2 diabetes, elderly patients (≥65 years old) had a longer duration of diabetes, higher frequency of DKA onset under diabetes treatment, higher effective osmolarity, lower BMI, and lower urinary C-peptide levels than nonelderly patients (＜65 years old) (p＜0.05). A correlation analysis showed that age was significantly negatively correlated with the index of insulin secretory capacity. Conclusion Patients with DKA and type 2 diabetes had a higher BMI and insulin secretion capacity than those with type 1 diabetes. However, elderly patients with type 2 diabetes, unlike younger patients, were characterized by a lean body, impaired insulin secretion, and more frequent DKA development while undergoing treatment for diabetes.
{"title":"Clinical Characteristics Associated with the Development of Diabetic Ketoacidosis in Patients with Type 2 Diabetes","authors":"Seizaburo Masuda, K. Ota, Rei Okazaki, Ryoko Ishii, K. Cho, Yuki Hiramatsu, Yuko Adachi, Sayo Koseki, Eri Ueda, Isao Minami, Tetsuya Yamada, Takayuki Watanabe","doi":"10.2169/internalmedicine.7266-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.7266-21","url":null,"abstract":"Objective This study analyzed the clinical and laboratory parameters that might influence the clinical outcomes of patients with type 2 diabetes who develop diabetic ketoacidosis (DKA), which has not been well investigated. Methods We reviewed the clinical and laboratory data of 158 patients who were hospitalized due to DKA between January 2006 and June 2019 and compared the data of patients stratified by the type of diabetes. In addition, the patients with type 2 diabetes were subdivided according to age, and their clinical and laboratory findings were evaluated. Results Patients with type 2 diabetes had a longer symptom duration associated with DKA, higher body mass index (BMI), and higher C-peptide levels than those with type 1 diabetes (p＜0.05). Among patients with type 2 diabetes, elderly patients (≥65 years old) had a longer duration of diabetes, higher frequency of DKA onset under diabetes treatment, higher effective osmolarity, lower BMI, and lower urinary C-peptide levels than nonelderly patients (＜65 years old) (p＜0.05). A correlation analysis showed that age was significantly negatively correlated with the index of insulin secretory capacity. Conclusion Patients with DKA and type 2 diabetes had a higher BMI and insulin secretion capacity than those with type 1 diabetes. However, elderly patients with type 2 diabetes, unlike younger patients, were characterized by a lean body, impaired insulin secretion, and more frequent DKA development while undergoing treatment for diabetes.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1125 - 1132"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46862455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-15DOI: 10.2169/internalmedicine.6942-20
K. Hamada, H. Kanzaki, K. Miyahara, M. Nakagawa, H. Mouri, M. Mizuno, Sakuma Takahashi, S. Hori, J. Nasu, Takao Tsuzuki, J. Miyaike, R. Takenaka, K. Yamauchi, Sayo Kobayashi, T. Toyokawa, M. Inoue, M. Nishimura, M. Matsubara, J. Tomoda, Y. Yamasaki, Takehiro Tanaka, Y. Shirakawa, Y. Kawahara, T. Fujiwara, H. Okada
Objective Although Barrett's adenocarcinoma (BA) remains a minor disease in Japan, its incidence has been gradually increasing. We analyzed the characteristics of BA in Japanese populations. Methods We retrospectively reviewed medical records and analyzed the clinicopathological differences between short-segment Barrett's esophagus (SSBE) and long-segment Barrett's esophagus (LSBE), as well as metastasis. Local recurrence and metachronous lesions were analyzed only in patients who underwent endoscopic resection (ER). Patients Consecutive patients who had pathological T1 BAs resected by ER or surgery from January 2003 to December 2017. Results A total of 168 patients were analyzed, including 139 with SSBE and 29 with LSBE. In total, 67% of the SSBE lesions and 32% of the LSBE lesions were located between 0 and 3 o'clock (p=0.0014). No patients who achieved pathological margin-free resection (pR0) and 17% of patients who did not achieve pR0 experienced local recurrence (p=0.0131). None of the patients without lymphovascular involvement, a poorly differentiated component, lesion size of ＞30 mm, and submucosal invasion of ＞500 μm experienced metastasis. The 5-year cumulative incidence rate of metachronous BA after ER was 0% in patients with SSBE and 40% in patients with LSBE (p=0.0005). Conclusion Superficial BA was likely to be detected at the right anterior wall of SSBE in the Japanese population. The risk for metachronous BA after ER was high in Japanese patients with LSBE, as in Western patients.
{"title":"Clinicopathological Characteristics of Superficial Barrett's Adenocarcinoma in a Japanese Population: A Retrospective, Multicenter Study","authors":"K. Hamada, H. Kanzaki, K. Miyahara, M. Nakagawa, H. Mouri, M. Mizuno, Sakuma Takahashi, S. Hori, J. Nasu, Takao Tsuzuki, J. Miyaike, R. Takenaka, K. Yamauchi, Sayo Kobayashi, T. Toyokawa, M. Inoue, M. Nishimura, M. Matsubara, J. Tomoda, Y. Yamasaki, Takehiro Tanaka, Y. Shirakawa, Y. Kawahara, T. Fujiwara, H. Okada","doi":"10.2169/internalmedicine.6942-20","DOIUrl":"https://doi.org/10.2169/internalmedicine.6942-20","url":null,"abstract":"Objective Although Barrett's adenocarcinoma (BA) remains a minor disease in Japan, its incidence has been gradually increasing. We analyzed the characteristics of BA in Japanese populations. Methods We retrospectively reviewed medical records and analyzed the clinicopathological differences between short-segment Barrett's esophagus (SSBE) and long-segment Barrett's esophagus (LSBE), as well as metastasis. Local recurrence and metachronous lesions were analyzed only in patients who underwent endoscopic resection (ER). Patients Consecutive patients who had pathological T1 BAs resected by ER or surgery from January 2003 to December 2017. Results A total of 168 patients were analyzed, including 139 with SSBE and 29 with LSBE. In total, 67% of the SSBE lesions and 32% of the LSBE lesions were located between 0 and 3 o'clock (p=0.0014). No patients who achieved pathological margin-free resection (pR0) and 17% of patients who did not achieve pR0 experienced local recurrence (p=0.0131). None of the patients without lymphovascular involvement, a poorly differentiated component, lesion size of ＞30 mm, and submucosal invasion of ＞500 μm experienced metastasis. The 5-year cumulative incidence rate of metachronous BA after ER was 0% in patients with SSBE and 40% in patients with LSBE (p=0.0005). Conclusion Superficial BA was likely to be detected at the right anterior wall of SSBE in the Japanese population. The risk for metachronous BA after ER was high in Japanese patients with LSBE, as in Western patients.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1115 - 1123"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48753589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-09DOI: 10.2169/internalmedicine.8541-21
K. Okada, S. Kakeda, M. Tahara
Objective Olfactory dysfunction is an important clinical feature in patients with multiple sclerosis (MS). The incidence and extent of olfactory dysfunction are reportedly higher in secondary progressive (SP) MS than in relapsing and remitting (RR) MS. We investigated the use of olfactory dysfunction for evaluating the disease status of Japanese patients with MS. Methods Olfactory identification was evaluated using the Odor Stick Identification Test for the Japanese (OSIT-J) in patients with RRMS (n=40) and SPMS (n=11) and compared the findings with those of healthy controls (n=40). Patients with RRMS for more than 10 years (L-RRMS, n=10) were included in the RRMS group. The cognitive function was evaluated using the Japanese version of the Wechsler Adult Intelligence Scale, 3rd edition. The third ventricle width (3rd VW) was measured as a marker of central brain atrophy using magnetic resonance imaging. Results SPMS patients had significantly lower OSIT-J scores than RRMS and L-RRMS patients. More SPMS patients had OSIT-J scores below the lower limit of the normal score (LLN) than RRMS patients. The LLN effectively discriminated between RRMS and SPMS (sensitivity 70%, specificity 91.5%, area under the curve 0.933, 95% confidence interval 0.874-1.000). Patients with SPMS had a significantly lower processing speed and larger 3rd VW than those with RRMS or L-RRMS. Conclusion The olfactory dysfunction was worse, along with cognitive impairment and brain atrophy, in SPMS patients than in RRMS patients, independent of disease duration, in our Japanese population. This directly reflected the disease progression and may have been able to distinguish SPMS from RRMS, independent of ethnic and cultural background.
{"title":"Olfactory Dysfunction Reflects Disease Progression in Japanese Patients with Multiple Sclerosis","authors":"K. Okada, S. Kakeda, M. Tahara","doi":"10.2169/internalmedicine.8541-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.8541-21","url":null,"abstract":"Objective Olfactory dysfunction is an important clinical feature in patients with multiple sclerosis (MS). The incidence and extent of olfactory dysfunction are reportedly higher in secondary progressive (SP) MS than in relapsing and remitting (RR) MS. We investigated the use of olfactory dysfunction for evaluating the disease status of Japanese patients with MS. Methods Olfactory identification was evaluated using the Odor Stick Identification Test for the Japanese (OSIT-J) in patients with RRMS (n=40) and SPMS (n=11) and compared the findings with those of healthy controls (n=40). Patients with RRMS for more than 10 years (L-RRMS, n=10) were included in the RRMS group. The cognitive function was evaluated using the Japanese version of the Wechsler Adult Intelligence Scale, 3rd edition. The third ventricle width (3rd VW) was measured as a marker of central brain atrophy using magnetic resonance imaging. Results SPMS patients had significantly lower OSIT-J scores than RRMS and L-RRMS patients. More SPMS patients had OSIT-J scores below the lower limit of the normal score (LLN) than RRMS patients. The LLN effectively discriminated between RRMS and SPMS (sensitivity 70%, specificity 91.5%, area under the curve 0.933, 95% confidence interval 0.874-1.000). Patients with SPMS had a significantly lower processing speed and larger 3rd VW than those with RRMS or L-RRMS. Conclusion The olfactory dysfunction was worse, along with cognitive impairment and brain atrophy, in SPMS patients than in RRMS patients, independent of disease duration, in our Japanese population. This directly reflected the disease progression and may have been able to distinguish SPMS from RRMS, independent of ethnic and cultural background.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"3181 - 3187"},"PeriodicalIF":0.0,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46839299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-09DOI: 10.2169/internalmedicine.8916-21
Koutaro Murao, Yuki Mori, Yukino Takahashi, Tatsuru Ishikawa, Yuichiro Asai, Tomofumi Kobayashi, Kimiyuki Ikeda, K. Kuronuma, Kazufumi Magara, Hiromi Fujita, Y. Hirohashi, A. Takasawa, H. Chiba
Pulmonary pleomorphic carcinoma is rare among lung tumors. Pulmonary pleomorphic carcinoma is resistant to chemotherapy. However, treatment with taxane anticancer agents and immune checkpoint inhibitors has been reported to be effective. When using immune checkpoint inhibitors, pseudoprogression and true progression are difficult to distinguish, and immune-related adverse events (irAEs) are common. We herein report a patient with simultaneous pseudoprogression and irAEs after combined therapy with cytotoxic agents and an immune checkpoint inhibitor for pulmonary pleomorphic carcinoma. Immune checkpoint inhibitors are effective against pulmonary pleomorphic carcinoma, but patients should be monitored for pseudoprogression and irAEs.
{"title":"Simultaneous Pseudoprogression and an Immune-related Adverse Event of Pulmonary Pleomorphic Carcinoma after Combined Therapy with Cytotoxic Anticancer Agents and Immune Checkpoint Inhibitor","authors":"Koutaro Murao, Yuki Mori, Yukino Takahashi, Tatsuru Ishikawa, Yuichiro Asai, Tomofumi Kobayashi, Kimiyuki Ikeda, K. Kuronuma, Kazufumi Magara, Hiromi Fujita, Y. Hirohashi, A. Takasawa, H. Chiba","doi":"10.2169/internalmedicine.8916-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.8916-21","url":null,"abstract":"Pulmonary pleomorphic carcinoma is rare among lung tumors. Pulmonary pleomorphic carcinoma is resistant to chemotherapy. However, treatment with taxane anticancer agents and immune checkpoint inhibitors has been reported to be effective. When using immune checkpoint inhibitors, pseudoprogression and true progression are difficult to distinguish, and immune-related adverse events (irAEs) are common. We herein report a patient with simultaneous pseudoprogression and irAEs after combined therapy with cytotoxic agents and an immune checkpoint inhibitor for pulmonary pleomorphic carcinoma. Immune checkpoint inhibitors are effective against pulmonary pleomorphic carcinoma, but patients should be monitored for pseudoprogression and irAEs.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"3259 - 3264"},"PeriodicalIF":0.0,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48472585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-09DOI: 10.2169/internalmedicine.8554-21
Y. Oshima, Shintaro Fujii, K. Horiuchi
Myasthenia gravis (MG) is an immune-related adverse event (irAE), and as an irAE, MG (irAE-MG) generally has a monophasic course, with only a few case reports of irAE-MG flare-ups during the course of the disease. We herein report a case of pembrolizumab-induced MG with relapsing symptoms. irAE-MG is a rare disease that has not yet been fully characterized, and our case shows that MG symptoms may relapse. Therefore, regular follow-up is necessary, even after the symptoms improve with immunosuppressive therapy.
{"title":"Pembrolizumab-induced Myasthenia Gravis Relapse after Immunosuppressive Therapy","authors":"Y. Oshima, Shintaro Fujii, K. Horiuchi","doi":"10.2169/internalmedicine.8554-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.8554-21","url":null,"abstract":"Myasthenia gravis (MG) is an immune-related adverse event (irAE), and as an irAE, MG (irAE-MG) generally has a monophasic course, with only a few case reports of irAE-MG flare-ups during the course of the disease. We herein report a case of pembrolizumab-induced MG with relapsing symptoms. irAE-MG is a rare disease that has not yet been fully characterized, and our case shows that MG symptoms may relapse. Therefore, regular follow-up is necessary, even after the symptoms improve with immunosuppressive therapy.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"3281 - 3285"},"PeriodicalIF":0.0,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43162361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-09DOI: 10.2169/internalmedicine.8976-21
H. Oka, Yoshito Homma, Yuki Nishino, K. Suemori, Norio Sato, Yuko Sakurai, Mizuki Sekimoto, Shota Ando, Saki Iwamoto, Takaki Iwamoto, Mika Kondo, Taro Kamimura, T. Nakano, T. Kitazono
A 73-year-old man receiving hemodialysis and antiplatelets was admitted with a mild case of COVID-19. Heparin was added, and iliopsoas hemorrhage developed. He was successfully treated by interventional radiology. A 76-year-old man receiving hemodialysis and antiplatelets was admitted with mild COVID-19. Heparin was added, and iliacus hemorrhage developed. Despite heparin discontinuation, he died of worsening pneumonia. A 74-year-old man undergoing hemodialysis was admitted with severe COVID-19. Gastrointestinal bleeding developed during continuous hemodiafiltration with heparin. Upon switching to nafamostat and increasing the dose, iliopsoas hemorrhage developed. Despite interventional radiology, he died of infectious complications. Attention to hemorrhagic complications is therefore needed in patients with COVID-19.
{"title":"Retroperitoneal Hemorrhage in Patients with COVID-19 Undergoing Hemodialysis: Three Case Reports","authors":"H. Oka, Yoshito Homma, Yuki Nishino, K. Suemori, Norio Sato, Yuko Sakurai, Mizuki Sekimoto, Shota Ando, Saki Iwamoto, Takaki Iwamoto, Mika Kondo, Taro Kamimura, T. Nakano, T. Kitazono","doi":"10.2169/internalmedicine.8976-21","DOIUrl":"https://doi.org/10.2169/internalmedicine.8976-21","url":null,"abstract":"A 73-year-old man receiving hemodialysis and antiplatelets was admitted with a mild case of COVID-19. Heparin was added, and iliopsoas hemorrhage developed. He was successfully treated by interventional radiology. A 76-year-old man receiving hemodialysis and antiplatelets was admitted with mild COVID-19. Heparin was added, and iliacus hemorrhage developed. Despite heparin discontinuation, he died of worsening pneumonia. A 74-year-old man undergoing hemodialysis was admitted with severe COVID-19. Gastrointestinal bleeding developed during continuous hemodiafiltration with heparin. Upon switching to nafamostat and increasing the dose, iliopsoas hemorrhage developed. Despite interventional radiology, he died of infectious complications. Attention to hemorrhagic complications is therefore needed in patients with COVID-19.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"1869 - 1876"},"PeriodicalIF":0.0,"publicationDate":"2022-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49560146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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