Internal medicine (Tokyo, Japan)最新文献

{"title":"An Anti-NH2 Terminal of α-enolase Antibody-positive Hashimoto's Encephalopathy with Bilateral Basal Ganglia Lesions: A Case Report and Literature Review.","authors":"Yu Matsuda, Mitsuhiro Kainaga, Mizue Maeda, Hideki Kitao, Shinichi Tokushige, Ayumi Uchibori, Chizuko Oishi, Yaeko Ichikawa","doi":"10.2169/internalmedicine.5692-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5692-25","url":null,"abstract":"<p><p>Hashimoto's encephalopathy (HE) is a type of encephalopathy characterized by neuropsychiatric symptoms, high serum anti-thyroid antibody concentrations, and good responsiveness to immunotherapy. We herein report a rare case of HE with positive serum anti-NH2 terminal of α-enolase (NAE) antibodies and abnormal findings in the bilateral basal ganglia on brain magnetic resonance imaging (MRI). In cases presenting with isolated lesions in the basal ganglia, HE should not be excluded from the differential diagnosis, particularly when other causes are excluded and serum anti-thyroid antibodies are elevated. In such cases, testing for anti-NAE antibodies may aid in the diagnosis.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602793","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":"Efficacy of Azacitidine Plus Venetoclax in Acute Myeloid Leukemia Transformed from Myelodysplastic Syndrome after Failure of Azacitidine Monotherapy.","authors":"Takafumi Furumoto, Koji Ando, Eo Toriyama, Tomoko Hata, Shinichi Katsuoka, Saori Nishimura, Masamitsu Ichinose, Miki Hashimoto, Machiko Fujioka, Chika Sakaki, Hikaru Sakamoto, Masahiko Chiwata, Rena Kamijo, Yuji Kobayashi, Hideaki Kitanosono, Jun Nakashima, Takeharu Kato, Masataka Taguchi, Makiko Horai, Masatoshi Matsuo, Junya Makiyama, Hidehiro Itonaga, Shinya Sato, Maki Baba, Yasushi Sawayama, Yumi Takasaki, Jun Taguchi, Daisuke Imanishi, Yoshitaka Imaizumi, Yasuhisa Kawaguchi, Hideki Tsushima, Tatsuro Jo, Shinichiro Yoshida, Yukiyoshi Moriuchi, Yasushi Miyazaki","doi":"10.2169/internalmedicine.5312-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5312-25","url":null,"abstract":"<p><p>Objective Patients with acute myeloid leukemia (AML) transformed from myelodysplastic syndrome (MDS) have a poor prognosis, including those treated with azacitidine during the MDS phase; there is no standard for the care of these patients. Recently, azacitidine plus venetoclax (AZA/VEN) was reported to prolong the survival in treatment-naïve AML patients compared with AZA monotherapy. However, the results of AZA/VEN for AML transformed from MDS, particularly after AZA monotherapy, remain unclear. The present study therefore compared the clinical results of AZA/VEN treatment in these patients. Methods and Patients Data from MDS patients diagnosed at 10 institutions in Nagasaki Prefecture were collected. Thereafter, patients with transformed AML following AZA monotherapy during the MDS phase were selected, and their treatment response and survival were analyzed. Results The overall response (OR) rate, overall survival (OS), and event-free survival (EFS) were compared among patients treated with AZA/VEN (n=13), chemotherapy (intensive and low-intensity, n=35), AZA monotherapy (mAZA, n=15), and best supportive care (BSC, n=43) after AML transformation. The corresponding OR rates were 38.5%, 20.0%, and 6.7% for the AZA/VEN, chemotherapy, and mAZA groups, respectively (p=0.235). The respective median OS and EFS were 10.7 and 8.9 months for AZA/VEN, 3.2 and 2.0 months for chemotherapy, and 3.8 and 2.7 months for mAZA, and 1.7 months for BSC (OS only) (p=0.000023 for the OS and p=0.026 for the EFS), Conclusion Our findings suggest the superiority of AZA/VEN for AML patients with transformation from MDS following AZA monotherapy.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602755","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 Abscess with Empyema Caused by Streptococcus Pyogenes.","authors":"Jiro Fujita, Tetsu Chinen, Kazutaka Yamaniha, Motoo Baba","doi":"10.2169/internalmedicine.5852-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5852-25","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602757","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":"Clinical Efficacy of Dapagliflozin in Cases of Advanced Renal Dysfunction in Chronic Kidney Disease.","authors":"Yoshihiko Imamura, Hayato Wakabayashi, Toshihide Hayashi, Yasunori Takahashi","doi":"10.2169/internalmedicine.5764-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5764-25","url":null,"abstract":"<p><p>Objective The present study investigated the various clinical effects of dapagliflozin in chronic kidney disease (CKD) and its efficacy in patients with advanced renal dysfunction. Methods A total of 94 CKD cases (non-diabetic, 58; diabetic, 36) were treated with dapagliflozin (10 mg) in an outpatient setting for 12 months. The estimated glomerular filtration rate (eGFR) was measured during the 12 months before and after, with laboratory findings determined at the baseline and at 12 months after dapagliflozin administration. In addition, the annual decrease in the eGFR (eGFR slope) was compared before and one year after the baseline readings, and the eGFR slope values before and after dapagliflozin administration in 34 rapid decliner cases with an eGFR slope >5 mL/min/1.73 m²/year before dapagliflozin administration and 19 cases with an eGFR <25 mL/min/1.73 m² at baseline were compared. Results The body mass index, blood pressure, uric acid, and urine protein-to-creatinine ratio significantly decreased, and hemoglobin levels significantly increased after dapagliflozin administration. There was a significant increase after administration in the mean eGFR slope of all cases, rapid decliners, and cases with an eGFR <25 mL/min/1.73 m² at baseline (all p<0.001). Furthermore, there was a higher ratio of improvement in the eGFR slope in 39 patients who underwent multidisciplinary care within 1 year of dapagliflozin administration. Conclusion Dapagliflozin is effective in preventing renal function decline in patients with rapidly worsening or advanced CKD, with the effect further enhanced after combination with multidisciplinary care.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602754","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":"Risks and Benefits of Obinutuzumab-Based Chemotherapy in the Context of SARS-CoV-2 Infection.","authors":"Kohei Shiroshita, Himari Kudo, Miki Sakamoto, Takaaki Toyama","doi":"10.2169/internalmedicine.5962-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5962-25","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602759","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":"Successful Remission of Nephrotic Syndrome Caused by IgA Nephropathy with Membranoproliferative Glomerulonephritis-pattern Lesion Treated by Cyclosporine and Oral Corticosteroids.","authors":"Yuki Nakao, Yutaro Mori, Junko Kunieda, Towako Taguchi, Katsuo Mori, Ayumi Yamamura, Shotaro Naito, Fumiaki Ando, Shintaro Mandai, Soichiro Iimori, Koichiro Susa, Takayasu Mori, Kenichi Ohashi, Eisei Sohara, Shinichi Uchida","doi":"10.2169/internalmedicine.5526-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5526-25","url":null,"abstract":"<p><p>Introduction Immunoglobulin A nephropathy (IgAN) is a common glomerular renal disease presenting with mesangial cell proliferation and mesangial matrix hyperplasia and is typically treated with oral glucocorticoids. However, the clinical presentations and treatment strategies for certain cases of oral glucocorticoid-resistant IgA nephropathy have not been established. Clinical Presentation We herein report a case of recurrent IgA nephropathy presenting with nephrotic syndrome and membranoproliferative glomerulonephritis-pattern lesions. A 42-year-old woman presented to our clinic 22 years ago after urinary occult blood was detected during a health examination, leading to a diagnosis of IgA nephropathy based on a renal biopsy. Although temporary remission was achieved with oral glucocorticoid therapy, the relapse occurred repeatedly. Eight years ago, she underwent a third renal biopsy, which revealed grade II (C) and Oxford classification M1E0S1T0 findings. Temporary remission was achieved following tonsillectomy and steroid pulse therapy. Subsequently, she presented with nephrotic syndrome and rapidly increasing urinary protein levels. A fourth renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) pattern lesions that were not previously observed. The administration of cyclosporine and corticosteroids after steroid pulse therapy led to complete remission. Conclusion In cases of recurrent IgA nephropathy complicated by nephrotic syndrome, MPGN-pattern lesions may underlie this condition. In these cases, both corticosteroids and additional cyclosporine may be effective.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602761","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":"Peritonitis due to Ruptured Splenic Abscess Managed by Trans-gastric Endoscopic Ultrasonography-guided Dual Drainage Combined with Lavage and Intermittent Negative Pressure: A Case Report and Literature Review.","authors":"Tesshin Ban, Yoshimasa Kubota, Naoto Imura, Shun Sasoh, Satoshi Tanida, Makoto Nakamura, Tomoaki Ando, Takashi Joh","doi":"10.2169/internalmedicine.5773-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5773-25","url":null,"abstract":"<p><p>There are no established guidelines for managing patients with rare but fatal ruptured splenic abscesses. In this clinical scenario, open splenectomy seems to be a standard literature-based intervention. However, open splenectomy under general anesthesia is not a priority in high-risk surgical patients. We herein report an endoscopic ultrasound-guided transmural dual drainage combined with lavage and intermittent negative pressure drainage as an alternative to surgery for a critical patient with a ruptured splenic abscess and discuss the benefits and drawbacks of open splenectomy as a case report and literature review.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602758","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":"Ventricular Tachycardia and Takotsubo-like Syndrome in a Patient Undergoing Afatinib Treatment for Advanced Lung Adenocarcinoma.","authors":"Keisho Kurokawa, Akinori Higaki, Yasuhisa Nakao, Arisa Abe, Tomoaki Nishikawa, Haruhiko Higashi, Takashi Ninomiya, Osamu Yamaguchi","doi":"10.2169/internalmedicine.5704-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5704-25","url":null,"abstract":"<p><p>Afatinib is a second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor approved for the treatment of non-small-cell lung cancer. We herein report a 61-year-old woman who developed dyspnea and ventricular tachycardia (VT) after afatinib treatment for lung adenocarcinoma. Following restoration of sinus rhythm with continuous amiodarone infusion, echocardiography and cardiac computed tomography revealed Takotsubo-like left ventricular wall motion abnormalities. Unfortunately, the patient's cardiac function did not improve, and she developed circulatory failure, which resolved on day 3 of hospitalization. Takotsubo-like cardiac dysfunction and VT should be recognized as potential side effects of afatinib.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602766","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":"Thyroid Storm Following Alemtuzumab-based Allogeneic Stem Cell Transplantation: A Case Report and Literature Review.","authors":"Sakura Saigusa, Kaori Uchino, Hideshige Seki, Yukie Sugita, Yuto Isaji, Yusuke Iida, Saki Shinohara, Tomohiro Horio, Satsuki Murakami, Shohei Mizuno, Kazuhiro Ikegame, Ichiro Hanamura, Junichiro Mokuno, Junko Takagi, Daiki Hirano, Hiroatsu Iida, Shinji Nakao, Akiyoshi Takami","doi":"10.2169/internalmedicine.5587-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5587-25","url":null,"abstract":"<p><p>Alemtuzumab-based conditioning for allogeneic hematopoietic stem cell transplantation (allo-HSCT) effectively reduces graft rejection but may predispose patients to autoimmune complications. We herein report a 30-year-old man with severe aplastic anemia who developed thyroid storm due to autoimmune thyroiditis 6 months after undergoing allo-HSCT with an alemtuzumab-based regimen. Despite prompt engraftment, mixed T-cell chimerism and insufficient immune regulation may have contributed to the early onset and severity of the thyroid storm. Careful monitoring of the thyroid function and immune chimerism might facilitate the early detection and management of post-transplant autoimmune complications, including thyroid storm, in patients receiving alemtuzumab-based conditioning.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602764","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 Evaluation of the Diagnostic Yield and Complications Associated with Bronchoscopy via Endobronchial Ultrasound with a Guide Sheath.","authors":"Keisuke Takeda, Satoshi Ikegame, Eiji Iwama, Tomoyoshi Takenaka, Keigo Ozono, Kazuya Tsubouchi, Isamu Okamoto","doi":"10.2169/internalmedicine.5777-25","DOIUrl":"https://doi.org/10.2169/internalmedicine.5777-25","url":null,"abstract":"<p><p>Background and objective Endobronchial ultrasound with a guide sheath (EBUS-GS) is used to accurately position a bronchoscope in lung lesions using a guide sheath. Previous studies have focused on diagnostic success as the endpoint. The achievement of 'within' defined as reaching the lesion, is considered crucial in EBUS-GS procedures. This study investigated cases wherein 'within' is likely to be achieved and cases that can be diagnosed after achieving 'within'. Methods This retrospective study evaluated 258 bronchoscopic examinations using EBUS-GS. We analyzed the relationship between patient background, lesion size and characteristics, achieving 'within', definitive diagnosis after achieving 'within', and complications. Results and Conclusion A multivariate analysis revealed that lesion size ≥20 mm (odds ratio 12, 95% confidence interval [CI]: 6.0-21, p<0.01) and lesions with solid components (odds ratio 13, 95% CI: 1.3-120, p=0.03) were associated with achieving 'within'. For cancer cases, lesion size ≥20 mm was associated with a higher diagnostic rate following achieving 'within' than smaller lesions (odds ratio 4.23, 95% CI: 1.38-12.9, p=0.01). The occurrence of complications was linked to lesion size ≥20 mm (odds ratio 2.7, 95% CI: 1.02-6.9, p=0.045). The factors associated with 'within'-achieving bronchoscopy via EBUS-GS included lesion size ≥20 mm and solid components. Larger lesions were associated with a definitive diagnosis. Lesion size was a determinant in improving diagnostic rates, both for achieving within and for successful diagnosis after achieving 'within'.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602762","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}