{"title":"A Transfusion-transmitted Chronic Hepatitis E Virus Infection after Allogeneic Bone Marrow Transplantation with Viral Clearance Following Immunosuppression Tapering.","authors":"Keijiro Sato, Hiroko Kazumoto, Ami Tanaka, Hidekatsu Sakata, Shunya Sunohara, Shintaro Kazama, Hiroko Kaiume, Hiromitsu Mori, Toshimitsu Ueki","doi":"10.2169/internalmedicine.6903-25","DOIUrl":"10.2169/internalmedicine.6903-25","url":null,"abstract":"<p><p>A hepatitis E virus (HEV) infection is typically self-limiting in immunocompetent individuals, but it may cause chronic persistent or fulminant hepatitis in immunocompromised hosts. We report the case of a 62-year-old woman with myelofibrosis who developed chronic hepatitis E due to transfusion-transmitted HEV genotype 3 infection after allogeneic bone marrow transplantation, which was confirmed by positivity for anti-HEV IgA and HEV RNA, as well as the viral RNA sequence identity between the transfusion donor and recipient. Liver dysfunction appeared two months after transfusion and worsened despite tacrolimus escalation for suspected graft-versus-host disease, but it resolved after tacrolimus tapering alone. Although foodborne transmission is common, transfusion and other unidentified sources can also cause an HEV infection. An HEV should be considered when a patient shows posttransplant liver dysfunction.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2680-2684"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358529","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":"Late-onset Acute Cellular Rejection after Lung Transplantation Triggered by a Fluctuation in the Tacrolimus Trough Level Which Was Successfully Treated with Steroid Pulse Therapy.","authors":"Ayaka Sugiura, Kensuke Kanaoka, Maiko Naito, Takashi Kanou, Takayuki Shiroyama, Kotaro Miyake, Haruhiko Hirata, Takahiro Matsui, Yoshito Takeda, Yasushi Shintani, Atsushi Kumanogoh","doi":"10.2169/internalmedicine.6307-25","DOIUrl":"10.2169/internalmedicine.6307-25","url":null,"abstract":"<p><p>Acute cellular rejection (ACR) usually develops within the first year of lung transplantation. We report a case of biopsy-proven ACR occurring 18 months post-transplant that was successfully treated with steroid pulse therapy and intensified immunosuppression. Onset followed azithromycin and clofazimine for Mycobacterium abscessus, which caused the tacrolimus trough levels to drop. The patient presented with dyspnea, diffuse ground-glass opacities, and reduced lung function. Although C4d staining was positive, the absence of donor-specific antibodies and histological findings supported the diagnosis of ACR. This case highlights the need for careful monitoring of tacrolimus trough levels and a comprehensive diagnostic workup to ensure the timely and appropriate treatment of late-onset rejection.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2732-2737"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483116","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":"Changes in Gait Speed During a 12-Month Multidisciplinary Obesity Management Program Including Semaglutide: A Real-World Observational Study in Japanese Adults With Musculoskeletal Disorders.","authors":"Masuomi Tomita, Fumiya Harashima, Naoto Takeda, Chikako Ishida, Kazuhito Nagasaki, Kyota Kikuchi, Katsuya Hisamichi","doi":"10.2169/internalmedicine.8145-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.8145-26","url":null,"abstract":"<p><p>Background Obesity is associated with musculoskeletal disorders, impaired mobility, and frailty. While semaglutide induces substantial weight loss, its effects on objectively measured physical function in routine clinical practice are unclear. We investigated the changes in gait speed and physical function during a multidisciplinary obesity management program that included semaglutide.Methods This retrospective observational study included 22 adults with obesity and musculoskeletal disorders who completed a 12-month multidisciplinary obesity management program. The program included nutritional counseling every two months, physical therapist-guided exercise intervention, and semaglutide treatment. The primary outcome was the usual gait speed. The secondary outcomes included body weight, pain score, step count, muscle function, and body composition.Results Body weight decreased significantly from 89.2±18.6 kg to 81.5±17.3 kg (p<0.001). Usual gait speed improved significantly from 0.77±0.20 m/s to 0.91±0.19 m/s (p<0.001). Pain scores also significantly improved (p<0.001). Improvements in gait speed were not associated with weight loss (r=0.22, p=0.32) or pain reduction (r=-0.04, p=0.84). Baseline gait speed was inversely associated with gait speed improvement (r=-0.44, p=0.043), indicating greater gains in participants with poorer baseline mobility.Conclusions A 12-month multidisciplinary obesity management program, including semaglutide, significantly improved gait speed in patients with obesity and musculoskeletal disorders. Greater improvements were observed in participants with impaired baseline mobility. These findings support the evaluation of obesity treatment not only by weight loss, but also by recovery of mobility.</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":"149187846","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}
Yuri Kawano, Toshitaka Kamon, Rika Hagihara, Nobuo Ito
{"title":"A Rare Case of Slowly Progressive Meningitis Caused by Streptococcus intermedius.","authors":"Yuri Kawano, Toshitaka Kamon, Rika Hagihara, Nobuo Ito","doi":"10.2169/internalmedicine.6465-25","DOIUrl":"10.2169/internalmedicine.6465-25","url":null,"abstract":"<p><p>This report describes a case of Streptococcus intermedius meningitis with an unusually gradual clinical course in an elderly patient with cancer. Such a subacute-to-chronic presentation has not been reported previously. Although S. intermedius meningitis typically involves intracranial suppuration, systemic imaging has revealed no abscesses or other infectious foci. The identification of this pathogen can be challenging in some clinical settings. In this patient, S. intermedius bacteremia was confirmed, whereas cerebrospinal fluid cultures were negative. However, a 16S rRNA gene analysis successfully identified S. intermedius in the cerebrospinal fluid. This case highlights the broad clinical manifestations of this reemerging pathogen and supports the utility of molecular diagnostic methods.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2763-2766"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483080","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":"Lung Cancer Initially Presenting with Diffuse Alveolar Damage and Brain Infarction: An Autopsy Case Report.","authors":"Taiki Ikeda, Yoshiaki Kinoshita, Masayo Yoshimura, Michiko Nakashima, Kengo Takata, Keita Hara, Chiharu Hirai, Takuhide Utsunomiya, Shota Nakashima, Hisako Kushima, Satoshi Nimura, Hiroshi Ishii","doi":"10.2169/internalmedicine.6806-25","DOIUrl":"10.2169/internalmedicine.6806-25","url":null,"abstract":"<p><p>A 67-year-old man presented with dyspnea, right hemiparesis, and dysarthria. Chest computed tomography revealed extensive pulmonary infiltrates and a small nodule in the left upper lobe. Brain magnetic resonance imaging revealed multiple acute cerebral infarctions. Despite comprehensive management, the patient died from progressive respiratory failure. Autopsy revealed pleomorphic carcinoma of the lung (pT1bN1M1c, pStage IVB), diffuse alveolar damage (DAD), and nonbacterial thrombotic endocarditis. To the best of our knowledge, this is the first report of lung cancer initially diagnosed based on the simultaneous presentation of DAD and cerebral infarction. The rarity and concurrence of these manifestations suggest a potential paraneoplastic link.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2720-2725"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483168","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":"Cerebral Attack With Cortical-Leptomeningeal Involvement and Seizures in AQP4-IgG-Positive Neuromyelitis Optica Spectrum Disorder.","authors":"Miyuki Miyamoto, Yuma Sato, Nobuyuki Ishii","doi":"10.2169/internalmedicine.7994-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7994-26","url":null,"abstract":"<p><p>Neuromyelitis optica spectrum disorder (NMOSD) rarely presents with corticalleptomeningeal involvement. A 47-year-old woman with aquaporin-4 immunoglobulin G (AQP4-IgG)-positive NMOSD developed acute headache, seizures, motor aphasia, and worsening right arm weakness. Brain magnetic resonance imaging revealed a tumefactive-appearing left frontal cortical-subcortical lesion with leptomeningeal enhancement. The clinical and radiological abnormalities improved after immunotherapy. This case illustrates a rare cerebral manifestation of AQP4-IgG-positive NMOSD with cortical-leptomeningeal involvement, seizures, and a tumefactive lesion.</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":"149187851","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}
Atsushi Furukawa, Hayato Tada, Kenji Sakata, Soichiro Usui, Masayuki Takamura
{"title":"Trends and Factors Associated with LDL-C Treatment Target Attainment Rates among Patients with Secondary Prevention Setting of Atherosclerotic Cardiovascular Disease: Assessments from Japanese Health Checkup Data.","authors":"Atsushi Furukawa, Hayato Tada, Kenji Sakata, Soichiro Usui, Masayuki Takamura","doi":"10.2169/internalmedicine.6925-25","DOIUrl":"10.2169/internalmedicine.6925-25","url":null,"abstract":"<p><p>Objective According to the latest Japanese Guidelines for the Prevention of Atherosclerotic Disease, the target for secondary prevention of low-density lipoprotein cholesterol (LDL-C) is <100 mg/dL in patients with coronary artery disease and <70 mg/dL in patients with acute coronary syndrome, familial hypercholesterolemia, diabetes, or atherothrombotic cerebral infarction. However, it is still unclear if the LDL-C treatment target attainment rates are in an upward trend and what are the factors associated with target attainment. This study aimed to investigate the trends and factors associated with LDL-C treatment target attainment. Methods Using the Health Checkup data in Kanazawa City in 2008, 2012, 2017, and 2022 (n = 38,146-51,969), we analyzed the trends of secondary prevention of LDL-C treatment target attainment rates using the Cochran-Armitage trend test and the factors associated with target attainment by a logistic regression analysis from the 2022 health examination. Results We found that the attainment rates showed a significant upward trend over time (p<0.001), and we also found that a male sex (odds ratio: 2.64, 95% confidence interval: 1.72-4.06, p<0.001) and several lifestyle factors, such as walking or any equivalent amount of physical activity for more than one hour a day, were significantly associated with LDL-C target attainment. Conclusion The LDL-C treatment target attainment rates tended to increase over time, and several factors were associated with LDL-C target attainment.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2666-2670"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147278137","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}
Miharu Yanagida, Yasushi Hosoi, Hisaya Hiramatsu, Michiko Ito
{"title":"A Case of Deep Cerebral Vein Thrombosis Which Is a Treatable Type of Dementia.","authors":"Miharu Yanagida, Yasushi Hosoi, Hisaya Hiramatsu, Michiko Ito","doi":"10.2169/internalmedicine.6932-25","DOIUrl":"10.2169/internalmedicine.6932-25","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2782-2783"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358523","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":"Effectiveness and Safety of Immunosuppressive Therapy in Recurrent Autoimmune Pancreatitis.","authors":"Yusuke Kurita, Kensuke Kubota, Ryusuke Yoshimi, Yuji Fujita, Emiko Tanida, Yu Honda, Takeshi Iizuka, Shin Yagi, Sho Hasegawa, Noritoshi Kobayashi, Masato Yoneda","doi":"10.2169/internalmedicine.6646-25","DOIUrl":"10.2169/internalmedicine.6646-25","url":null,"abstract":"<p><p>Objective Autoimmune pancreatitis (AIP) is a distinct type of chronic pancreatitis that responds well to glucocorticoid therapy. However, some patients experience frequent relapses or become glucocorticoid-dependent. In Western countries, immunosuppressive agents such as azathioprine are widely used to maintain remission. In contrast, evidence for the use of immunosuppressive agents for AIP is limited in Japan and other Asian countries. Therefore, this study aimed to evaluate the efficacy and safety of immunosuppressive agents in patients with refractory AIP. Methods We retrospectively analyzed 12 Japanese patients with type 1 AIP who experienced two or more documented relapses and received immunosuppressive therapy. Clinical remission, adverse events, and the incidence of malignancy were assessed. Results Among 199 patients with AIP treated between 2006 and 2024, 12 (6.0%) with multiple relapses were administered immunosuppressive agents, including azathioprine (n=9), tacrolimus (n=2), and methotrexate (n=1). Nine patients continued therapy for at least two months; of these, eight (88.9%) maintained clinical remission without relapse during treatment. One patient relapsed. However, three patients (25.0%) were unable to continue therapy due to adverse events. Two patients developed malignancies during the long-term follow-up: one with malignant lymphoma and the other with small cell lung cancer. Conclusion Immunosuppressive therapy may contribute to the maintenance of remission in some AIP patients with glucocorticoid-dependent or repeated relapses, even among Japanese patients. However, adverse events led to treatment discontinuation in 25% of patients, and two developed malignancies during follow-up. These findings underscore the need for careful patient selection, individualized risk-benefit evaluation, and ongoing monitoring.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2658-2665"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358518","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":"Salmonella Osteomyelitis with Cutaneous Fistula in an Immunocompetent Adult Presenting as a Tumor-like Bone Lesion.","authors":"Taito Sakurai, Kei Furui Ebisawa, Takashi Koyama, Goh Ohji, Kentaro Iwata","doi":"10.2169/internalmedicine.6800-25","DOIUrl":"10.2169/internalmedicine.6800-25","url":null,"abstract":"<p><p>Non-typhoidal Salmonella (NTS) commonly causes acute gastroenteritis. It can also lead to invasive infections such as osteomyelitis. However, these are rare occurrences in healthy individuals. A healthy Japanese man in his 30s presented with right leg pain and a cutaneous fistula that persisted for four months. NTS was identified in the bone culture. The patient was treated with ceftriaxone and de-escalated to ampicillin, followed by oral amoxicillin. This case demonstrates that chronic osteomyelitis caused by NTS can present as a cutaneous fistula. Furthermore, it underscores the importance of obtaining a bone culture to identify the causative organism and ensure an accurate diagnosis.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2767-2772"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483114","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}