{"title":"Inappropriate Therapy of Subcutaneous Implantable Cardioverter-Defibrillator Induced by an Electrical Bath.","authors":"Motohiro Shingu, Tatsuya Nishikawa, Ryouta Yoshioka, Go Nakano, Atsushi Iseki, Tatsuya Matsubara, Yuya Oga, Hibiki Kadohara, Yuto Osumi, Kenta Ishibashi, Mana Hiraishi, Mitsuo Kinugasa, Yasutaka Hirayama, Koichi Tamita","doi":"10.2169/internalmedicine.6607-25","DOIUrl":"10.2169/internalmedicine.6607-25","url":null,"abstract":"<p><p>We describe the case of a 73-year-old man who had a subcutaneous implantable cardioverter-defibrillator (S-ICD) implanted for the secondary prevention of ventricular fibrillation. He received inappropriate shock therapy for S-ICD while using a Japanese electric bath (denki buro). The records of S-ICDs obtained by device interrogation showed that inappropriate therapy was induced by electric waves in the bath. S-ICDs might be more sensitive than transvenous ICD because of the nature of the anatomic position of the electrode. Patients should therefore be carefully educated regarding the risk of inappropriate S-ICD therapy induced by the use of electric baths.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2705-2709"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takeru Ichikawa, Kenichiro Kudo, Yuki Takigawa, Tomoya Osedo, Yuto Sasano, Toki Kitano, Jun Nishimura, Hiromi Watanabe, Ken Sato, Keiichi Fujiwara
{"title":"Favorable Response to Chemotherapy with Durvalumab Plus Tremelimumab in Two Cases of KRAS G12C-positive Pulmonary Sarcomatoid Carcinoma.","authors":"Takeru Ichikawa, Kenichiro Kudo, Yuki Takigawa, Tomoya Osedo, Yuto Sasano, Toki Kitano, Jun Nishimura, Hiromi Watanabe, Ken Sato, Keiichi Fujiwara","doi":"10.2169/internalmedicine.6660-25","DOIUrl":"10.2169/internalmedicine.6660-25","url":null,"abstract":"<p><p>Pulmonary sarcomatoid carcinoma (PSC) and Kirsten rat sarcoma viral oncogene homologue (KRAS) mutations are poor prognostic factors in non-small cell lung cancer. We report two cases of metastatic KRAS G12C-positive PSC in men (aged 69 and 66 years). Both patients were treated with chemotherapy combined with durvalumab and tremelimumab (POSEIDON regimen). They thereafter achieved excellent clinical outcomes, including complete and partial responses, with sustained benefits. The POSEIDON regimen may represent a potent therapeutic option for this rare patient population with multiple negative prognostic factors.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2726-2731"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Prevalence and Clinical Characteristics of Atrial Fibrillation and Reflux Esophagitis Among Individuals Undergoing Health Checkups.","authors":"Kyoichi Adachi, Norihisa Ishimura, Yuko Miki, Kanako Kishi, Utae Sakamoto, Eiko Okimoto, Yuko Matsubara, Madoka Furuta, Nobuhide Watanabe, Shunji Ishihara","doi":"10.2169/internalmedicine.8127-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.8127-26","url":null,"abstract":"<p><p>Objective To examine the association between atrial fibrillation (AF) and reflux esophagitis (RE).Methods A total of 5,205 adults (3,262 men, 1,943 women; mean age, 54.9±9.8 years) who underwent esophagogastroduodenoscopy (EGD) as part of a routine health checkup were enrolled in this study. AF was defined as AF detected on electrocardiography during the checkup and/or a documented history of the condition. RE was assessed endoscopically according to the Los Angeles classification. The smoking history, habitual alcohol consumption, and use of acid-suppressive agents were also assessed.Results AF was observed in 36 participants (0.7%). Compared with those without AF, participants with AF were more likely to be male, older, have a higher body mass index, and have a history of smoking and acid-suppressive agent use. After excluding participants receiving acid-suppressive medications, RE was significantly more prevalent in patients with AF than in those without AF (39.1% vs. 22.0%, p=0.049). The prevalence of AF was 0.9% among patients with RE and 0.4% among those without RE. However, multiple logistic regression analysis indicated that RE was not independently associated with AF after adjusting for sex, age, and other clinical factors.Conclusion AF may be associated with RE in individuals undergoing routine health checkups. However, this association was attenuated after adjustment for sex, age, and other clinical factors, suggesting that it may be largely explained by shared confounding factors.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yusaku Yokotani, Hiroaki Kitae, Kyoka Ozawa, Mika Mazaki, Hoshu Kurebayashi, Koki Yamamoto
{"title":"Endoscopic Submucosal Dissection as a Diagnostic and Minimally Invasive Therapeutic Excision Modality for Primary Anorectal Malignant Melanoma.","authors":"Yusaku Yokotani, Hiroaki Kitae, Kyoka Ozawa, Mika Mazaki, Hoshu Kurebayashi, Koki Yamamoto","doi":"10.2169/internalmedicine.6841-25","DOIUrl":"10.2169/internalmedicine.6841-25","url":null,"abstract":"<p><p>Primary anorectal malignant melanoma is a rare mucosal malignancy with nonspecific symptoms, frequent misdiagnoses, delayed treatment, and the lack of an established standard therapeutic strategy are the reasons for a poor prognosis. Diagnostic challenges are further compounded by the low rate of preoperative histological confirmation, especially for amelanotic lesions. Given its poor prognosis, performing a less invasive resection is crucial. We herein report the case of an 82-year-old male patient who underwent endoscopic submucosal dissection as a total biopsy and was treated with immune checkpoint inhibitors as adjuvant therapy.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2690-2694"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Double Mutations in the FLNA and MYH11 Genes Causing Familial Thoracic Aortic Aneurysm and Dissection: A Report of Two Cases.","authors":"Nobuhiro Ogasawara, Wakana Sato, Hiroko Morisaki, Hiroyuki Watanabe","doi":"10.2169/internalmedicine.6761-25","DOIUrl":"10.2169/internalmedicine.6761-25","url":null,"abstract":"<p><p>In some cases, familial thoracic aortic aneurysm and dissection is caused by multiple gene mutations. A 36-year-old woman (Patient 1) experienced acute aortic dissection requiring emergency surgery. Eight years later, her child (Patient 2) was diagnosed with an aortic aneurysm, and head magnetic resonance imaging revealed periventricular nodular heterotopia, thus prompting genetic testing to identify possible mutations in the FLNA and MYH11 genes. Subsequently, Patient 1 underwent genetic testing, which revealed the same mutations. Double mutations in FLNA and MYH11 can lead to aortic aneurysms and aortic dissection, while often manifesting at a young age.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2700-2704"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147278153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takehiro Okuda, Yuta Hanyu, Hana Mineshige, Yuta Inoue, Maki Sakurada, Masashi Matsui, Naomi Katsuki, Makoto Iwasaki, June Takeda, Junya Kanda, Yasuhito Nannya, Seishi Ogawa, Akifumi Takaori-Kondo, Yasuko Miyahara, Mitsuru Itoh
{"title":"Severe Aplastic Anemia Concurrent with Lymphoplasmacytic Lymphoma/Waldenström's Macroglobulinemia.","authors":"Takehiro Okuda, Yuta Hanyu, Hana Mineshige, Yuta Inoue, Maki Sakurada, Masashi Matsui, Naomi Katsuki, Makoto Iwasaki, June Takeda, Junya Kanda, Yasuhito Nannya, Seishi Ogawa, Akifumi Takaori-Kondo, Yasuko Miyahara, Mitsuru Itoh","doi":"10.2169/internalmedicine.6790-25","DOIUrl":"10.2169/internalmedicine.6790-25","url":null,"abstract":"<p><p>A 79-year-old female presented with progressive dyspnea. A bone marrow biopsy revealed hypoplastic marrow with abnormal lymphoid cells. A genetic analysis revealed a MYD88 p.V204F mutation, supporting the diagnosis of lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia (LPL/WM). Additional evaluations established a concomitant diagnosis of aplastic anemia (AA). Treatment prioritized AA with cyclosporine and eltrombopag. Subsequently, the LPL/WM was treated with rituximab monotherapy. This sequential treatment resulted in a symptomatic improvement. Although AA is a diagnosis of exclusion, its coexistence with lymphoma is rare. This case highlights the diagnostic and therapeutic complexity of AA and LPL/WM overlap and suggests that prioritizing the treatment of AA may lead to better outcomes.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2743-2749"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atypical Subacute Thyroiditis without Thyroid Dysfunction: A Report of Two Cases.","authors":"Yuji Nagayama, Seigo Tachibana, Takashi Fukuda, Hiroyuki Yamashita","doi":"10.2169/internalmedicine.7012-25","DOIUrl":"10.2169/internalmedicine.7012-25","url":null,"abstract":"<p><p>Subacute thyroiditis (SAT) is a painful inflammation of the thyroid that causes transient thyrotoxicosis, followed by hypothyroidism and an eventual recovery. We report two atypical cases of SAT that presented with anterior neck pain, tender thyroid nodules, elevated inflammatory markers, and characteristic ultrasound findings, all suggestive of SAT, but who remained euthyroid throughout their courses. The serum thyroglobulin level increased in one case. These cases demonstrate rare euthyroid presentations of SAT despite not meeting the current diagnostic criteria for SAT established by the Japan Thyroid Association, and underscore that normal thyroid function tests do not exclude this diagnosis.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2710-2714"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pulmonary Cryptococcosis Mimicking Lung Metastasis in a Patient with Pancreatic Cancer: A Case Report and Review of the Literature.","authors":"Kaho Uesugi, Reiko Yamada, Yoshifumi Nakamura, Yasuaki Shimada, Minako Urata, Takamitsu Tanaka, Kenji Nose, Tetsuro Miwata, Hayato Nakagawa","doi":"10.2169/internalmedicine.6722-25","DOIUrl":"10.2169/internalmedicine.6722-25","url":null,"abstract":"<p><p>Pulmonary cryptococcosis is a fungal infection that mimics metastatic lung tumors. A man with pancreatic head cancer and liver metastases harboring a germline BRCA2 mutation received FOLFOX chemotherapy. Despite a favorable response from the primary tumor and a decline in the CA19-9 levels, a rapidly enlarging solitary pulmonary nodule appeared. Because of the discordance between the response of the primary tumor and the lung nodule, thoracoscopic partial lung resection was performed for a definitive diagnosis, which confirmed pulmonary cryptococcosis. Postoperatively, fluconazole was administered without recurrence and systemic chemotherapy was resumed. Early histopathological confirmation is crucial to make an accurate diagnosis and select the appropriate management.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2738-2742"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Embolic Ischemic Stroke Associated with Maintenance Intravenous Immunoglobulin Therapy.","authors":"Ryoji Miyano, Yu Yoshida, Kazuki Fujita, Yuka Hayashi, Yoshio Sakiyama","doi":"10.2169/internalmedicine.6976-25","DOIUrl":"10.2169/internalmedicine.6976-25","url":null,"abstract":"<p><p>We describe the case of a 51-year-old man who experienced an embolic ischemic stroke during long-term maintenance of intravenous immunoglobulin (IVIG) therapy for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). At 43 years of age, he was diagnosed with CIDP and had tolerated IVIG well. Immediately after completing the 112th infusion, he exhibited acute right-hand clumsiness. Brain magnetic resonance imaging revealed an acute embolic infarction, and neither risk factors for ischemic stroke nor alternative embolic sources were identified. Although IVIG is generally considered safe, this case highlights that embolic stroke may occur even in relatively younger, low-risk patients during uneventful maintenance IVIG therapy, warranting continued vigilance.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2758-2762"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147278144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}