{"title":"Treatment of Anti-myelin-associated Glycoprotein Neuropathy with Tirabrutinib and a 3-year Follow-up.","authors":"Chinami Yuzawa, Masateru Tajiri, Maho Usuda, Akira Matsushima, Minori Kodaira, Nagaaki Katoh, Yoshiki Sekijima","doi":"10.2169/internalmedicine.4785-24","DOIUrl":"10.2169/internalmedicine.4785-24","url":null,"abstract":"<p><p>A 69-year-old man was admitted to our hospital because of progressive numbness in the lower legs and fingertips as well as a burning sensation in the soles of both feet. The patient was diagnosed with anti-myelin-associated glycoprotein (anti-MAG) neuropathy based on increased serum IgM levels and anti-MAG antibody titers. Atypical pulmonary mycobacteriosis was also suspected. Following treatment with tirabrutinib (a second-generation Bruton tyrosine kinase inhibitor), his symptoms improved and the anti-MAG antibody titer and IgM levels decreased. Tirabrutinib may therefore be an effective treatment option for anti-MAG neuropathy, particularly in patients at risk of infection.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"3039-3043"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy and Safety of Rituximab plus Modified EPOCH (Etoposide, Vincristine, Doxorubicin, Carboplatin, and Prednisolone) for Transplant-ineligible Relapsed/Refractory Diffuse Large B-cell Lymphoma.","authors":"Eriko Fujioka, Junichi Kiyasu, Ilseung Choi, Yu Yagi, Taro Sawabe, Makoto Oyama, Kosuke Hoashi, Mariko Tsuda, Akiko Takamatsu, Shojiro Haji, Yuji Yufu, Youko Suehiro, Motoaki Shiratsuchi","doi":"10.2169/internalmedicine.5175-24","DOIUrl":"10.2169/internalmedicine.5175-24","url":null,"abstract":"<p><p>Objective Despite the recent development of various novel therapeutic approaches for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), optimal management of patients with R/R DLBCL who are elderly and/or unfit has not yet been established. Methods We retrospectively analyzed the efficacy and safety of the R-mEPOCH regimen comprising rituximab, etoposide, vincristine, doxorubicin, carboplatin, and prednisolone in transplant-ineligible patients with R/R DLBCL. Results In total, 22 patients were included in this study. The median patient age was 75 years old. The median number of prior lines of therapy was one (range, 1-5). The overall response rate was 68%, with 45% achieving complete response (CR) or unconfirmed CR and 23% achieving partial response. With a median follow-up of 27.8 months, the median progression-free survival and overall survival (OS) were 17.1 and 27.4 months, respectively. The 2- and 5-year OS rates were 50% and 28%, respectively. The most common grade ≥3 adverse events were neutropenia [n=18 (82%)], febrile neutropenia [n=16 (73%)], anemia [n=12 (55%)], and thrombocytopenia [n=8 (36%)]. The median total lifetime cumulative dose of anthracyclines was 281 mg/m<sup>2</sup> (range, 69-536 mg/m<sup>2</sup>) in doxorubicin equivalents. One case of grade 1 bradycardia occurred, leading to the discontinuation of R-mEPOCH. No other cardiac adverse events of grade ≥3 and/or discontinuation of treatment were observed. Conclusion Our study suggests that the R-mEPOCH regimen may be an effective and tolerable salvage regimen for transplant-ineligible R/R DLBCL patients.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2953-2959"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Idiopathic Interstitial Lung Disease with Positive Anti-Zo and Anti-Ro52/SSA1 Antibodies.","authors":"Mizuha Haraguchi Hashiguchi, Ryusuke Yoshimi, Takuya Ozawa, Masato Asaoka, Junko Kagyo, Yoshie Kawahara, Tetsuya Shiomi","doi":"10.2169/internalmedicine.5062-24","DOIUrl":"10.2169/internalmedicine.5062-24","url":null,"abstract":"<p><p>A 70-year-old male presented with infiltration, ground-glass opacities, and bronchiectasis on chest radiography, which indicated interstitial pneumonia. Clinical findings (thickening of the skin on the fingers, slight nail fold petechiae, and skin lesions resembling mechanic's hands) suggested early systemic sclerosis and/or polymyositis/dermatomyositis. However, anti-Scl-70, anti-centromere, and anti-aminoacyl tRNA synthetase (anti-ARS) antibodies were negative. Exertion-related oxygenation gradually worsened. Since the multiplex protein array confirmed anti-Zo and anti-Ro52/SSA1 antibody positivity, anti-ARS antibody syndrome was diagnosed and treated with steroids and immunosuppressive drugs. The patient was concurrently diagnosed with advanced colorectal cancer. Treating interstitial pneumonia first allowed for the subsequent treatment of colorectal cancer without worsening the condition.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2990-2994"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment of Desquamative Interstitial Pneumonia and Systemic Sclerosis with Corticosteroids and Immunosuppressants.","authors":"Eiki Omoto, Kazuhiro Sato, Daichi Takahashi, Kentaroh Kudoh, Kengo Shimada, Satoshi Goshima, Ruriko Asahi, Yuri Takita, Yuka Izumiya, Sho Sakamoto, Mariko Asano, Yuji Okuda, Masahide Takeda, Katsutoshi Nakayama","doi":"10.2169/internalmedicine.5001-24","DOIUrl":"10.2169/internalmedicine.5001-24","url":null,"abstract":"<p><p>A 66-year-old male ex-smoker presented with fatigue and non-productive cough, as well as a 2-year history of ground-glass opacities. Deterioration on chest radiography and increased Krebs von den Lungen-6 levels coincided with the progression of diffuse ground-glass opacities on high-resolution computed tomography. Surgical lung biopsy revealed features consistent with desquamative interstitial pneumonia. Concurrent skin hardening and presence of anti-Scl-70 antibodies supported the diagnosis of systemic sclerosis. Treatment with oral corticosteroids proved to be effective, leading to radiographic improvement. The subsequent administration of cyclophosphamide and mycophenolate mofetil stabilized disease progression.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2985-2989"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Obinutuzumab-induced Acute Thrombocytopenia Mimicking Immune Thrombocytopenia in a Patient with Follicular Lymphoma.","authors":"Misato Tane, Hiroki Hosoi, Takayuki Hiroi, Shogo Murata, Toshiki Mushino, Takashi Sonoki","doi":"10.2169/internalmedicine.5191-24","DOIUrl":"10.2169/internalmedicine.5191-24","url":null,"abstract":"<p><p>Obinutuzumab-induced acute thrombocytopenia is characterized by a rapid decrease in the platelet count after administration. The underlying mechanisms remain unclear. However, we present novel laboratory findings related to its pathophysiology. A 65-year-old woman with follicular lymphoma developed acute thrombocytopenia within 24 hours after obinutuzumab administration. Laboratory results showed features resembling acute immune thrombocytopenic purpura, including an elevated immature platelet fraction, mildly increased thrombopoietin levels, elevated platelet-associated immunoglobulin G, and refractory to platelet transfusion. Our case and her laboratory findings suggest that increased platelet consumption might be involved in the development of obinutuzumab-induced acute thrombocytopenia.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"3007-3011"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delayed Hepatitis B Virus Reactivation at 33 Months after the Completion of Rituximab-based Chemotherapy.","authors":"Banri Ogawa, Toshiro Kamoshida, Asaji Yamamoto, Yuji Yamaguchi, Yukako Hamano, Haruka Okawara, Atsushi Okawara, Nobushige Kakinoki, Shinji Hirai","doi":"10.2169/internalmedicine.5179-24","DOIUrl":"10.2169/internalmedicine.5179-24","url":null,"abstract":"<p><p>We herein report a case of hepatitis B virus (HBV) reactivation in a female patient in her 70s with isolated anti-hepatitis B core (IAHBc) antibodies [HB surface antigen (HBsAg)-negative, HB surface antibody (HBsAb)-negative, and HB core antibody (HBcAb)-positive], receiving rituximab-based chemotherapy for follicular lymphoma. Her serum HBV DNA was negative. The patient was treated with rituximab for 21 months, and 33 months after completion of treatment, her HBV DNA level increased to 5.1 Log IU/mL, and the patient developed hepatic failure. Tenofovir alafenamide fumarate treatment was initiated for HBV reactivation, and DNA was not detected 9 months later.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2966-2970"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Development of Diffuse Large B Cell Lymphoma in a Patient with Systemic Lupus Erythematosus within Two Years after the Initiation of Anifrolumab and Mycophenolate Mofetil Treatment.","authors":"Takuya Matsubara, Masahiro Takita, Ikue Sekai, Naoya Omaru, Natsuki Okai, Masahiro Morita, Ken Kamata, Kosuke Minaga, Tomohiro Watanabe, Masatoshi Kudo","doi":"10.2169/internalmedicine.5362-25","DOIUrl":"10.2169/internalmedicine.5362-25","url":null,"abstract":"<p><p>Anifrolumab is a newly developed biological agent for patients with moderate-to-severe systemic lupus erythematosus (SLE). Anifrolumab neutralizes the signaling pathways mediated by type I interferons (IFNs), which are involved in viral clearance and anticancer immunity. Although susceptibility to viral infections has been reported in patients treated with anifrolumab, whether anifrolumab treatment increases the cancer risk in patients with SLE is unknown. We herin report a case of SLE that manifested as aggressive diffuse large B-cell lymphoma (DLBCL) after treatment with anifrolumab. The neutralization of type I IFNs by anifrolumab may promote the development of DLBCL owing to defective anticancer immunity.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"3044-3050"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dyskeratosis Congenita Complicated by Pulmonary Fibrosis and Myelodysplastic Syndrome with a Germline Mutation of the DKC1 Gene and a Somatic Mutation of the U2AF1 Gene in Leukocytes.","authors":"Hiroko Watanabe, Yuta Takahashi, Tomohiro Namiki, Ryusei Nakagawa, Toshihide Inui, Hiroaki Ishikawa, Manabu Wakamatsu, Hideki Muramatsu, Tohru Sakamoto","doi":"10.2169/internalmedicine.5153-24","DOIUrl":"10.2169/internalmedicine.5153-24","url":null,"abstract":"<p><p>Dyskeratosis congenita (DC) is a rare genetic disorder that is caused by abnormal telomere shortening. We herein report the case of a 40-year-old man with classic DC characterized by a mucocutaneous triad complicated by pulmonary fibrosis and myelodysplastic syndrome (MDS). The telomere length of lymphocytes was extremely short (-3.3 standard deviations). We identified the germline mutation c.C91A in DKC1 gene. We also identified a somatic mutation c.C101T in the U2AF1 gene of leukocytes, which may be associated with MDS development. Nintedanib was started, but the patient died of bilateral pneumothorax 6 months after diagnosis.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"3000-3006"},"PeriodicalIF":1.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}