Journal of Nippon Medical School最新文献

Ascites Caused by Intestinal Anisakiasis: A Case Report and Literature Review. 由肠道蛔虫病引起的腹水：病例报告与文献综述

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-09-02 Epub Date: 2024-06-18 DOI: 10.1272/jnms.JNMS.2025_92-401

Yutaka Furuta, Naoto Matsuda, Hiroaki Wakakuri, Hideya Hyodo, Toshihiko Ohara, Gen Takagi, Masahiro Yasutake

{"title":"Ascites Caused by Intestinal Anisakiasis: A Case Report and Literature Review.","authors":"Yutaka Furuta, Naoto Matsuda, Hiroaki Wakakuri, Hideya Hyodo, Toshihiko Ohara, Gen Takagi, Masahiro Yasutake","doi":"10.1272/jnms.JNMS.2025_92-401","DOIUrl":"10.1272/jnms.JNMS.2025_92-401","url":null,"abstract":"Anisakiasis is a parasitic infection affecting the human gastrointestinal tract. It is caused by the consumption of contaminated, raw or inadequately cooked fish or squid, which is typically used for making sushi and sashimi. Most cases involve gastric anisakiasis, whereas intestinal anisakiasis is rare. This report describes the case of a 63-year-old Japanese woman with a history of raw fish consumption who presented with acute-onset abdominal pain and vomiting. Abdominal computed tomography (CT) demonstrated thickened small bowel loops and ascites on the liver surface. The patient was admitted for supportive care. On the second day of hospitalization, contrast-enhanced abdominal CT revealed that the ascites had moved from the liver surface to the pouch of Douglas. On the fifth day of hospitalization, the patient was discharged with a substantial improvement in abdominal pain. Five days after the discharge, her eosinophil count was elevated, and parasitic disease was therefore suspected. Anti-Anisakis IgG/A and IgE (RAST) antibody levels were elevated, confirming the diagnosis of intestinal anisakiasis. A review of 51 reported cases of intestinal anisakiasis suggests that the presence of ascites and measurement of anti-Anisakis antibody titers are helpful for diagnosis in cases presenting with nonspecific abdominal symptoms after consumption of raw or undercooked fish.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":"368-373"},"PeriodicalIF":1.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of a Rigid Curved Laryngoscope for Observation and Debridement of Degenerated Cricoid Cartilage in Nasogastric Tube Syndrome: A Case Report. 使用硬质弯曲喉镜观察和清创鼻胃管综合征的环状软骨变性：病例报告。

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-09-02 Epub Date: 2024-08-21 DOI: 10.1272/jnms.JNMS.2025_92-402

Kotoko Arai, Koji Sakamoto, Masashi Nakaishi, Atsuko Sakanushi, Ayaho Yoshino, Kimihiro Okubo

{"title":"Use of a Rigid Curved Laryngoscope for Observation and Debridement of Degenerated Cricoid Cartilage in Nasogastric Tube Syndrome: A Case Report.","authors":"Kotoko Arai, Koji Sakamoto, Masashi Nakaishi, Atsuko Sakanushi, Ayaho Yoshino, Kimihiro Okubo","doi":"10.1272/jnms.JNMS.2025_92-402","DOIUrl":"10.1272/jnms.JNMS.2025_92-402","url":null,"abstract":"Nasogastric tube syndrome (NGTS) is a complication of NGT placement that can cause sore throat, bilateral vocal cord paralysis, and airway constriction. Although rare, this condition should be known by all physicians because it is sometimes fatal. We report a case of NGTS that was successfully diagnosed and debrided with a rigid curved laryngoscope. A 79-year-old man was referred to our department for evaluation of persistent pharyngeal pain and dysphagia after thoracic aortic aneurysm surgery. He had restricted bilateral vocal fold abduction, and the NGT had been placed for nearly 120 days. After induction of general anesthesia, the patient underwent laryngeal examination using a rigid curved laryngoscope, which revealed ossified cricoid cartilage in the postcricoid area, leading to confirmation of NGTS. The NGT was removed, and the protruding bony lesion was debrided. Subsequently, the patient underwent gastrostomy to improve his nutritional status. One month later, the postcricoid lesion improved, and the patient was able to tolerate an oral diet. The pathophysiology of NGTS is thought to involve ulceration of the postcricoid mucosa and injury of the posterior cricoarytenoid muscle by contact with the NGT. Although the treatment has not been established, early removal of the NGT is important. In the present case, the rigid curved laryngoscope was useful for resection of the bony lesion, which contributed to early epithelialization and symptom improvement.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":"374-378"},"PeriodicalIF":1.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Small intestinal adhesion at a parastomal hernia of the ileal conduit and hernia repair with laparoscopy and tailored mesh: A case report. 回肠导管造口旁疝小肠粘连及腹腔镜及特制补片修补1例报告。

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-08-26 DOI: 10.1272/jnms.JNMS.2026_93-303

Shin Imura, Yusuke Ogi, Kei Ishimaru, Shigehiro Koga, Motohira Yoshida, Satoshi Akita, Satoshi Kikuchi, Hiroki Sugishita, Jun Kuwabara, Hironori Matsumoto, Kai Goyo, Taro Oshikiri

{"title":"Small intestinal adhesion at a parastomal hernia of the ileal conduit and hernia repair with laparoscopy and tailored mesh: A case report.","authors":"Shin Imura, Yusuke Ogi, Kei Ishimaru, Shigehiro Koga, Motohira Yoshida, Satoshi Akita, Satoshi Kikuchi, Hiroki Sugishita, Jun Kuwabara, Hironori Matsumoto, Kai Goyo, Taro Oshikiri","doi":"10.1272/jnms.JNMS.2026_93-303","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-303","url":null,"abstract":"Parastomal hernia of the ileal conduit (PHIC) is a long-term complication of radical cystectomy (RC) for bladder cancer. A systematic review reported an estimated incidence of PHIC after RC of 17%. Several surgical techniques have been reported for treating parastomal hernias. However, few studies have investigated treatment of PHIC, and there are no guidelines for the optimal approach for PHIC repair. Here, we describe a case in which good results were achieved using the laparoscopic Sugarbaker (LS) technique with a tailored mesh for PHIC. An 80-year-old Japanese woman underwent robot-assisted radical cystectomy for bladder cancer. Ten months after surgery, she was diagnosed as having bowel obstruction due to PHIC. The LS technique was performed using a tailored mesh. Severe small-intestinal adhesions from previous surgeries were safely divided using laparoscopic surgery. No hernia recurrence was observed at 2 years postoperatively. We used the LS technique to treat PHIC, and severe small-intestinal adhesions were safely treated using laparoscopic surgery. The LS technique appears to be a viable therapeutic option for such cases.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Collaborative Management Between Dermatologists and Pediatricians of a 3-Year-Old Boy with Atopic Dermatitis-Related Sleep Disturbance and Reduced Quality of Life Using Dupilumab: A Case Report. 皮肤科医生和儿科医生合作管理一名患有特应性皮炎相关睡眠障碍和使用杜匹单抗降低生活质量的3岁男孩：一例报告。

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-08-26 DOI: 10.1272/jnms.JNMS.2026_93-601

Toru Sugimoto, Yuri Kinoshita, Toru Igarashi, Mami Kurihara, Yuka Ota, Keigo Ito, Hidehisa Saeki, Azusa Ogita

{"title":"Collaborative Management Between Dermatologists and Pediatricians of a 3-Year-Old Boy with Atopic Dermatitis-Related Sleep Disturbance and Reduced Quality of Life Using Dupilumab: A Case Report.","authors":"Toru Sugimoto, Yuri Kinoshita, Toru Igarashi, Mami Kurihara, Yuka Ota, Keigo Ito, Hidehisa Saeki, Azusa Ogita","doi":"10.1272/jnms.JNMS.2026_93-601","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-601","url":null,"abstract":"A 3-year-old boy presented with recurrent eczema that began at 2 months of age. The patient was treated by multiple dermatologists using topical steroids, topical immunosuppressants, and oral antihistamines. The patient was subsequently referred to our clinic for improved symptom control. During the initial visit, he exhibited serous erythema, scaling, and scratch marks on the scalp, face, and limbs. Laboratory findings revealed elevated levels of immunoglobulin E at 5400 IU/mL, thymus and activation-regulated chemokine at 3029 pg/mL, and an Eczema Area and Severity Index score of 16. Due to sleep disturbances caused by nocturnal itching and substantially reduced quality of life, we initiated treatment with dupilumab. A pediatrician conducted pre-treatment assessments, including blood tests and chest radiography. Following the initiation of dupilumab therapy, the pediatrician monitored the patient for potential reactions and side effects, and the dermatologist managed the skin symptoms. This case underscores the importance of interdisciplinary collaboration between pediatrics and dermatology in managing severe eczema in young children treated with dupilumab.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Possible Role of Local Anesthetics in Permanent Lower Limb Motor Paralysis After Epidural Anesthesia: A Case Report. 局麻药在硬膜外麻醉后永久性下肢运动麻痹中的可能作用：1例报告。

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-08-26 DOI: 10.1272/jnms.JNMS.2026_93-302

Ichiro Kamiya, Chol Kim, Atsuko Kageyama, Masashi Ishikawa

{"title":"Possible Role of Local Anesthetics in Permanent Lower Limb Motor Paralysis After Epidural Anesthesia: A Case Report.","authors":"Ichiro Kamiya, Chol Kim, Atsuko Kageyama, Masashi Ishikawa","doi":"10.1272/jnms.JNMS.2026_93-302","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-302","url":null,"abstract":"We present a case of permanent bilateral lower limb paralysis after epidural anesthesia. A 71-year-old woman (height 159 cm; weight 48.5 kg; American Society of Anesthesiologists Physical Status 2) with a history of hypertension (treated with nifedipine), benign goiter (under surveillance), surgeries for appendicitis, and a previous left humerus fracture had received general anesthesia with epidural anesthesia during two surgical procedures, namely, laparoscopic-assisted low anterior resection with colostomy and laparoscopic-assisted colostomy closure. She developed left-predominant lower limb paralysis after the first epidural anesthesia (using ropivacaine and levobupivacaine). The symptoms had no identifiable cause, persisted after removal of the epidural catheter, and gradually resolved during rehabilitation. Her lower limb paralysis recurred and progressed, however, after the second epidural anesthesia (using levobupivacaine alone), and she has abnormal spinal reflexes and elevated myelin basic protein in cerebrospinal fluid. Although these findings suggested that bilateral lower limb paralysis was caused by a lesion in the central nervous system (thoracolumbar spinal cord), postoperative MRI scans of the vertebrae/spinal cord and head failed to identify the site of the damage. We concluded that permanent bilateral lower limb paralysis was likely caused by epidural anesthesia, but the mechanism could not be identified.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Autoimmune Hemolytic Anemia in a Patient with Generalized Pustular Psoriasis Treated with Brodalumab: A Case Report. 布罗达鲁单抗治疗广泛性脓疱性银屑病患者自身免疫性溶血性贫血1例

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-08-26 DOI: 10.1272/jnms.JNMS.2026_93-301

Toru Sugimoto, Yuri Kinoshita, Keigo Ito, Hidehisa Saeki, Azusa Ogita

{"title":"Autoimmune Hemolytic Anemia in a Patient with Generalized Pustular Psoriasis Treated with Brodalumab: A Case Report.","authors":"Toru Sugimoto, Yuri Kinoshita, Keigo Ito, Hidehisa Saeki, Azusa Ogita","doi":"10.1272/jnms.JNMS.2026_93-301","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-301","url":null,"abstract":"Psoriasis is a condition characterized by chronic inflammation of the skin, epidermal hyperproliferation, and dysregulated differentiation driven by acceleration of the tumor necrosis factor-alpha/interleukin (IL) -23/IL-17 axis. Herein, we report a case of generalized pustular psoriasis initially managed with etretinate, apremilast, and risankizumab in a Japanese man. Because of side effects, a therapeutic transition was made to brodalumab at 7 months after the initial consultation. His dermatological symptoms improved; however, hemoglobin concentration decreased to 7.6 g/dl after 4 months of treatment. Diagnostic investigation revealed warm autoimmune hemolytic anemia (AIHA). To our knowledge, this is the first report of AIHA during treatment with brodalumab for generalized pustular psoriasis. The etiological association between AIHA and psoriasis is unclear. Future studies should investigate whether AIHA accompanies pustular psoriasis or results from drug-induced AIHA secondary to brodalumab administration. Our findings suggest that the risk of AIHA in patients with psoriasis treated with brodalumab warrants careful consideration.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Laparoscopic Resection of a Large Mucinous Cystic Neoplasm of the Liver: A Case Report. 腹腔镜下肝大粘液囊性肿瘤切除术1例报告。

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-08-26 DOI: 10.1272/jnms.JNMS.2026_93-503

Yuto Aoki, Yukio Oshiro, Ryo Ga, Mampei Kawashima, Chikako Hasegawa, Youichi Kawano, Junji Ueda, Yoshiharu Nakamura, Hiroshi Yoshida

{"title":"Laparoscopic Resection of a Large Mucinous Cystic Neoplasm of the Liver: A Case Report.","authors":"Yuto Aoki, Yukio Oshiro, Ryo Ga, Mampei Kawashima, Chikako Hasegawa, Youichi Kawano, Junji Ueda, Yoshiharu Nakamura, Hiroshi Yoshida","doi":"10.1272/jnms.JNMS.2026_93-503","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-503","url":null,"abstract":"Mucinous cystic neoplasms of the liver (MCNs-L) are rare cystic tumors characterized by multilocular cysts lined with a mucin-producing epithelium and supported by ovarian-like stroma. These tumors account for <5% of all cystic liver lesions and carry a potential risk of malignant transformation, necessitating early diagnosis and surgical resection. This report describes the successful laparoscopic partial liver resection of segments 4 and 5 for a large MCN-L in a woman in her 40s who presented with upper abdominal discomfort. Imaging studies revealed a multilocular cystic lesion measuring 11.9 × 8.5 × 13.0 cm in segments 4 and 5 of the liver. The primary challenges were the size of the lesion and the need to prevent cystic content spillage during surgery. Using meticulous techniques, including the use of a retrieval bag and controlled aspiration, we successfully excised the tumor laparoscopically and without contamination. Pathological analysis confirmed a diagnosis of mucinous cystic adenoma with no evidence of malignancy. The patient recovered uneventfully and was discharged on postoperative day 7. This case highlights the feasibility and safety of a laparoscopic approach for large MCNs-L. Furthermore, it underscores the importance of preoperative planning, precise surgical techniques, and measures to prevent cystic content dissemination. Minimally invasive surgery offers significant benefits, including reduced recovery time and improved cosmetic outcomes, and can be effectively applied to large hepatic cystic lesions by experienced surgical teams.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Combination therapy with laparoscopic Hassab's procedure and three subsequent endoscopic variceal ligation sessions for pipeline esophageal varices: A report of two cases. 联合腹腔镜Hassab手术和随后的三次内镜下静脉曲张结扎治疗食道静脉曲张：两例报告。

IF 1.4 4区医学

Journal of Nippon Medical School Pub Date : 2025-08-26 DOI: 10.1272/jnms.JNMS.2026_93-602

Tetsuya Shimizu, Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Masato Yoshioka, Akira Matsushita, Yoichi Kawano, Junji Ueda, Takahiro Murokawa, Takashi Ono, Takahiro Haruna, Akira Hamaguchi, Ryo Ga

{"title":"Combination therapy with laparoscopic Hassab's procedure and three subsequent endoscopic variceal ligation sessions for pipeline esophageal varices: A report of two cases.","authors":"Tetsuya Shimizu, Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Masato Yoshioka, Akira Matsushita, Yoichi Kawano, Junji Ueda, Takahiro Murokawa, Takashi Ono, Takahiro Haruna, Akira Hamaguchi, Ryo Ga","doi":"10.1272/jnms.JNMS.2026_93-602","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-602","url":null,"abstract":"High blood flow and intravariceal pressure in pipeline esophageal varices (EVs) can cause refractory variceal bleeding that is difficult to control with endoscopic procedures and interventional radiology. We used combination therapy with Hassab's procedure (HP) and subsequent endoscopic variceal ligation (EVL) to successfully treat two patients with pipeline EVs.Case 1A woman in her 30s with recurrent hemorrhagic pipeline EVs caused by idiopathic portal hypertension was referred for surgery. Magnetic resonance imaging revealed a dilated left gastric vein (LGV) connected to EVs with no palisade zone. Esophagogastroduodenoscopy (EGD) identified high-risk EVs (Ls, F3, Cw, RC1) and gastric varices (GVs) (Lg-c, F2, Cw, RC0). Eradication of the esophagogastric varices was maintained 5 years after laparoscopic HP followed by EVL at 1, 6 and 16 months postoperatively.Case 2A woman in her 50s with cirrhosis (type B) and enlarged pipeline EVs was referred for prophylactic surgery. Computed tomography (CT) imaging revealed that the EVs were supplied by a dilated LGV without a palisade zone. EGD identified high-risk EVs (Lm, F3, Cb, RC2) and GVs (Lg-c, F3, Cw, RC1). Combination therapy with laparoscopic HP and EVL at 2, 4, and 6 months showed the eradication of esophagogastric varices 8 months after surgery. CT scanning performed 10 days postoperatively in case 2 revealed residual EVs supplied by gastric intramural blood flow, strongly supporting the need for additional EVL after HP. HP involves gastroesophageal devascularization and splenectomy, which reduce blood supply to EVs, facilitating subsequent EVL to eradicate pipeline EVs. This combination therapy appears to enhance outcomes and should be considered a viable option for treating refractory pipeline EVs.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Delayed Diagnosis of Painless Thyroiditis in an Adolescent Presenting with Aggression and Disruptive Behavior Initially Attributed to Worsening of a Psychiatric Disorder. 最初因精神障碍恶化而出现攻击和破坏行为的青少年被延迟诊断为无痛性甲状腺炎》（Delayed Diagnosis of Painless Thyroiditis in an Adolescent Presenting with Aggression and Disruptive Behavior Initially Attributed to Worseening of a Psychiatric Disorder）。

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2025-07-02 Epub Date: 2024-06-18 DOI: 10.1272/jnms.JNMS.2025_92-302

Yutaka Furuta, Takahiro Masuoka, Ryuichiro Narishige, Amane Tateno

{"title":"Delayed Diagnosis of Painless Thyroiditis in an Adolescent Presenting with Aggression and Disruptive Behavior Initially Attributed to Worsening of a Psychiatric Disorder.","authors":"Yutaka Furuta, Takahiro Masuoka, Ryuichiro Narishige, Amane Tateno","doi":"10.1272/jnms.JNMS.2025_92-302","DOIUrl":"10.1272/jnms.JNMS.2025_92-302","url":null,"abstract":"Painless thyroiditis, which is rare in children, exhibits the characteristic sequence of hyperthyroidism, including aggressive and disruptive behaviors. Unlike subacute thyroiditis or Graves' disease, painless thyroiditis is challenging to diagnose because of its mild symptoms and minimal or absent physical findings. Moreover, aggressive and disruptive behaviors in children with psychiatric disorders may be misconstrued as exacerbation of underlying symptoms. The present patient was a 16-year-old male with adjustment disorder who presented to a pediatric psychiatric clinic for assessment of irritability. After 4 months, he developed aggressive and disruptive behaviors that prompted initiation of risperidone but without improvement. After 1 month, he reported palpitations and dyspnea. His neck was supple and non-tender without thyroid enlargement. Thyroid studies revealed elevated free T4 and T3 levels and suppressed thyroid-stimulating hormone level, suggesting hyperthyroidism. A radioactive iodine uptake test revealed a barely visible thyroid gland, consistent with thyroiditis. Painless thyroiditis, without thyroid tenderness, was diagnosed. We describe a case of painless thyroiditis in an adolescent patient with aggressive and disruptive behaviors that were initially attributed to worsening of an underlying adjustment disorder. Even when minimal or no signs of hyperthyroidism are present, painless thyroiditis should be considered in the differential diagnosis of children with aggressive and disruptive behaviors. Awareness of potential anchoring bias is also recommended to prevent its delayed diagnosis of such behaviors.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":"296-299"},"PeriodicalIF":1.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New-Onset Schizophrenia in an Adolescent after COVID-19. 一名青少年在服用 COVID-19 后新发精神分裂症。

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2025-07-02 Epub Date: 2024-06-18 DOI: 10.1272/jnms.JNMS.2025_92-301

Masatsugu Ishii, Kakusho C Nakajima-Ohyama, Hayato Saito, Tomoyuki Ohya, Shotaro Uchiyama, Mizuho Takahashi, Masanori Sakamaki, Akihiro Watanabe, Jun-Ichi Inoue, Tetsuro Sekine, Amane Tateno, Yasuhiro Kishi

{"title":"New-Onset Schizophrenia in an Adolescent after COVID-19.","authors":"Masatsugu Ishii, Kakusho C Nakajima-Ohyama, Hayato Saito, Tomoyuki Ohya, Shotaro Uchiyama, Mizuho Takahashi, Masanori Sakamaki, Akihiro Watanabe, Jun-Ichi Inoue, Tetsuro Sekine, Amane Tateno, Yasuhiro Kishi","doi":"10.1272/jnms.JNMS.2025_92-301","DOIUrl":"10.1272/jnms.JNMS.2025_92-301","url":null,"abstract":"Schizophrenia develops during adolescence. Maternal infections during the fetal period increase the incidence of schizophrenia in children, which suggests that the pathogenesis involves neuroinflammation. Here, we report a case of new-onset schizophrenia in a 16-year-old boy after COVID-19. After developing COVID-19, he entered a catatonic state 4 days later and was hospitalized. Benzodiazepines alleviated his catatonia, but hallucinations and delusions persisted. Encephalitis and epilepsy were excluded by magnetic resonance imaging (MRI), encephalography, and cerebrospinal fluid examination. Psychosis persisted after the virus titer declined and the inflammatory response subsided. Moreover, the patient exhibited delusions of control-a Schneider's first-rank symptom. Schizophrenia was diagnosed, and olanzapine improved his symptoms. He had a brief history of insomnia before COVID-19 but his symptoms did not satisfy the ultra-high-risk criteria. However, COVID-19 may have facilitated development of schizophrenia through neuroinflammation and volume reduction in the gray matter of the right medial temporal lobe. This case demonstrates that infectious diseases in adolescents should be carefully managed, to prevent schizophrenia.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":"287-295"},"PeriodicalIF":1.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0