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Risk Factors for Liver Injury and Their Association with Treatment in Hospitalized Patients with COVID-19. COVID-19住院患者肝损伤危险因素及其与治疗的关系
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 DOI: 10.2169/internalmedicine.4705-24
Chihiro Kato, Yutaka Ito, Yuta Mori, Keima Ito, Kensuke Fukumitsu, Satoshi Fukuda, Yoshihiro Kanemitsu, Takehiro Uemura, Tomoko Tajiri, Hirotsugu Ohkubo, Tetsuya Oguri, Atsushi Nakamura, Akio Niimi
{"title":"Risk Factors for Liver Injury and Their Association with Treatment in Hospitalized Patients with COVID-19.","authors":"Chihiro Kato, Yutaka Ito, Yuta Mori, Keima Ito, Kensuke Fukumitsu, Satoshi Fukuda, Yoshihiro Kanemitsu, Takehiro Uemura, Tomoko Tajiri, Hirotsugu Ohkubo, Tetsuya Oguri, Atsushi Nakamura, Akio Niimi","doi":"10.2169/internalmedicine.4705-24","DOIUrl":"https://doi.org/10.2169/internalmedicine.4705-24","url":null,"abstract":"<p><p>Objective This study investigated the frequency and risk factors of acute liver injury (ALI) and the association between ALI and treatment in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods This was a single-center retrospective study of 631 hospitalized patients ≥18 years old who were diagnosed with COVID-19 and received treatment between July 1, 2020, and January 31, 2024. Demographic and clinical data were extracted from the electronic medical records. ALI was defined according to the consensus guidelines of the Asia Pacific Association of the Study of Liver. Patients were divided into two groups according to the presence of ALI to assess the risk factors for the occurrence of ALI. Results Seventy-six patients (12.0%) developed ALI. Seven patients discontinued remdesivir owing to hepatic impairment, and only 1 patient (0.2%) had an increase in alanine aminotransferase (ALT) ≥10 times the upper limit of normal. ALI was associated with men (odds ratio [OR]=3.052, 95% confidence interval [CI]=1.456-6.398), a higher WHO ordinal scale score at admission (OR=1.408, 95% CI=1.036-1.912), higher ALT level at admission (OR=1.017, 95% CI=1.009-1.024), tocilizumab administration (OR=2.788, 95% CI=1.372-5.666), the absence of diabetes (OR=0.456, 95% CI=0.226-0.922) and the absence of dyslipidemia (OR=0.244, 95% CI=0.083-0.723). In the comparison of the propensity score-matched groups, neither remdesivir nor tocilizumab administration was associated with ALI. Conclusion Men, severe COVID-19, and elevated ALT levels at admission were significantly associated with an increased risk of ALI in patients treated for COVID-19. ALI may have been associated with tocilizumab administration but not with remdesivir administration.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639695","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}
引用次数: 0
Successful Resolution of Suspected Red Yeast Rice-induced Nephropathy. 成功解决疑似红曲米肾病。
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 DOI: 10.2169/internalmedicine.4908-24
Haruka Maruyama, Ken-Ei Sada, Machiko Oka, Mitsuru Yanai, Sumi Hidaka, Shuzo Kobayashi
{"title":"Successful Resolution of Suspected Red Yeast Rice-induced Nephropathy.","authors":"Haruka Maruyama, Ken-Ei Sada, Machiko Oka, Mitsuru Yanai, Sumi Hidaka, Shuzo Kobayashi","doi":"10.2169/internalmedicine.4908-24","DOIUrl":"https://doi.org/10.2169/internalmedicine.4908-24","url":null,"abstract":"<p><p>Recently, several Japanese patients have developed interstitial nephritis or acute tubular injury/necrosis, both accompanied by Fanconi syndrome, after consuming a specific red yeast rice supplement. In most cases, the renal function did not fully recover even after discontinuation of supplements and glucocorticoid treatment. A 52-year-old woman developed interstitial nephritis and Fanconi syndrome after receiving supplements. A renal biopsy revealed mild lymphocytic infiltration. Her renal function recovered after discontinuing the supplement without glucocorticoids. The supplement was contaminated with puberulic acid, a known cause of tubular necrosis; however, the cause of interstitial nephritis remains uncertain. Biopsy findings guided the decision to avoid glucocorticoids.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639712","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}
引用次数: 0
Successful Surgical Resection of Pancreatic Arteriovenous Malformation Complicated by Acute Pancreatitis. 成功切除急性胰腺炎并发的胰动静脉畸形：病例报告。
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 Epub Date: 2024-09-04 DOI: 10.2169/internalmedicine.3699-24
Shota Iwata, Takuji Iwashita, Akihiko Senju, Ryuichi Tezuka, Shinya Uemura, Masahiro Fukada, Katsutoshi Murase, Nobuhisa Matsuhashi, Chiemi Saigo, Tatsuhiko Miyazaki, Masahito Shimizu
{"title":"Successful Surgical Resection of Pancreatic Arteriovenous Malformation Complicated by Acute Pancreatitis.","authors":"Shota Iwata, Takuji Iwashita, Akihiko Senju, Ryuichi Tezuka, Shinya Uemura, Masahiro Fukada, Katsutoshi Murase, Nobuhisa Matsuhashi, Chiemi Saigo, Tatsuhiko Miyazaki, Masahito Shimizu","doi":"10.2169/internalmedicine.3699-24","DOIUrl":"10.2169/internalmedicine.3699-24","url":null,"abstract":"<p><p>A 73-year-old man presented with left hypochondral pain. Dynamic computed tomography (CT) revealed abnormal vessels surrounding the pancreas, leading to a suspected diagnosis of pancreatic arteriovenous malformation (PAVM). At the time of the initial examination, dynamic CT revealed mild acute pancreatitis, and PAVM was diagnosed based on the findings of dynamic CT. Although repeated abdominal pain was observed after the improvement of pancreatitis, distal pancreatectomy was performed. At >1 year after surgery, no recurrence of PAVM was observed. Surgical resection should be considered in patients with symptomatic PAVM.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"839-844"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132669","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}
引用次数: 0
A Case of Cutaneous Arteritis Complicated by Crohn's Disease. 一例克罗恩病并发皮肤动脉炎病例
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 DOI: 10.2169/internalmedicine.5052-24
Takao Nagashima, Hiroki Yabe, Naoka Umemoto, Satohiro Matsumoto, Hisashi Oshiro
{"title":"A Case of Cutaneous Arteritis Complicated by Crohn's Disease.","authors":"Takao Nagashima, Hiroki Yabe, Naoka Umemoto, Satohiro Matsumoto, Hisashi Oshiro","doi":"10.2169/internalmedicine.5052-24","DOIUrl":"https://doi.org/10.2169/internalmedicine.5052-24","url":null,"abstract":"<p><p>Cutaneous arteritis (CA) is a rare cutaneous manifestation of Crohn's disease. A 50-year-old woman with a 15-year history of CA was admitted to our hospital with a fever, abdominal pain, and hematochezia. Based on these symptoms and increased C-reactive protein levels, systemic vasculitis was considered. However, emergency colonoscopy revealed multiple longitudinal ulcers throughout the colon, thus suggesting Crohn's disease. Prednisolone (60 mg/day) was administered intravenously. A histopathological examination of the biopsied colonic mucosa revealed epithelioid granulomas, which confirmed the diagnosis of Crohn's disease. Because the systemic evolution of CA is rare, other comorbidities should be considered when patients with CA experience systemic manifestations.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639632","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}
引用次数: 0
Subacute Finger Gangrene with Severe Raynaud's Phenomenon. 伴有严重雷诺氏现象的亚急性手指坏疽。
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 DOI: 10.2169/internalmedicine.4689-24
Kazuro Kamada, Michihito Kono, Tatsuya Atsumi
{"title":"Subacute Finger Gangrene with Severe Raynaud's Phenomenon.","authors":"Kazuro Kamada, Michihito Kono, Tatsuya Atsumi","doi":"10.2169/internalmedicine.4689-24","DOIUrl":"https://doi.org/10.2169/internalmedicine.4689-24","url":null,"abstract":"","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639711","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}
引用次数: 0
Diagnostic Pitfalls of the Bleeding Origin after a Percutaneous Renal Biopsy. 经皮肾活检术后出血起源的诊断陷阱：两例病例报告。
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 Epub Date: 2024-08-08 DOI: 10.2169/internalmedicine.3888-24
Yu Asai, Takamasa Iwakura, Sayaka Ishigaki, Shinsuke Isobe, Tomoyuki Fujikura, Naro Ohashi, Akihiko Kato, Hideo Yasuda
{"title":"Diagnostic Pitfalls of the Bleeding Origin after a Percutaneous Renal Biopsy.","authors":"Yu Asai, Takamasa Iwakura, Sayaka Ishigaki, Shinsuke Isobe, Tomoyuki Fujikura, Naro Ohashi, Akihiko Kato, Hideo Yasuda","doi":"10.2169/internalmedicine.3888-24","DOIUrl":"10.2169/internalmedicine.3888-24","url":null,"abstract":"<p><p>A percutaneous renal biopsy (PRB) is a standard procedure for diagnosing renal disease, but can cause bleeding complications. Bleeding after a PRB can be classified as early- or late-onset, depending on the timing of the onset of the bleeding symptoms (<24 h or ≥24 h). We herein report two patients who experienced bleeding complications: one experienced early-onset bleeding from the 12th subcostal artery, and the other experienced late-onset bleeding from an arteriovenous fistula between a branch of the renal artery and renal vein. In both cases, the origin of the bleeding vessel was misjudged during the first examination. We discuss the diagnostic pitfalls of the origin of bleeding after a PRB and propose measures to avoid falling such pitfalls.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"881-885"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901641","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}
引用次数: 0
Takotsubo Syndrome Development Immediately Following Hemodialysis Initiation. 血液透析启动后立即出现塔克次氏综合征：病例报告。
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 Epub Date: 2024-08-08 DOI: 10.2169/internalmedicine.3983-24
Ryo Kurose, Yu Mihara, Asuka Fujikita, Kenji Matsumoto, Masashi Nakamura, Ayumi Ogata, Asuka Yamauchi, Tomoharu Ida, Hiroshi Kado, Tsuguru Hatta
{"title":"Takotsubo Syndrome Development Immediately Following Hemodialysis Initiation.","authors":"Ryo Kurose, Yu Mihara, Asuka Fujikita, Kenji Matsumoto, Masashi Nakamura, Ayumi Ogata, Asuka Yamauchi, Tomoharu Ida, Hiroshi Kado, Tsuguru Hatta","doi":"10.2169/internalmedicine.3983-24","DOIUrl":"10.2169/internalmedicine.3983-24","url":null,"abstract":"<p><p>We herein report a case of Takotsubo syndrome in an 80-year-old woman with end-stage renal disease who hesitated to initiate hemodialysis for pulmonary edema. On hospital day 2, the patient experienced cardiac arrest. Coronary angiography after spontaneous return of circulation showed no substantial stenosis. Takotsubo syndrome was diagnosed based on echocardiography findings. On hospital day 3, she developed ventricular fibrillation but was spontaneously resuscitated. Patients with chronic kidney disease and those who postpone dialysis initiation may be at an increased risk of developing Takotsubo syndrome. Early and careful monitoring and adequate shared decision-making are essential for seamless initiation of dialysis.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"851-856"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901648","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}
引用次数: 0
Primary Aldosteronism and Hypokalemia-induced Rhabdomyolysis in a Patient with Aldosterone-producing Adenoma: A Case Report and Literature Review. 一名醛固酮生成腺瘤患者的原发性醛固酮增多症和低钾血症引发的横纹肌溶解症：病例报告和文献综述。
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 Epub Date: 2024-08-10 DOI: 10.2169/internalmedicine.3629-24
Nobumasa Ohara, Takashi Tani, Kenshi Terajima, Tetsutaro Ozawa, Yuichiro Yoneoka, Hiroki Shimada, Yasuhiro Nakamura, Go Hasegawa, Tsutomu Nishiyama
{"title":"Primary Aldosteronism and Hypokalemia-induced Rhabdomyolysis in a Patient with Aldosterone-producing Adenoma: A Case Report and Literature Review.","authors":"Nobumasa Ohara, Takashi Tani, Kenshi Terajima, Tetsutaro Ozawa, Yuichiro Yoneoka, Hiroki Shimada, Yasuhiro Nakamura, Go Hasegawa, Tsutomu Nishiyama","doi":"10.2169/internalmedicine.3629-24","DOIUrl":"10.2169/internalmedicine.3629-24","url":null,"abstract":"<p><p>Many cases of primary aldosteronism (PA) in patients who developed hypokalemia-induced rhabdomyolysis and underwent adrenalectomy for aldosterone-producing adenoma (APA) have been reported; however, the immunohistopathological and molecular features remain unknown. We herein report the case of a 28-year-old woman with PA who presented with hypokalemia-induced rhabdomyolysis and underwent adrenalectomy for unilateral APA. An immunohistochemical analysis revealed that most adenoma cells were positive for steroidogenic enzymes, including CYP11B2. A genetic analysis revealed a somatic mutation in the KCNJ5. These findings suggest a strong aldosterone production capacity in our patient's adenoma, which was presumably related to her severe hyperaldosteronism and the resultant hypokalemia-induced rhabdomyolysis.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"871-879"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971050","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}
引用次数: 0
Efgartigimod Successfully Ameliorated Acute Exacerbation of Myasthenia Gravis with Anti-muscle-specific Kinase Antibodies. 依夫加替莫德成功地改善了伴有抗肌肉特异性激酶抗体的肌无力 Gravis 急性加重症状
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 Epub Date: 2024-08-08 DOI: 10.2169/internalmedicine.3726-24
Koya Tanaka, Masaaki Yoshikawa, Yukako Inoue, Keisuke Tsumura, Yuki Hoshino, Chika Shichijo, Toshihiro Ide, Kohei Suzuyama, Haruki Koike
{"title":"Efgartigimod Successfully Ameliorated Acute Exacerbation of Myasthenia Gravis with Anti-muscle-specific Kinase Antibodies.","authors":"Koya Tanaka, Masaaki Yoshikawa, Yukako Inoue, Keisuke Tsumura, Yuki Hoshino, Chika Shichijo, Toshihiro Ide, Kohei Suzuyama, Haruki Koike","doi":"10.2169/internalmedicine.3726-24","DOIUrl":"10.2169/internalmedicine.3726-24","url":null,"abstract":"<p><p>We herein report two patients with anti-muscle-specific kinase (MuSK) antibody-positive myasthenia gravis who experienced rapid deterioration of weakness, particularly respiratory muscle weakness, necessitating non-invasive positive pressure ventilation (NIPPV) and were treated with efgartigimod. After treatment initiation, a rapid reduction in IgG levels and recovery from clinical symptoms were observed. NIPPV was no longer required two to three weeks after the first infusion of efgartigimod. These findings suggest that the reduction of IgG levels using efgartigimod is a good treatment option in patients with myasthenia gravis positive for anti-MuSK antibodies, even during the acute phase of the disease.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"925-929"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901642","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}
引用次数: 0
Cancer of Unknown Primary Presenting with Chylothorax. 一例原发灶不明的癌症伴有乳糜胸。
IF 1 4区 医学
Internal Medicine Pub Date : 2025-03-15 Epub Date: 2024-08-08 DOI: 10.2169/internalmedicine.3988-24
Emi Tanaka, Naohiro Oda, Tsuneyoshi Ogawa, Ichiro Takata, Masako Terao, Toru Ueki
{"title":"Cancer of Unknown Primary Presenting with Chylothorax.","authors":"Emi Tanaka, Naohiro Oda, Tsuneyoshi Ogawa, Ichiro Takata, Masako Terao, Toru Ueki","doi":"10.2169/internalmedicine.3988-24","DOIUrl":"10.2169/internalmedicine.3988-24","url":null,"abstract":"<p><p>A 56-year-old man presented to our hospital with dyspnea on exertion for two months. Bilateral pleural effusions were found, and a close examination revealed a chylothorax, including adenocarcinoma. The primary tumor could not be identified by systemic examination. Therefore, the patient was diagnosed with cancer of unknown primary (CUP) presenting with chylothorax. Chemotherapy was administered for CUP, and thoracentesis, pleurodesis, ascites puncture, and nutritional therapy were performed for chylothorax and chylous ascites. Although drainage frequency and tumor marker levels (CA19-9, DUPAN-2, and Span-1) temporarily decreased, disease control deteriorated, and the patient died 12 months after the initial diagnosis.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"887-891"},"PeriodicalIF":1.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901637","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}
引用次数: 0
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