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Internal Medicine

Keisuke Kasuga, Minako Sako, Shogo Kasai, Hiroshi Yoshimoto, Kuniko Iihara, Hideaki Miura
We herein report the case of a 61-year-old Japanese cirrhotic patient who developed rat bite fever (RBF) and whose first presentation was serious clinical features mimicking those of Henoch-Schönlein purpura (HSP). In addition to the critical clinical conditions, since the histopathology from purpuric skin eruptions was not inconsistent with that of HSP, therapy with prednisolone was promptly started in order to prevent his death. However, initial blood culture on admission yielded a small and slow-growing bacterial growth, which was gradually revealed by further subculture to be a peculiar bacterium, Streptobacillus moniliformis, leading to a definitive diagnosis of RBF...
April 27, 2018: Internal Medicine
Maki Watanabe, Ken Ohyama, Masashi Suzuki, Yasunobu Nosaki, Takashi Hara, Katsushige Iwai, Satoshi Kono, Hiroaki Miyajima, Kenji Mokuno
Aceruloplasminemia is an autosomal recessive inherited disorder caused by ceruloplasmin gene mutations. The loss of ferroxidase activity of ceruloplasmin due to gene mutations causes a disturbance in cellular iron transport. We herein describe a patient with aceruloplasminemia, who presented with diabetes mellitus that was treated by insulin injections, liver hemosiderosis treated by phlebotomy therapy, and neurological impairment. A genetic analysis of the ceruloplasmin gene revealed novel compound heterozygous mutations of c...
April 27, 2018: Internal Medicine
Kenichiro Majima, Yosuke Muraki, Takeshi Shimamoto
Objective Multiple white and flat elevated lesions (MWFLs) observed in the stomach have only been presented in abstracts at academic conferences over the last decade; therefore, relatively little is known about these lesions. Our aim was to prospectively clarify the clinical characteristics of MWFLs, to identify their risk factors and to retrospectively evaluate the clinical progression of these lesions. Methods A prospective analysis of clinical characteristics and risk factors was conducted in participants who underwent esophagogastroduodenoscopic screening at our hospital...
April 27, 2018: Internal Medicine
Daisuke Himeji, Sachika Hara, Takeshi Kawaguchi, Gen-Ichi Tanaka
A 75-year-old man visited our hospital complaining of a low-grade fever, dry cough, and chest abnormal shadow. Chest computed tomography revealed a nodule with a cavity in the right upper lobe. Endobronchial ultrasonography (EBUS) of the lesion suggested that the lesion was benign. Actinomyces graevenitzii was cultured from the specimen obtained by bronchoscopy using endobronchial ultrasonography with a guide sheath technique and was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA sequencing...
April 27, 2018: Internal Medicine
Eun Jin Kim
The author reports the case of a patient with a tuberculosis-associated endobronchial inflammatory polyp. Acid-fast bacillus (AFB) staining and culturing of sputum and bronchial washing fluid specimens were negative on three occasions. Biopsy results twice showed chronic inflammation. The patient was finally diagnosed with Mycobacterium tuberculosis based on a polymerase chain reaction (PCR) of a biopsy tissue specimen, along with the finding of chronic granulomatous inflammation. The author herein reports a rare case of a tuberculosis-associated endobronchial inflammatory polyp that was AFB smear- and culture-negative and the patient's clinical course after treatment...
April 27, 2018: Internal Medicine
Daisuke Honda, Isao Ohsawa, Yuki Shimizu, Masayuki Maiguma, Teruo Hidaka, Hitoshi Suzuki, Hiroaki Io, Satoshi Mano, Hisatsugu Takahara, Hisaki Rinno, Yasuhiko Tomino, Yusuke Suzuki
A 42-year-old Japanese man with hereditary angioedema suffered accidental trauma to his jaw in Shizuoka Prefecture, Japan, which gradually caused facial edema. Since plasma-derived human C1 inhibitor (pdh C1-INH) was unavailable, he had to be transferred to Juntendo University Hospital in Tokyo. Due to his severe edema, he suffered asphyxiation leading to cardiopulmonary arrest upon arrival. The patient was resuscitated and promptly treated with pdh C1-INH. In Japan, the self-administration of pdh C1-INH is not allowed, and every prefecture does not always possess stocks of pdh C1-INH...
April 27, 2018: Internal Medicine
Katsutoshi Takahashi, Toshiyuki Unno
No abstract text is available yet for this article.
April 27, 2018: Internal Medicine
Kazunori Sato, Masaaki Niino, Atsushi Kawashima, Moemi Yamada, Yusei Miyazaki, Toshiyuki Fukazawa
Objective In Japan, following the launch of dimethyl fumarate (DMF) after fingolimod as a disease-modifying drug in multiple sclerosis (MS), some patients switched from fingolimod to DMF. The aim of this study was to determine the follow-up status of MS patients who switched to DMF after fingolimod cessation. Methods Clinical and magnetic resonance imaging (MRI) data in 19 patients with MS who switched to DMF were collected for at least for 6 months after fingolimod cessation. Results Ten patients (52.6%) experienced clinical or MRI exacerbation after fingolimod cessation...
April 27, 2018: Internal Medicine
Tomonori Sekizaki, Chiho Yamamoto, Hiroshi Nomoto
Carcinoembryonic antigen (CEA), the level of which is known to increase in both patients with gastrointestinal cancers and those with non-neoplastic conditions, is one of the most widely-used tumor markers. Hypothyroidism is a common endocrinological disorder in which CEA levels can rise, and is sometimes overlooked as a diagnosis in the absence of typical symptoms or thyroid enlargement. We report the cases of two patients with non-goiterous severe hypothyroidism with markedly elevated CEA levels that effectively decreased with levothyroxine replacement therapy alone...
April 27, 2018: Internal Medicine
Atsuki Fukada, Mikio Toyoshima, Daisuke Akahori, Takafumi Suda
No abstract text is available yet for this article.
April 27, 2018: Internal Medicine
Masaya Iwamuro, Takehiro Tanaka, Tomoko Kawabata, Yuusaku Sugihara, Keita Harada, Sakiko Hiraoka, Hiroyuki Okada
A 74-year-old Japanese woman was diagnosed with pseudolipomatosis of the cecum and ascending colon. Colonoscopy was performed, which revealed the presence of slightly elevated white lesions, while a magnifying observation showed microbubbles within the mucosa. A month after colonoscopy, the patient was diagnosed with pneumatosis intestinalis. Although the exact pathogenesis is unclear, pneumatosis intestinalis may arise secondary to pseudolipomatosis. This case also indicates that a magnifying observation during colonoscopy may aid in the diagnosis of pseudolipomatosis of the large intestine, since it shows microbubbles within the mucosa, which may be a distinctive feature reflecting the pathology of this disease...
April 27, 2018: Internal Medicine
Satoshi Hamada, Mitsuhiro Tsukino
No abstract text is available yet for this article.
April 27, 2018: Internal Medicine
Jumpei Hasegawa, Sachiko Wakai, Momoko Kono, Yusuke Imaizumi, Sakiko Masuda, Akihiro Ishizu, Kazuho Honda
Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV) and cryoglobulinemic vasculitis (CV) rarely coexist. An 83-year-old woman was admitted with rapidly progressive renal failure, gastrointestinal hemorrhage and purpura with myeloperoxidase (MPO) -ANCA positivity and cryoglobulinemia. Despite intensive immunosuppressive treatment, she died of aspergillus pneumonia. Autopsy revealed necrotizing crescentic glomerulitis in the majority of the glomeruli, accompanied by partially membranoproliferative-like glomerular changes...
April 27, 2018: Internal Medicine
Takuya Oyakawa, Kei Iida, Atsushi Urikura, Masatoshi Kusuhara
No abstract text is available yet for this article.
April 27, 2018: Internal Medicine
Yuki Sakamoto, Ryo Hiruta, Ayako Iijima, Yuya Sakuma, Yutaka Konno
A 60-year-old man was admitted to our hospital because of abdominal pain and disturbed consciousness. Head magnetic resonance imaging showed right vertebral artery dissection and abdominal enhanced computed tomography showed dissection of the superior mesenteric artery. The patient was diagnosed as having fibromuscular dysplasia (FMD) based on conventional angiography. Although multiple vascular bed involvement is observed in approximately 40% of FMD patients, reports of sequential symptomatic dissections in various vascular beds are rare...
April 27, 2018: Internal Medicine
Junko Ishii, Yukiko Shishido-Hara, Michi Kawamoto, Satoru Fujiwara, Yukihiro Imai, Kazuo Nakamichi, Nobuo Kohara
A 37-year-old woman with systemic lupus erythematosus (SLE) presented with gait disturbance and cognitive dysfunction. Brain magnetic resonance imaging (MRI) revealed small, punctate, T2-/fluid-attenuated inversion recovery-hyperintense and T1-hypointense lesions without gadolinium enhancement, which is atypical for progressive multifocal leukoencephalopathy (PML). On a pathological examination of biopsied brain tissues, JC virus-infected cells were hardly detected via immunohistochemistry but were certainly detected via in situ hybridization, conclusively verifying the PML diagnosis...
April 27, 2018: Internal Medicine
Hiroyuki Arai, Naohiro Toda, Ryo Kamimatsuse, Keisuke Nishioka, Shuichiro Endo, Shinichi Akiyama, Shoichi Maruyama, Takeshi Matsubara, Hideki Yokoi, Motoko Yanagita
A 58-year-old man with type 1 autoimmune pancreatitis was referred to nephrologists for severe proteinuria. Laboratory data revealed a high serum IgG4 level, hypoalbuminemia, and massive proteinuria, which were compatible with nephrotic syndrome. The renal pathological findings confirmed the diagnosis of secondary membranous nephropathy concurrent with IgG4-related tubulointerstitial nephritis. Despite the improvement of interstitial markers, the proteinuria was refractory to prednisolone, requiring cyclosporine to achieve complete remission...
April 27, 2018: Internal Medicine
Tomoe Kinoshita, Hideaki Kaneto, Fumiko Kawasaki, Takatoshi Anno, Takeyuki Kurihara, Haruki Yamada, Yoshiyuki Oshiro, Naoyuki Miyashita, Niro Okimoto, Kohei Kaku
Fulminant type 1 diabetes mellitus (T1DM) is idiopathic T1DM with the rapid destruction of pancreatic β-cells. We herein report a 48-year-old man who developed fulminant T1DM complicated with a life-threatening electrolyte abnormality and abnormal electrocardiogram findings. He had no remarkable medical history, but one day, he developed general fatigue. His blood glucose level and HbA1c were 806 mg/dL and 6.3%, and his insulin secretion was markedly suppressed. He had ketoacidosis, hyponatremia and hyperkalemia...
April 27, 2018: Internal Medicine
Go Igarashi, Kenichiro Mikami, Naoya Sawada, Tetsu Endo, Norihiko Sueyoshi, Ken Sato, Fumiyasu Tsushima, Shinya Kakehata, Shuichi Ono, Masahiko Aoki, Akira Kurose, Hideki Iwamura, Shinsaku Fukuda
A 73-year-old woman with massive ascites associated with a giant hepatic mass accompanied by arterio-portal (AP) shunt was admitted to our hospital. Based on contrast-enhanced computed tomography (CT) and angiography findings, hepatic hemangioma with AP shunt and ascites due to portal hypertension was diagnosed. Transcatheter arterial embolization (TAE) by N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patient's ascites disappeared, and her liver function test results improved after the treatment...
April 27, 2018: Internal Medicine
Kazuki Hamada, Keiji Oishi, Sho Uehara, Ryo Suetake, Yoshikazu Yamaji, Maki Asami-Noyama, Nobutaka Edakuni, Tsunahiko Hirano, Kenji Sakamoto, Tsuneo Matsumoto, Kazuto Matsunaga
A 44-year-old man was referred to our hospital for the treatment of a pulmonary and deep sternal wound tuberculosis infection, which is an extremely rare type of extrapulmonary tuberculosis. Laboratory testing revealed a serum immunoglobulin (Ig) G level of 286 mg/dl, IgA of 22 mg/dl and IgM of 13 mg/dl. We therefore diagnosed him with hypo-gamma-globulinemia. He was treated with anti-tuberculosis medications and intravenous immunoglobulin. At present, the tuberculosis has not relapsed in the past six years...
April 27, 2018: Internal Medicine
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