{"title":"An Autopsy Case of Varicella-zoster Virus Uveitis Progressing to Vasculopathy with Multiple Cerebral Infarctions.","authors":"Hiroaki Ando, Yuichi Kawagashira, Jun-Ichi Niwa, Akio Akagi, Manabu Doyu","doi":"10.2169/internalmedicine.4511-24","DOIUrl":"10.2169/internalmedicine.4511-24","url":null,"abstract":"<p><p>We herein report an autopsy case of multiple cerebral infarctions caused by varicella-zoster virus (VZV) vasculopathy. A 60-year-old man, previously diagnosed with VZV uveitis, subsequently developed cerebral infarction with multiple cerebral vessel stenoses. Based on the results of a polymerase chain reaction test of cerebrospinal fluid, the patient was diagnosed with VZV vasculopathy. Despite treatment with acyclovir and prednisolone, the vascular stenosis progressed and became complicated by extensive cerebral infarctions. Upon autopsy, inflammatory cell infiltration was pathologically observed in the vessel walls of the anterior and middle cerebral arteries, consistent with the magnetic resonance imaging findings.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2774-2778"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Plasma Cell-rich Nephritis with a Systemic Polyclonal Lymphoproliferative Disorder, Mimicking Idiopathic Multicentric Castleman Disease, Systemic Lupus Erythematosus, and IgG4-related Disease.","authors":"Yu Hebisawa, Akihito Ohta, Ryutaro Sekimoto, Natsuko Sakurai, Keigo Setoguchi","doi":"10.2169/internalmedicine.4906-24","DOIUrl":"10.2169/internalmedicine.4906-24","url":null,"abstract":"<p><p>Idiopathic multicentric Castleman disease (iMCD), systemic lupus erythematosus (SLE), and IgG4-related disease (IgG4-RD) can cause lymphadenopathy with renal involvement. As no gold standards have been set for diagnosing these conditions, diagnoses can be made by excluding other conditions. However, some cases are difficult to identify. A 60-year-old man presented with lymphadenopathy, renal dysfunction, and hypocomplementemia. Autoimmune pancreatitis and iMCD had been suspected. A renal biopsy revealed immune complex-mediated glomerulonephritis superimposed on endothelial injury and plasma cell-rich tubulointerstitial nephritis with storiform-like fibrosis. While the features of iMCD, SLE, and IgG4-RD were present, a clear classification could not be achieved.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2747-2754"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Usefulness of Repeated Lusutrombopag Administration in Clinical Practice and Its Correlation with the Simulation Software-Predicted Platelet Count: A Multicenter Study.","authors":"Takushi Manabe, Chikara Ogawa, Takashi Tamada, Naoki Yoshioka, Takehiro Akahane, Hideki Fujii, Hirotaka Arai, Kei Takuma, Mai Nakahara, Kyoko Oura, Tomoko Tadokoro, Koji Fujita, Joji Tani, Asahiro Morishita, Hideki Kobara, Shinichiro Nakamura, Hironori Ochi, Shintaro Takaki, Nami Mori, Keiji Tsuji, Masayuki Kurosaki, Namiki Izumi","doi":"10.2169/internalmedicine.4822-24","DOIUrl":"10.2169/internalmedicine.4822-24","url":null,"abstract":"<p><p>Objective Lusutrombopag is recommended for severe thrombocytopenia (<5.0×10<sup>4</sup>/μL) in patients with chronic liver disease who are scheduled to undergo invasive procedures. However, reports on the efficacy of repeated lusutrombopag dosing are scarce. It is also not known whether lusutrombopag causes the platelet count to exceed 5.0×10<sup>4</sup>/μL. We evaluated the efficacy of repeated lusutrombopag dosing and the efficacy of the platelet prediction simulation software program. Methods We evaluated the number of platelet elevations according to the number of lusutrombopag administrations. We also evaluated the correlation between the highest software-predicted platelet count and the platelet count measured in actual clinical practice. Patients This retrospective study included 236 patients treated with lusutrombopag at 11 medical institutions in Japan. Results The platelet count increased with the number of lusutrombopag administrations (1, 2, 3, 4, >4) in all groups, and no significant difference was found among the groups (p=0.169). In all groups, the platelet counts reached their highest levels at 8-14 days after treatment with lusutrombopag (p=0.243). There was a correlation between the highest software-predicted platelet count and the platelet count measured in actual clinical practice in all dose frequency groups; however, the correlation was the strongest in the one-dose group (r=0.74, p<0.0001). Conclusion Frequent lusutrombopag administration is therefore both effective and safe, and a platelet prediction simulation software program is thus considered to be useful in practice.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2692-2698"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Inherited Prion Disease with a 5-octapeptide Repeat Insertion in the PRNP Gene Presenting with Familial Juvenile Dementia.","authors":"Masafumi Nishikawa, Akitoshi Takeda, Naotaka Miyazawa, Norikazu Hara, Kazunari Ishii, Takeshi Ikeuchi, Yoshiaki Itoh","doi":"10.2169/internalmedicine.5143-24","DOIUrl":"10.2169/internalmedicine.5143-24","url":null,"abstract":"<p><p>A 47-year-old man with a family history of juvenile dementia in his mother presented with memory loss and cognitive decline. Neuropsychological tests revealed impaired orientation, working memory, and apraxia. Magnetic resonance imaging revealed diffuse brain atrophy, and fluorodeoxyglucose positron emission tomography (PET) showed hypometabolism in the bilateral parietal lobes, posterior cingulate gyri, and precuneus, suggestive of Alzheimer's disease. However, amyloid-beta and tau PET scans were negative. Genetic testing revealed an abnormal repeat insertion in the prion protein gene, confirming inherited prion disease. This case highlights the need to consider inherited prion disease in the differential diagnosis of early-onset familial dementia.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2769-2773"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stationary Oxygen Concentrator with Built-in Respiratory Rate Monitor: Clinical Validation of Its Efficacy in Patients with Interstitial Lung Disease and Chronic Obstructive Pulmonary Disease.","authors":"Satoshi Hamada, Tomohiro Handa, Kimihiko Murase, Naoya Tanabe, Yoshinari Nakatsuka, Kohei Ikezoe, Hironobu Sunadome, Susumu Sato, Atsuyasu Sato, Toyohiro Hirai","doi":"10.2169/internalmedicine.5012-24","DOIUrl":"10.2169/internalmedicine.5012-24","url":null,"abstract":"<p><p>Objective The respiratory rate (RR) can be monitored continuously using a HiSanso<sup>®</sup>i, a stationary oxygen concentrator with a built-in respiratory sensor. To examine the efficacy of this device, we compared its performance with that of polysomnography in inpatient settings and the home sleep apnea test (HSAT) in residential settings for patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). Methods The oxygen flow rate was set at 1, 3, and 5 L/min in inpatient settings and 1-3 L/min (conditions similar to the home surroundings) in residential settings. Intraclass correlation coefficients (ICCs) (2,1) were calculated to determine the agreement between the RR measured with the HiSanso<sup>®</sup>i and that measured with polysomnography or the HSAT. The minimum acceptable reliability level is 0.7. Results In total, 14 (10 with ILD and 4 with COPD) and 5 (all with ILD) patients were assessed in inpatient and residential settings, respectively. In inpatient settings, the detection rate of patients' respiration measured with the HiSanso<sup>®</sup>i was 77.0% and 73.3% in patients with ILD and COPD, respectively. At oxygen flow rates of 1, 3, and 5 L/min, the ICCs (2,1) were 0.91, 0.85, and 0.91, respectively, for patients with ILD and 0.96, 0.90, and 0.74, respectively, for patients with COPD. In residential settings, the detection rate of patients' respiration measured with the HiSanso<sup>®</sup>i was 86.6%, and the ICC (2,1) was 0.97. Conclusion The HiSanso<sup>®</sup>i accurately monitored the RR without any additional devices, independent of oxygen flow rates or disease status.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2708-2715"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delayed Methotrexate Elimination Following High-dose Methotrexate Prophylaxis in High-risk Diffuse Large B-cell Lymphoma.","authors":"Masahiro Akimoto, Takuya Miyazaki, Hiroyuki Takahashi, Takaaki Takeda, Yuto Hibino, Mayumi Tokunaga, Takuma Ohashi, Ayako Matsumura, Haruka Teshigawara, Taisei Suzuki, Hiroshi Teranaka, Yuki Nakajima, Kenji Matsumoto, Chizuko Hashimoto, Katsumichi Fujimaki, Hiroyuki Fujita, Rika Sakai, Shin Fujisawa, Hideaki Nakajima","doi":"10.2169/internalmedicine.4999-24","DOIUrl":"10.2169/internalmedicine.4999-24","url":null,"abstract":"<p><p>Objective High-dose methotrexate (HD-MTX) is widely used as central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL) who are at a high risk of CNS relapse. Ensuring safe prophylactic administration with minimal adverse events is a key concern; however, few studies have detailed the safety profile of HD-MTX prophylaxis in patients with high-risk DLBCL. We analyzed the adverse events associated with HD-MTX in this population, focusing on delayed MTX elimination. Methods This multicenter retrospective study included 98 patients with DLBCL at high risk of CNS relapse who received HD-MTX as part of frontline therapy between 2014 and 2020. CNS prophylaxis involved 2 cycles of HD-MTX (3.0 g/m<sup>2</sup>) at 2-week intervals. Results The median age at the diagnosis was 63 (34-84) years old, and 34 patients received a reduced methotrexate (MTX) dose. The overall incidence of delayed MTX elimination was 18.4%. No cases of delayed MTX elimination were observed in the group that received a 3-h MTX infusion (n=50). Toxicities were more frequent in patients with delayed MTX elimination than in those without (77.8% vs. 26.2%, p≤0.05), including higher incidences of grade ≥3 adverse events and grade ≤2 renal dysfunction. Conclusion Delayed MTX elimination is associated with increased complications. Shorter MTX infusion rates, particularly at 3 h, may reduce the risk of delayed MTX elimination.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2716-2722"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Thyrotoxicosis and Excess Iodine Due to Habitual Use of Polyvinylpyrrolidone Iodine While Gargling in an Iodine-sufficient Area.","authors":"Kanako Sato, Hiroaki Asai, Saori Yoshioka, Keisuke Murakawa, Hiroyuki Sho, Ryoko Inui, Motohiro Kosugi, Yoji Hazama, Tetsuyuki Yasuda","doi":"10.2169/internalmedicine.4868-24","DOIUrl":"10.2169/internalmedicine.4868-24","url":null,"abstract":"<p><p>Excess iodine can influence the pathophysiology of the thyroid gland and results of various thyroid-related examinations. We herein report a 60-year-old Japanese man with thyrotoxicosis and excess iodine due to habitual use of polyvinylpyrrolidone iodine (PVP-I) to gargle for 20 years. Initial laboratory and imaging findings were suggestive of painless thyroiditis. However, after cessation of PVP-I use for gargling, these results changed to findings suggestive of Graves' disease, with worsening thyrotoxicosis. A detailed questionnaire regarding excess iodine is important for the accurate diagnosis of thyrotoxicosis, even in patients living in iodine-sufficient areas where iodine-induced thyrotoxicosis is rare.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2733-2739"},"PeriodicalIF":1.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Randomized Prospective Controlled Open-labeled Trial of Cyclosporine with/without Low-dose Oral Corticosteroids in Idiopathic Membranous Nephropathy in Adults with Nephrotic Syndrome.","authors":"Joichi Usui, Kouichi Hirayama, Masaki Kobayashi, Satoshi Suzuki, Itaru Ebihara, Kenta Nishiki, Kaori Mase, Aki Hirayama, Chie Saito, Michihiro Goto, Akio Koyama, Kunihiro Yamagata","doi":"10.2169/internalmedicine.4803-24","DOIUrl":"10.2169/internalmedicine.4803-24","url":null,"abstract":"<p><p>Objective We conducted a prospective, randomized controlled, open-label study to investigate the efficacy of a combination of cyclosporine and low-dose prednisolone in patients with idiopathic membranous nephropathy (IMN). Methods We recruited biopsy-proven IMN patients with nephrotic syndrome who had never been treated with immunosuppressants. The patients were randomized into 2 groups treated after randomization with cyclosporine (3 mg/kg/day) alone or with an oral low-dose corticosteroid (prednisolone 15 mg/day) for 24 months. Results We recruited 30 patients with IMN and nephrotic-range proteinuria, 28 of whom were included in this study. Fourteen patients were randomized for treatment with only cyclosporine (Group A), and 14 were randomized for treatment with cyclosporine plus low-dose corticosteroids (Group B). Cyclosporine monotherapy induced remission in 12 of the 14 patients in Group A, including partial remission in 7 patients (50.0%) and complete remission in 5 patients (36.7%). In Group B, 12 of 14 patients achieved proteinuria remission, including 11 (78.6%) with complete remission and 1 (7.1%) with partial remission. Although there was no marked difference in the overall remission rate, the complete remission rate was significantly higher in Group B than in Group A (p=0.02). Furthermore, there was a statistically significant difference between the groups in the time from the start of the study to complete remission (10.2±7.8 months in Group A; 9.5±6.1 months in Group B, p=0.03). Conclusion The combination of cyclosporine and low-dose corticosteroid treatment is an effective and important option in the management of patients with IMN with nephrotic-range proteinuria, either as an initial therapy or as a long-term treatment.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2541-2548"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Internal MedicinePub Date : 2025-09-01Epub Date: 2025-05-21DOI: 10.2169/internalmedicine.4790-24
Takayuki Yamaji, Aya Mizobuchi, Yukihito Higashi
{"title":"Detection of Four Cases of Familial Hypercholesterolemia during a Workers' Compensation Insurance Secondary Health Examination.","authors":"Takayuki Yamaji, Aya Mizobuchi, Yukihito Higashi","doi":"10.2169/internalmedicine.4790-24","DOIUrl":"10.2169/internalmedicine.4790-24","url":null,"abstract":"<p><p>Familial hypercholesterolemia (FH), a genetic disorder characterized by the early onset of coronary artery disease, is found in one of 300 people. In the 2022 Japanese FH guidelines, a cut-off value for Achilles tendon thickness measured using ultrasound has been added, enabling the diagnosis of FH during a Workers' Compensation Insurance Secondary Health Examination. In individuals for whom the possibility of FH could not be ruled out based on low-density lipoprotein cholesterol levels, we measured the Achilles tendon thickness by ultrasound and found four cases of FH. The detection of FH in asymptomatic workers is crucial for long-term cardiovascular risk management.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2610-2614"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}