Internal MedicinePub Date : 2025-08-15Epub Date: 2025-02-08DOI: 10.2169/internalmedicine.4791-24
Takashi Ozaki, Chiharu Imada, Kohei Shirakami, Tasuku Abe, Yuta Shingai, Tatsuhito Umeki, Akihiro Fukuda, Koji Ishii, Hirotaka Shibata
{"title":"Serum Soluble Interleukin-2 Receptor as a Potential Marker for Assessing Disease Activity in the TAFRO Subtype of Idiopathic Multicentric Castleman Disease.","authors":"Takashi Ozaki, Chiharu Imada, Kohei Shirakami, Tasuku Abe, Yuta Shingai, Tatsuhito Umeki, Akihiro Fukuda, Koji Ishii, Hirotaka Shibata","doi":"10.2169/internalmedicine.4791-24","DOIUrl":"10.2169/internalmedicine.4791-24","url":null,"abstract":"<p><p>Idiopathic multicentric Castleman disease (iMCD) accompanied by thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal insufficiency, and organomegaly (TAFRO) frequently develops into prolonged severe thrombocytopenia and multiorgan dysfunction, which is associated with a high mortality rate. We herein describe three cases of iMCD-TAFRO in which serum soluble interleukin-2 receptor (sIL-2R) levels varied in relation to disease activity following the initiation of treatment. Thrombocytopenia persisted for several weeks to months after the normalization of the patients' C-reactive protein levels, whereas their sIL-2R levels normalized 10-47 days prior to platelet recovery (≥100×10<sup>9</sup>/L). The serum sIL-2R measurement may therefore be an effective method for evaluating the disease activity in iMCD-TAFRO patients with prolonged thrombocytopenia.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2500-2505"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382539","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":"Helicobacter pylori-positive Colorectal MALT Lymphoma with Repeated Metachronous Recurrence after a Complete Response to Eradication Therapy and Regression after a Watch-and-wait Strategy.","authors":"Daisuke Shimizu, Hidehiko Takigawa, Yuki Kitadai, Misa Ariyoshi, Ryo Miyamoto, Yuichi Hiyama, Yuji Urabe, Akira Ishikawa, Toshio Kuwai, Shiro Oka","doi":"10.2169/internalmedicine.4907-24","DOIUrl":"10.2169/internalmedicine.4907-24","url":null,"abstract":"<p><p>A 77-year-old man underwent a colonoscopy. A submucosal cecal tumor was found, and localized colorectal MALT lymphoma (Lugano stage I) was diagnosed with a Helicobacter pylori infection. The first-line eradication therapy was successful, and the cecal lesion regressed. However, a new lesion was observed in the lower rectum. The rectal lesion regressed after the second-line eradication therapy. Two new lesions were identified in the sigmoid colon. However, no additional treatment was administered and a watch-and-wait strategy was adopted. Both of the lesions regressed. There are no established treatments for colorectal MALT lymphomas. The watch-and-wait strategy may be effective in cases of recurrence after eradication therapy.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2452-2457"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457929","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":"Hepatic Sarcoidosis Mimicking a Metastatic Tumor.","authors":"Naohiro Nakamura, Yoshiki Matsuno, Kazunori Aoi, Hisashi Kosaka, Sanshiro Kobayashi, Yu Takahashi, Tomomitsu Tahara, Yuri Noda, Koji Tsuta, Makoto Naganuma","doi":"10.2169/internalmedicine.4528-24","DOIUrl":"10.2169/internalmedicine.4528-24","url":null,"abstract":"<p><p>Although the liver is often involved in sarcoidosis, the majority of patients are asymptomatic and have a normal liver function; therefore, hepatic sarcoidosis may sometimes not be recognized in clinical practice. Radiologically, most hepatic nodules show hypoenhancement on contrast-enhanced computed tomography or magnetic resonance imaging (MRI) and they are hypointense across all sequences of MRI. In this case, hepatic nodules were slightly hyperintense on T2-weighted images and contrasted from the early phases on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid. We faced difficulties in distinguishing hepatic sarcoidosis from metastatic liver tumors with concurrent duodenal adenocarcinomas. Consequently, this case was diagnosed based on the pathological findings from a laparoscopic lateral segment hepatectomy.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2439-2445"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457932","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":"Post-Transplant Lymphoproliferative Disorder Which Developed 45 Years After Kidney Transplantation.","authors":"Nobuaki Nishima, Yoshifumi Hamasaki, Giyoung Kwoun, Yosuke Hirakawa, Akira Chiba, Yuki Horiguchi, Kensuke Fukuda, Masaomi Nangaku","doi":"10.2169/internalmedicine.4828-24","DOIUrl":"10.2169/internalmedicine.4828-24","url":null,"abstract":"<p><p>Post-transplant lymphoproliferative disorder (PTLD) affects from 0.8-2.5% of kidney transplant patients, with peaks in incidence within 1 year and 10-14 years post-transplant. Very late-onset PTLD (VL-PTLD) can occur over 10 years post-transplant, reportedly up to 30 years, but its characteristics remain unclear. A 61-year-old man developed PTLD 45 years after kidney transplant, presenting with fever and shortness of breath. Computed tomography revealed lung and liver masses and biopsy-confirmed stage IVB monomorphic PTLD. Despite obtaining an initial improvement, the patient died on day 66. VL-PTLD may differ from early- or late-onset PTLD, thus necessitating further research on both the associated risks and management.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2466-2471"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457962","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":"Acute Kidney Injury and Fanconi Syndrome Caused by a Red Yeast Rice Supplement.","authors":"Toshiki Doi, Akira Shimizu, Emi Morimoto, Kenichi Morii, Aiko Okubo, Sonoo Mizuiri, Yoshiko Nishizawa, Takao Masaki","doi":"10.2169/internalmedicine.4330-24","DOIUrl":"10.2169/internalmedicine.4330-24","url":null,"abstract":"<p><p>We herein report a case of acute kidney injury and Fanconi syndrome associated with a red yeast rice supplement. A 72-year-old woman's serum creatinine rose from 0.7 to 3.97 mg/dL after starting the supplement, accompanied by metabolic acidosis, proteinuria, hematuria, and glucosuria. A kidney biopsy showed proximal tubular injury without abundant tubulitis. Immunostaining showed dilated tubules that were positive for CD 10, confirming proximal tubule localization. Discontinuation of the supplement and steroid pulse therapy improved the patient's condition. This case highlights the health risks associated with unregulated dietary supplementation.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2472-2477"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491931","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":"Successful Switch to Afatinib and Osimertinib Rechallenge with Corticosteroids after Osimertinib-induced Interstitial Lung Disease: A Case Report and Literature Review.","authors":"Masaaki Yanai, Tomohiro Sakamoto, Naoki Uetani, Takafumi Nonaka, Tatsuya Nakada, Shuichi Matsuoka, Shiro Moriyama, Yasuhiko Teruya, Yoshihiro Funaki, Tomoya Harada, Naoki Kinoshita, Kosuke Yamaguchi, Masahiro Kodani, Akira Yamasaki","doi":"10.2169/internalmedicine.4877-24","DOIUrl":"10.2169/internalmedicine.4877-24","url":null,"abstract":"<p><p>Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are highly effective against EGFR-mutant non-small-cell lung carcinoma but can cause serious adverse events, such as interstitial lung disease (ILD). Treatment strategies for osimertinib-induced ILD are not well established. Cytotoxic anticancer drugs are considered first, although several cases of successful rechallenge with EGFR-TKIs have been reported. We herein report a 67-year-old woman with symptomatic osimertinib-induced ILD who was switched to afatinib and later rechallenged with osimertinib and corticosteroids. Neither treatment resulted in ILD relapse, suggesting that these may be viable treatment options when alternative treatments are limited.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2478-2483"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079890","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":"Concurrent Therapy for Immunoglobulin Light Chain Cardiac Amyloidosis and Transthyretin Cardiac Amyloidosis.","authors":"Yuichi Horigome, Shunsuke Ishii, Manabu Matsumoto, Yoshihiko Ikeda, Kinta Hatakeyama, Junya Ako, Takahiro Suzuki","doi":"10.2169/internalmedicine.4526-24","DOIUrl":"10.2169/internalmedicine.4526-24","url":null,"abstract":"<p><p>Cardiac amyloidosis (CA), predominantly caused by amyloid transthyretin (ATTR) or immunoglobulin light chain (AL), has a poor prognosis, and a precise diagnosis is crucial because the optimal treatments differ between the two conditions. However, diagnosing AL-CA is challenging because of the unavailability of effective AL-detecting antibodies, particularly in cases with coexisting AL- and ATTR-CA. This report presents a successfully diagnosed case of complicated AL- and ATTR-CA that was successfully treated with tafamidis for ATTR-CA and combination chemotherapy for AL-CA. This case highlights the importance of a precise diagnosis of CA and supports the efficacy and safety of concurrent treatment for coexisting amyloidosis.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2494-2499"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382532","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":"Hypercalcemia with the Oral Administration of Active Vitamin D3 and Chinese Herbal Medicine.","authors":"Natsuki Matsumoto, Miku Otomaru, Kumiko Asai, Kenji Hara, Takafumi Tsuchiya, Kohzo Takebayashi, Koshi Hashimoto","doi":"10.2169/internalmedicine.4431-24","DOIUrl":"10.2169/internalmedicine.4431-24","url":null,"abstract":"<p><p>The causes of hypercalcemia vary. There are high-calcium-containing preparations in Chinese herbal medicine, which may contribute to drug-induced hypercalcemia. We encountered a case of hypercalcemia following the simultaneous administration of an active vitamin D3 preparation and several Chinese herbal medicines. The patient had been treated at several medical institutions, with one institution administering eldecalcitol and another institution administering Keishikaryukotsuboreito, Borei powder, and Goreisan. The patient presented with drug-induced hypercalcemia due to an unexpected synergistic effect. Confirmation of prescriptions for patients with multiple medical visits and recognition of the components and side effects of Chinese herbal medicines is thus considered to be extremely important.</p>","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2458-2461"},"PeriodicalIF":1.1,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457918","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}