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Internal Medicine

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https://www.readbyqxmd.com/read/28717096/disseminated-mycobacterium-scrofulaceum-infection-in-an-immunocompetent-host
#1
Yu Takemoto, Hirokazu Tokuyasu, Tomoyuki Ikeuchi, Hirofumi Nakazaki, Satoru Nakamatsu, Suguru Kakite, Keiichi Yamasaki
A 56-year-old woman, without any immunocompromising diseases, was referred to our hospital because of a recurrence of pyogenic spondylitis. Computed tomography revealed multiple osteolytic changes in the whole body. Vertebral magnetic resonance imaging revealed osteomyelitis and spondylitis. Mycobacterium scrofulaceum was detected in sputum cultures, in abscesses from the right knee, and in a subcutaneous forehead abscess. Therefore, the patient was diagnosed with disseminated Mycobacterium scrofulaceum infection...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717095/encephalopathy-associated-with-influenza-b-in-a-healthy-young-man
#2
Masaki Shimamoto, Satoshi Okada, Takeshi Terashima
A 19-year-old man presented with a fever, convulsions, and loss of consciousness at our hospital. The patient had a Glasgow Coma Scale score of 12. Influenza B virus infection was diagnosed using the rapid test kit, and an eight-fold increase in the serum levels of anti-influenza B virus antibody was confirmed using the complement fixation test. Brain magnetic resonance imaging showed multifocal high-signal lesions, and an electroencephalogram showed diffuse slowing of the background activity, indicating acute encephalopathy...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717094/limbic-encephalitis-associated-with-human-herpesvirus-7-hhv-7-in-an-immunocompetent-adult-the-first-reported-case-in-japan
#3
Yoko Aburakawa, Takayuki Katayama, Tsukasa Saito, Jun Sawada, Tatsuo Suzutani, Hitoshi Aizawa, Naoyuki Hasebe
A 35-year-old male who had not previously suffered any major illnesses was admitted to our hospital because of general fatigue, fever, headache, vomiting, consciousness disturbance, and seizures. A neurological examination showed that he was in a semi-comatose state and exhibited neck stiffness. Brain magnetic resonance imaging detected high-intensity areas in the bilateral hippocampi and periventricular white matter. A cerebrospinal fluid examination revealed mononuclear pleocytosis, an elevated protein level, and positivity for human herpesvirus-7 (HHV-7) DNA...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717093/paraneoplastic-anti-3-hydroxy-3-methylglutary-coenzyme-a-reductase-antibody-positive-immune-mediated-necrotizing-myopathy-in-a-patient-with-uterine-cancer
#4
Atsushi Mizuma, Maiko Kouchi, Shizuka Netsu, Sachiko Yutani, Ruriko Kitao, Shigeaki Suzuki, Kenya Murata, Eiichiro Nagata, Shunya Takizawa
We report the case of a 69-year-old woman with proximal limb muscle weakness, who received post-operative chemotherapy for uterine cancer. Her serum creatinine kinase level was high (10,779 mg/dL) and a muscle biopsy from her left biceps revealed various sizes of muscle fibers accompanied by necrotic and regenerating fibers. She was positive for anti-3 hydroxy-3-methylglutary-coenzyme A reductase (anti-HMGCR) antibodies, but negative for anti-signal recognition particle (anti-SRP) antibodies. She was diagnosed with immune-mediated necrotizing myopathy (IMNM) and treated with prednisolone...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717092/cerebrospinal-fluid-rhinorrhea-and-subsequent-bacterial-meningitis-due-to-an-atypical-clival-fracture
#5
Rie Tohge, Makio Takahashi
Cases of cerebrospinal fluid (CSF) rhinorrhea due to clival fracture are rare. We present a case of bacterial meningitis with CSF rhinorrhea after a clival fracture. Heavily T2-weighted images showed a bone flap in the thinned clivus and fluid collection in the sphenoid sinus. CSF rhinorrhea developed at 1 month after mild trauma. The fracture may have been caused by the trauma and/or by the pressure gradient between the intracranial CSF space and the sphenoid sinus. A detailed history to identify trauma and an examination to detect bone defects in the skull base are necessary when patients present with bacterial meningitis and persistent rhinorrhea...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717091/thrombolysis-related-multiple-lobar-hemorrhaging-in-cerebral-amyloid-angiopathy-with-extensive-strictly-lobar-cerebral-microbleeding
#6
Makoto Eriguchi, Yusuke Yakushiji, Jun Tanaka, Masashi Nishihara, Hideo Hara
A hemi-paralyzed 86-year-old man was diagnosed with ischemic stroke and underwent thrombolysis. Pre-thrombolysis brain magnetic resonance imaging revealed extensive strictly lobar cerebral microbleeding (CMB). Post-thrombolytic computed tomography revealed asymptomatic multiple intracerebral hemorrhaging (ICH). His age, CMB topography, and decreased cerebral spinal fluid amyloid-β 40 and 42 levels were compatible with a diagnosis of cerebral amyloid angiopathy (CAA). There is no consensus on the safety of thrombolysis for acute stroke patients with CAA...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717090/delayed-polyneuropathy-induced-by-organophosphate-poisoning
#7
Shunsuke Kobayashi, Reiko Okubo, Yoshikazu Ugawa
An 89-year-old man attempted suicide by ingesting a pesticide (trichlorfon). After surviving the initial critical period in the intensive care unit, he developed rapidly progressive distal weakness and sensory disturbance. Electrophysiological examinations revealed sensory motor axonal polyneuropathy. Delayed polyneuropathy is a rare manifestation of organophosphate poisoning. Nerve conduction studies play an important role in the diagnosis of this rare clinical condition.
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717089/an-autopsy-case-of-fulminant-hepatitis-in-a-patient-with-multiple-sclerosis-treated-by-interferon-beta-1a
#8
Yuichi Yamazaki, Aya Suzuki, Kimitoshi Hirayanagi, Yusuke Tsukagoshi, Ryota Uehara, Kazuhiko Horiguchi, Tatsuya Ohyama, Takuya Tomaru, Norio Horiguchi, Sumihito Nobusawa, Hayato Ikota, Ken Sato, Satoru Kakizaki, Motoyasu Kusano, Yoshio Ikeda, Hideaki Yokoo, Masanobu Yamada
A 44-year-old woman with multiple sclerosis (MS) receiving interferon (IFN)-beta-1a treatment was admitted to a local hospital for severe icterus and liver injury. She was transferred to our university hospital because fulminant hepatitis (FH) was suspected. She was diagnosed with acute-type FH based on hepatic coma, severe liver injury and liver failure, and she received plasma exchange and continuous hemodiafiltration therapy. On hospital day 6, she died from liver failure despite intensive care. An autopsy revealed histological findings consistent with FH...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717088/long-term-effects-of-intravenous-cyclophosphamide-in-combination-with-mesna-provided-intravenously-and-via-bladder-perfusion-in-a-patient-with-severe-multifocal-motor-neuropathy
#9
Eri Iwasawa, Takuya Ohkubo, Tadashi Kanouchi, Takashi Kanda, Hidehiro Mizusawa, Takanori Yokota
A 25-year-old woman presenting with progressive muscle weakness in the distal extremities in the absence of sensory involvement for 2 years was diagnosed with multifocal motor neuropathy (MMN). Her disease was difficult to manage with various immunosuppressants, and the muscle weakness eventually progressed to involve the respiratory muscles, necessitating mechanical ventilation. Intravenous cyclophosphamide (CY) dramatically improved her symptoms, and she has since maintained her ambulatory status for 18 years with intermittent CY therapy...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717087/pulmonary-intravascular-large-b-cell-lymphoma-ivlbcl-disguised-as-an-asthma-exacerbation-in-a-patient-with-asthma
#10
Tomohito Takeshige, Norihiro Harada, Yasuhito Sekimoto, Ryota Kanemaru, Takeo Tsutsumi, Kei Matsuno, Satomi Shiota, Azuchi Masuda, Akihiko Gotoh, Miki Asahina, Toshimasa Uekusa, Kazuhisa Takahashi
A 62-year-old man with asthma presented with a 1-month history of wheezing and exertional dyspnea. Although the wheezing symptoms disappeared after systemic corticosteroid therapy, the exertional dyspnea and hypoxemia did not improve. A diagnosis of intravascular large B-cell lymphoma (IVLBCL) with pulmonary involvement was suspected because of the increased serum lactic dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) level, increased alveolar-arterial oxygen difference (AaDO2), decreased pulmonary diffusing capacity for carbon monoxide (DLCO) and scintigraphic, computed tomography (CT) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT findings...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717086/therapy-related-acute-myeloid-leukemia-after-the-long-term-administration-of-low-dose-etoposide-for-chronic-type-adult-t-cell-leukemia-lymphoma-a-case-report-and-literature-review
#11
Naoki Shimada, Nobuhiro Ohno, Ryuji Tanosaki, Shigeo Fuji, Yuhko Suzuki, Koichiro Yuji, Kaoru Uchimaru, Arinobu Tojo
A 61-year-old woman with chronic-type adult T-cell leukemia-lymphoma (ATL) had been taking low-dose oral etoposide for progressive lymphocytosis. After taking this for 3.5 years, she was diagnosed with therapy-related acute myeloid leukemia (t-AML), with a chromosomal translocation of t (6:11) (q27; q23). She thus received remission induction therapy, consolidation therapy, and allogeneic hematopoietic stem cell transplantation. Although both t-AML and ATL were in remissive states, she died of a therapy-related infection within 1 year...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717085/high-dose-chemotherapy-with-stem-cell-rescue-provided-durable-remission-for-classical-hodgkin-lymphoma-type-post-transplant-lymphoproliferative-disorder-after-unrelated-cord-blood-transplantation-a-case-report-and-review-of-the-literature
#12
Hidehiro Itonaga, Takeharu Kato, Machiko Fujioka, Masataka Taguchi, Hiroaki Taniguchi, Yoshitaka Imaizumi, Shinichiro Yoshida, Hiroaki Miyoshi, Yukiyoshi Moriuchi, Koichi Ohshima, Yasushi Miyazaki
An adult woman developed polymorphic post-transplant lymphoproliferative disorder (PTLD) 58 months after unrelated cord blood transplantation. She was treated successfully with chemotherapy and radiation therapy but presented with lymphadenopathy and splenomegaly 74 months after transplantation. A lymph node biopsy confirmed the diagnosis of nodular sclerosis type Hodgkin lymphoma (classical Hodgkin lymphoma [CHL]-type PTLD). After salvage therapy and hematopoietic stem cell harvesting, she was subsequently treated with consolidative high-dose chemotherapy with melphalan followed by stem cell rescue, which resulted in durable remission...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717084/pathologically-proven-spontaneous-remission-of-igg4-related-retroperitoneal-fibrosis
#13
Hideaki Yamakawa, Akimasa Sekine, Yumie Yamanaka, Shinko Sadoyama, Tomohisa Baba, Eri Hagiwara, Koji Okudela, Takashi Ogura
Some forms of idiopathic retroperitoneal fibrosis (RF) have recently been considered to be a part of the spectrum of immunoglobulin G4 (IgG4)-related disease. This case report is the first description of a spontaneous remission in a patient with pathologically proven IgG4-related RF. Although the pathogenesis and long-term disease behavior of IgG4-related RF remains unknown, we believe that an initial assessment consisting of only careful monitoring might be one important strategy, especially in asymptomatic IgG4-related RF patients without nephropathy, while carefully monitoring these patients for the risk of recurrence...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717083/pirfenidone-induced-eosinophilic-pleurisy
#14
Isano Hase, Bunpei Yamaguchi, Hidenori Takizawa, Hiroaki Arakawa, Hideo Sakuma, Koichi Fujiu, Hideaki Miyamoto, Yoshiki Ishii
The patient was a 69-year-old man with idiopathic pulmonary fibrosis who was taking pirfenidone. After 7 weeks of treatment, he suffered from left-sided eosinophilic pleurisy. Medical thoracoscopy was performed and the histopathological examination of the parietal pleura revealed the massive infiltration of eosinophils and lymphoid follicles. After stopping pirfenidone therapy, the patient's pleural effusion disappeared without additional treatment, and never recurred. This is the first case report of pirfenidone-induced pleurisy...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717082/post-cytokine-release-salt-wasting-as-inverse-tumor-lysis-syndrome-in-a-non-cerebral-natural-killer-cell-neoplasm
#15
Hirotsugu Ariizumi, Yosuke Sasaki, Hiroshi Harada, Yui Uto, Remi Azuma, Tomohide Isobe, Koji Kishimoto, Eisuke Shiozawa, Masafumi Takimoto, Nobuyuki Ohike, Hiraku Mori
The pathogenesis of cerebral/renal salt-wasting syndrome remains unknown. We herein present a case of salt-wasting syndrome with a natural killer-cell neoplasm without cerebral invasion. A 78-year-old man with hemophagocytic syndrome received two cycles of chemotherapy that did not induce tumor lysis syndrome, but repeatedly caused polyuria and natriuresis. The expression of tumor necrosis factor-α in the neoplasm led us to hypothesize that an oncolysis-induced cytokine storm may have caused renal tubular damage and salt wasting...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717081/severe-glomerular-endothelial-injury-associated-with-a-short-d4z4-repeat-on-chromosome-4q35
#16
Satoshi Hibino, Asami Takeda, Ichizo Nishino, Naoyuki Iwata, Masaru Nakano, Kazuki Tanaka, Satoshi Yamakawa, Takuhito Nagai, Osamu Uemura
The short D4Z4 repeat on chromosome 4q35 is a confirmatory genetic cause of facioscapulohumeral muscular dystrophy (FSHD), which presents with no renal complications. We herein report a five-year-old girl previously diagnosed with Coat's-like retinopathy, deafness, and mental retardation, who was found to have early-onset, severe FSHD. Despite the absence of muscle weakness, a Southern blot analysis showed a short D4Z4 repeat on chromosome 4q35. She presented with steroid-resistant nephrotic syndrome, and her renal histopathological findings were severe glomerular endothelial injury, which is a new complication associated with this genetic abnormality...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717080/addison-s-disease-caused-by-tuberculosis-with-atypical-hyperpigmentation-and-active-pulmonary-tuberculosis
#17
Hiroki Namikawa, Yasuhiko Takemoto, Shigeto Kainuma, Sakurako Umeda, Ayako Makuuchi, Kazuo Fukumoto, Masanori Kobayashi, Shigeki Kinuhata, Yoshihiro Isaka, Hiromitsu Toyoda, Noriko Kamata, Yoshihiro Tochino, Yoshikazu Hiura, Mina Morimura, Taichi Shuto
We herein report a case of Addison's disease caused by tuberculosis characterized by atypical hyperpigmentation, noted as exacerbation of the pigmentation of freckles and the occurrence of new freckles, that was diagnosed in the presence of active pulmonary tuberculosis. The clinical condition of the patient was markedly ameliorated by the administration of hydrocortisone and anti-tuberculosis agents. When exacerbation of the pigmentation of the freckles and/or the occurrence of new freckles are noted, Addison's disease should be considered as part of the differential diagnosis...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717079/severe-hypocalcemia-in-a-patient-with-recurrent-chondrosarcoma
#18
Jung Nam Eun, Yoo Duk Choi, Jeong Ho Lee, Yun Ah Jeong, Jee Hee Yoon, Hee Kyung Kim, Ho-Cheol Kang
Hypocalcemia is relatively uncommon paraneoplastic syndrome. Only one case of hypocalcemia has been reported in a patient with chondrosarcoma. We herein report a case of a 32-year-old woman with metastatic chondrosarcoma with tetany. Her imaging findings revealed multiple calcific metastatic lesions in the lungs, pancreas, left atrium, and pulmonary vein. A laboratory examination showed hypocalcemia with no evidence of any other disease that could induce hypocalcemia. On the basis of the laboratory and clinical findings, we concluded the etiology of her severe hypocalcemia to be excessive calcium consumption by the tumor itself...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717078/dermatomyositis-induced-by-hepatitis-b-virus-related-hepatocellular-carcinoma-a-case-report-and-review-of-the-literature
#19
Jen-Wei Chou, Yin-Lan Lin, Ken-Sheng Cheng, Po-Yuan Wu, Teressa Reanne Ju
Dermatomyositis or polymyositis as a paraneoplastic syndrome of hepatocellular carcinoma (HCC) is an uncommon event. Few cases have been reported in the literature. We herein report the case of a 55-year-old man with chronic hepatitis B and alcoholism who presented with skin rash. Abdominal computed tomography revealed multiple hypervascular liver tumors consistent with HCC. He subsequently developed dysphagia with proximal limb weakness. Laboratory tests and electromyography demonstrated inflammatory myopathy...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28717077/gastric-hyperplastic-polyps-associated-with-proton-pump-inhibitor-use-in-a-case-without-a-history-of-helicobacter-pylori-infection
#20
Shuichi Miyamoto, Mototsugu Kato, Kana Matsuda, Satoshi Abiko, Momoko Tsuda, Takeshi Mizushima, Keiko Yamamoto, Shoko Ono, Takahiko Kudo, Yuichi Shimizu, Kanako C Hatanaka, Izumi Tsunematsu, Naoya Sakamoto
A 56-year-old man with gastroesophageal reflux disease (GERD) was referred to our hospital. Esophagogastroduodenoscopy (EGD) revealed no evidence of any polypoid lesions in the stomach, and the patient had no history of Helicobacter pylori infection. He received omeprazole (20 mg) once daily for the GERD. EGD was performed at 1 year after the start of omeprazole administration, and this time, gastric hyperplastic polyps (GHPs) were detected. The GHPs increased in size as the omeprazole treatment continued, but they markedly decreased in size following omeprazole discontinuation...
2017: Internal Medicine
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