Internal medicine (Tokyo, Japan)最新文献

{"title":"A Case of Insulin Autoimmune Syndrome Complicated by IgG4-Related Disease, Both Successfully Treated with Corticosteroids.","authors":"Yosuke Oshima, Naohiro Saito, Takahisa Kawaguchi, Mikio Okayama, Hiroaki Taguchi, Hideki Orikasa, Takashi Ando","doi":"10.2169/internalmedicine.7479-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7479-26","url":null,"abstract":"<p><p>We present the case of a 73-year-old man diagnosed with insulin autoimmune syndrome (IAS) during an investigation of hypoglycemia. This disease is a rare cause of hypoglycemia induced by autoantibodies against insulin. The patient was diagnosed with IgG4-related disease (IgG4-RD). Moreover, the patient had myelodysplastic syndrome (MDS). We hypothesized that immunological dysregulation driven by MDS may have contributed to the coexistence of these two rare conditions in our patient. Treatment with prednisolone promptly resolved hypoglycemia and improved the disease activity of IgG4-RD. We present this case as, to the best of our knowledge, it is the first peer-reviewed case report of coexisting IAS and IgG4-RD.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130057","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":"A Cerebral Tumor Embolism from Colorectal Cancer via a Patent Foramen Ovale: A Diagnosis Made by Mechanical Thrombectomy.","authors":"Yuya Kobayashi, Nobuhiko Ohashi, Yasufumi Kondo, Kanji Yamamoto, Hiroshi Suzuki, Yukiko Kusama, Yoshiki Sekijima","doi":"10.2169/internalmedicine.7927-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7927-26","url":null,"abstract":"<p><p>A 56-year-old woman presented with an acute cerebral embolism. Mechanical thrombectomy retrieved a white embolus, and a pathological examination revealed a tumor fragment consistent with colorectal carcinoma. Imaging revealed no liver or lung metastases, but it identified a patent foramen ovale and pulmonary embolism, suggesting a paradoxical embolic pathway. Given the size of the tumor fragment, passage through the hepatic or pulmonary microcirculation would be difficult to explain given the size of the tumor fragment. These findings suggest venous invasion with direct entry of tumor material into the circulation, followed by right-to-left shunting, which resulted in a cerebral embolism.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130121","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":"Subdural Hematoma During Lorlatinib-Induced Regression of Leptomeningeal Carcinomatosis with Suspected Dural Involvement in ALK-Positive Lung Adenocarcinoma.","authors":"Taiyo Kakefuda, Katsuyoshi Tomomatsu, Kaiki Suzuki, Kohei Umemoto, Yukihiro Horio, Jun Nishiyama, Naoki Hayama, Yoko Ito, Koichiro Asano, Tsuyoshi Oguma","doi":"10.2169/internalmedicine.8083-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.8083-26","url":null,"abstract":"<p><p>Lorlatinib, a central nervous system (CNS)-penetrant anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor, is effective in treating leptomeningeal carcinomatosis. A woman in her 30s with ALK-positive lung adenocarcinoma and leptomeningeal carcinomatosis developed an asymptomatic subdural hematoma (SDH) 7 weeks after starting lorlatinib, coinciding with the regression of leptomeningeal lesions. The posterior extent of the SDH appeared to be partially contiguous with the focal dural enhancement observed before treatment. Lorlatinib was continued under multidisciplinary supervision. The hematoma resolved without surgery and did not recur during the 6 years of treatment. SDH may occur during the rapid regression of leptomeningeal disease with suspected dural involvement under CNS-penetrant ALK inhibitor therapy.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130187","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":"Idiopathic Mesenteric Phlebosclerosis Complicated by Diverticular Bleeding.","authors":"Atsushi Ikehata, Shota Yano, Manabu Nakayama, Sadahide Ono","doi":"10.2169/internalmedicine.8098-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.8098-26","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130093","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":"Stercoral Ulcer-related Lower Rectal Perforation Associated with Persistent Rectal Fecal Impaction: Three Case Reports and Clinical Implications.","authors":"Hirotada Nishie, Ayano Yamamura, Naoki Nakagawa, Ryo Sato, Taketo Suzuki, Reo Yamazaki, Seiichi Nakaya, Takehiro Wakasugi, Itaru Naitoh","doi":"10.2169/internalmedicine.8261-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.8261-26","url":null,"abstract":"<p><p>Stercoral ulcer-related lower rectal perforation is an uncommon but potentially under-recognized condition. We report three cases of elderly women with localized lower rectal perforation associated with persistent rectal fecal impaction. All patients presented with hematochezia without generalized peritonitis despite the continued passage of loose or muddy stools. Serial computed tomography revealed persistent fecal impaction in the lower rectum during the clinical course. Continued bowel movement does not necessarily indicate effective rectal evacuation. Recognition of persistent rectal fecal impaction may facilitate an earlier diagnosis and appropriate management.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130060","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":"Clinicopathological Review of Renovascular Hypertension and Hypertensive Emergency-related Nephropathy Based on Case Series.","authors":"Yoshifumi Ubara, Kei Kono, Naoki Sawa","doi":"10.2169/internalmedicine.8138-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.8138-26","url":null,"abstract":"<p><p>Renal complications resulting from persistent, uncontrolled hypertension include renovascular hypertension (RVH) and hypertensive emergency (crisis)-related nephropathy (HEN), both of which are characterized by hyperreninemia and are involved in the progression of nephropathy. In RVH, renal artery stenosis leads to increased renin secretion from the affected kidney, which induces focal segmental glomerulosclerosis (FSGS) lesions in the contralateral kidney, resulting in proteinuria. In HEN, severe hypertension (>200/120 mmHg) induces endothelial cell proliferation in renal arterioles, resulting in edematous thickening of the intima and narrowing of the lumen. This process increases renin secretion from the juxtaglomerular apparatus (JGA), further worsening hypertension and resulting in glomerular collapse and rapidly progressive renal impairment. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) suppress aldosterone activity and promote renin activity, respectively. Prolonged administration has been suggested to lead to JGA hyperplasia and smooth muscle cell proliferation in the renal arterioles.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130075","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":"Persistent SIADH-like Hyponatremia Requiring Tolvaptan Despite Glucocorticoid Replacement in Rathke's Cleft Cyst-Associated Hypophysitis: A Therapeutic Dilemma.","authors":"Yuya Shimizu, Reo Ishii, Kazumasa Tanaka, Koki Kinoshita, Jun Toyama, Noriaki Fukuhara, Masahiro Nezu","doi":"10.2169/internalmedicine.7951-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7951-26","url":null,"abstract":"<p><p>A 52-year-old man presented with severe hyponatremia and Rathke's cleft cyst (RCC)-associated hypophysitis with enlargement of the pituitary stalk. Hyponatremia persisted despite treatment with high-dose hydrocortisone, hypertonic saline, and loop diuretics, ultimately requiring low-dose tolvaptan. Hyponatremia associated with RCC is usually attributed to secondary adrenal insufficiency (SAI), in which glucocorticoid replacement generally restores free water excretion but may unmask arginine vasopressin deficiency (AVP-D). In the present case, however, persistent AVP-mediated water retention beyond SAI appeared to predominate, suggesting AVP dysregulation associated with inflammatory pituitary involvement. This case highlights the therapeutic dilemma of balancing masked AVP-D against persistent AVP excess in hyponatremia associated with RCC.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130112","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":"Hospitalized Infection Risk and Organ-specific Infection Patterns Across Advanced Therapies in Ulcerative Colitis: A Japanese Claims Analysis.","authors":"Yu Nishida, Shuhei Hosomi, Rieko Nakata, Hirotsugu Maruyama, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Yasuhiro Fujiwara","doi":"10.2169/internalmedicine.7882-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7882-26","url":null,"abstract":"<p><p>Background　Evidence comparing infections across advanced therapies (ADTs) for ulcerative colitis (UC) remains inconsistent, and infection category profiles are poorly characterized, particularly in real-world Japanese settings. We compared the risk of hospitalized infections and descriptively characterized the distribution of infection categories among hospitalized infection events across ADTs.Methods　We conducted a retrospective cohort study using the Medical Data Vision Database. Patients with UC who initiated treatment with a tumor necrosis factor (TNF) antagonist, ustekinumab, tofacitinib, or vedolizumab between April 2008 and May 2022 were followed. Adjusted hazard ratios (aHRs) were estimated using Cox models (TNF antagonists as the reference), and hospitalized infections were classified according to the organ system.Results　We included 9,012 patients receiving ADTs (TNF antagonists, 3,990; ustekinumab, 1,380; tofacitinib, 1,183; and vedolizumab, 2,459). Hospitalized infections occurred in 90, 16, 21, and 52 patients prescribed TNF antagonists, ustekinumab, tofacitinib, and vedolizumab, respectively; the incidence rates per 1,000 person-years were 19.09, 9.64, 14.53, and 17.24, respectively. In the multivariable analysis, ustekinumab was associated with a lower risk of hospitalized infection than TNF antagonists (aHR 0.46, 95% confidence interval [CI] 0.25-0.82), whereas tofacitinib (aHR 0.73, 95% CI 0.43-1.22) and vedolizumab (aHR 0.76, 95% CI 0.53-1.10) were not significantly different. Among the first hospitalized infection events, the distribution of infection categories was comparable across ADTs, with respiratory infections being the most common.Conclusions　Ustekinumab was associated with a lower risk of infection-related hospitalization than TNF antagonists. The distribution of infection categories among the first hospitalized infection events was comparable across the ADTs. These findings provide the first large-scale, real-world, comparative evidence from Japan.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130096","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":"Anti-GQ1b-Positive Bickerstaff Brainstem Encephalitis Complicated by Diffuse Hypertrophic Pachymeningitis: A Case Report.","authors":"Taiki Matsubayashi, Kaoru Morita, Jun Terai, Misako Furuki, Ayumi Uchibori, Masato Obayashi","doi":"10.2169/internalmedicine.7558-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7558-26","url":null,"abstract":"<p><p>A 36-year-old man developed acute progressive ataxia, an impaired consciousness, and ophthalmoplegia after an upper respiratory tract infection. A cerebrospinal fluid analysis revealed pleocytosis in the patient. Initial plain brain magnetic resonance imaging (MRI) showed no remarkable findings, whereas initial brain perfusion single-photon emission computed tomography demonstrated hyperperfusion in the brainstem. Follow-up contrast-enhanced MRI revealed diffuse dural thickening, and a histopathological examination supported the diagnosis of hypertrophic pachymeningitis. Anti-GQ1b antibodies were detected, leading to a diagnosis of Bickerstaff brainstem encephalitis (BBE). This case suggests that hypertrophic pachymeningitis may be a rare complication of BBE.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130072","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":"An Active Cytomegalovirus Infection and Epstein-Barr Virus Reactivation Complicated by Cytomegalovirus Meningitis and Virus-Associated Hemophagocytic Lymphohistiocytosis during Methotrexate and Upadacitinib Therapy in a Patient with Rheumatoid Arthritis.","authors":"Kazuki Tomiyama, Soma Fukami, Toshitaka Yukishima, Haruka Yonezawa, Shin-Ichiro Ohmura","doi":"10.2169/internalmedicine.8164-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.8164-26","url":null,"abstract":"<p><p>Methotrexate (MTX) and Janus kinase (JAK) inhibitors are effective treatments for rheumatoid arthritis (RA); however, they may increase the risk of opportunistic infections. We herein report a case of a patient with RA receiving MTX and upadacitinib who developed an active cytomegalovirus (CMV) infection and Epstein-Barr virus (EBV) reactivation, complicated by CMV meningitis and virus-associated hemophagocytic lymphohistiocytosis (HLH). This case highlights that clinicians should consider not only herpes zoster, but also infection or reactivation involving non-VZV herpesviruses, including CMV and EBV, particularly in patients receiving JAK inhibitors in combination with other immunosuppressive agents.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130133","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}