Journal of Nippon Medical School最新文献

A Case of Bacteremia and Meningitis in a Neonate Infected with Group B Streptococcus via Breastfeeding Who Survived without Neurological Sequelae: A Case Report. 一例通过母乳喂养感染 B 组链球菌的新生儿发生菌血症和脑膜炎，但未出现神经系统后遗症：病例报告。

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2024-11-06 Epub Date: 2023-06-02 DOI: 10.1272/jnms.JNMS.2024_91-501

Ryohei Fukunaga, Takeshi Asano, Ryosuke Matsui, Masanori Abe, Naruhiko Ishiwada, Yoshio Shima

{"title":"A Case of Bacteremia and Meningitis in a Neonate Infected with Group B Streptococcus via Breastfeeding Who Survived without Neurological Sequelae: A Case Report.","authors":"Ryohei Fukunaga, Takeshi Asano, Ryosuke Matsui, Masanori Abe, Naruhiko Ishiwada, Yoshio Shima","doi":"10.1272/jnms.JNMS.2024_91-501","DOIUrl":"10.1272/jnms.JNMS.2024_91-501","url":null,"abstract":"Invasive neonatal infection with Group B Streptococcus (GBS) is a disease of concern that can lead to neurological sequelae. Guidelines for preventing mother-to-child transmission have been introduced to reduce the incidence of early-onset infection, but guidelines for controlling the late-onset form are lacking. Recently, the trans-breastfeeding route of transmission has been highlighted as an example of late-onset infection, but no consensus on how to manage such infections has been reached. In this report, we describe a case of late-onset bacteremia/meningitis in a neonate suspected to have been infected with GBS via breastfeeding. A vaginal culture test of the mother at 35 weeks' gestation was negative for GBS. Since she had symptoms of mastitis, breast milk and nipple cultures were also tested and found to be positive for the strain of GBS identified in the neonate on genetic analysis. Diagnosis of trans-mammary GBS infection is challenging because breastfeeding-related events are difficult to identify. In our case, the diagnosis was based on the mother's history of mastitis, and the patient was treated without escalation to sequelae. When a neonate develops a fever, physicians should consider GBS infection and examine the mother's medical history to facilitate accurate diagnosis, especially if the history includes mastitis. A breast milk culture should be performed if the mother has mastitis, especially in cases of infection in preterm infants and in recurrent cases.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9572315","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

Ravulizumab Can Effectively Treat Ischemic Enteritis Caused by Paroxysmal Nocturnal Hemoglobinuria. 雷珠单抗可有效治疗阵发性夜间血红蛋白尿引起的缺血性肠炎

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2024-11-06 Epub Date: 2023-08-08 DOI: 10.1272/jnms.JNMS.2024_91-505

Atsushi Marumo, Haruka Okabe, Hisae Sugihara, Masanobu Eguchi

{"title":"Ravulizumab Can Effectively Treat Ischemic Enteritis Caused by Paroxysmal Nocturnal Hemoglobinuria.","authors":"Atsushi Marumo, Haruka Okabe, Hisae Sugihara, Masanobu Eguchi","doi":"10.1272/jnms.JNMS.2024_91-505","DOIUrl":"10.1272/jnms.JNMS.2024_91-505","url":null,"abstract":"Ischemic colitis is a common disease with a good prognosis; however, complications can occur in the presence of a serious underlying disease. Herein, we present a case report in which characteristic findings on lower gastrointestinal endoscopy led to a diagnosis of paroxysmal nocturnal hemoglobinuria (PNH). An 82-year-old woman visited our hospital for chronic heart and renal failure. She had a history of breast cancer, myocardial infarction, and hemorrhoidal fistula and was initially hospitalized for ischemic colitis. Subsequent lower gastrointestinal endoscopy revealed extensive ulcerative lesions in the ascending, transverse, and descending colon. Histopathologically, small vessels exhibited multiple fibrin thrombus formations. Based on histopathological and endoscopic results, the presence of an underlying disease was suspected. Flow cytometric analysis showed that erythrocytes and granulocytes had 5.5 and 86.4% CD55- and CD59-negative cells, respectively. The patient was ultimately diagnosed with PNH and considered severely ill, given the ischemic colitis-induced abdominal pain and the need for red blood cell transfusions (4-6 units per month). Accordingly, the patient was administered ravulizumab. Ischemic enteritis did not relapse following ravulizumab administration, and transfusion dependence improved. If a patient with ischemic colitis presents atypical lower gastrointestinal endoscopic findings, it is important to explore the presence of an underlying disease.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9967157","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

24-Hour Intraocular Pressure Fluctuation Suppressed by Microhook Trabeculotomy in Ocular Hypertension: A Case Report. 微钩小梁切开术抑制眼压过高症患者 24 小时眼压波动：病例报告。

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2024-08-21 DOI: 10.1272/jnms.JNMS.2025_92-501

Yutaro Tobita, Naka Shiratori, Yusuke Nishio, Kenji Nakamoto, Fumiki Okamoto

{"title":"24-Hour Intraocular Pressure Fluctuation Suppressed by Microhook Trabeculotomy in Ocular Hypertension: A Case Report.","authors":"Yutaro Tobita, Naka Shiratori, Yusuke Nishio, Kenji Nakamoto, Fumiki Okamoto","doi":"10.1272/jnms.JNMS.2025_92-501","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-501","url":null,"abstract":"A 76-year-old woman was referred to our hospital for evaluation of markedly high intraocular pressures (IOPs): ≥40 mmHg in both eyes. No intraocular inflammation, pseudoexfoliation, or glaucomatous optic neuropathy was observed on ophthalmological examination. The 24-hour IOP fluctuations, measured with a Goldmann tonometer in the sitting position at 8, 12, 16, 20, and 24 o' clock, were 22/17, 33/28, 41/33, 30/22, and 30/24 mmHg, respectively, and showed a peak in the afternoon. The patient was diagnosed with ocular hypertension, and microhook trabeculotomy (μLOT) (right eye with lens reconstruction, left eye initially pseudophakic) was performed. After μLOT surgery in both eyes (4 days postoperatively in the right eye and 1 day postoperatively in the left eye), IOP decreased in both eyes to 12/15, 11/14, 12/15, 10/11, and 10/10 mmHg, and the fluctuation range was suppressed. At 3 months postoperatively (measured at 8, 12, 16, 20, 24, and 4 o' clock), the effect was maintained at 14/15, 15/19, 14/19, 11/12, 13/14, and 13/13 mmHg, respectively, but was slightly attenuated. In a patient with marked 24-hour IOP fluctuation, μLOT was effective in reducing IOP values and fluctuation.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019753","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

Acute focal bacterial nephritis in an infant referred with apnea caused by mixed infection with Enterococcus raffinosus and Escherichia coli. 一名因呼吸暂停而转诊的婴儿因混合感染拉菲诺斯肠球菌和大肠埃希菌而引发急性局灶性细菌性肾炎。

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2024-08-21 DOI: 10.1272/jnms.JNMS.2025_92-502

Yuna Kamioka, Kensuke Izumida, Eiji Ohtaka, Yoshiaki Hashimoto, Hajime Okada, Hidehiko Narazaki, Yasuhiko Itoh

{"title":"Acute focal bacterial nephritis in an infant referred with apnea caused by mixed infection with Enterococcus raffinosus and Escherichia coli.","authors":"Yuna Kamioka, Kensuke Izumida, Eiji Ohtaka, Yoshiaki Hashimoto, Hajime Okada, Hidehiko Narazaki, Yasuhiko Itoh","doi":"10.1272/jnms.JNMS.2025_92-502","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-502","url":null,"abstract":"A 38-day-old infant was referred to our hospital for evaluation of apnea, fever, and pyuria. Invasive bacterial infection, including meningitis, was suspected because of the presence of apnea. A contrast-enhanced CT scan revealed acute localized bacterial nephritis, and meningitis was ruled out. Gram-positive cocci and Gram-negative rods, ie, Enterococcus raffinosus and Escherichia coli, were isolated from a urine culture at the referring hospital. This case report describes the youngest case of E. raffinosus infection. Apnea was the main complaint, but the origin of fever was infant acute focal bacterial nephritis (AFBN) with mixed infection. In infants, bacterial infections, especially invasive bacterial infections, can result in poor outcomes and require careful evaluation and treatment. Furthermore, the possibility of AFBN should not be overlooked, because bacteriuria or leukocyturia may be absent and can flare up if antimicrobials are not administered for an adequate duration. Although ampicillin-susceptible E. raffinosus infection in our patient responded well to treatment, there have been reports of vancomycin-resistant enterococci, which highlights the importance of proper use of antimicrobial agents to avoid producing drug-resistant bacteria.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019754","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 1.2 4区医学

Journal of Nippon Medical School Pub 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-21","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

Early Laparoscopic Colostomy in Advanced Cancer Patients with Rectovaginal Fistula: Results of Seven Patients. 直肠阴道瘘晚期癌症患者的早期腹腔镜结肠造口术：七名患者的治疗结果

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2024-08-21 DOI: 10.1272/jnms.JNMS.2025_92-504

Satoshi Akita, Kei Ishimaru, Mitsunori Sato, Katsuya Watanabe, Hiroki Sugishita, Yusuke Ogi, Jun Kuwabara, Kazufumi Tanigawa, Satoshi Kikuchi, Hironori Matsumoto, Motohira Yoshida, Shigehiro Koga, Taro Oshikiri

{"title":"Early Laparoscopic Colostomy in Advanced Cancer Patients with Rectovaginal Fistula: Results of Seven Patients.","authors":"Satoshi Akita, Kei Ishimaru, Mitsunori Sato, Katsuya Watanabe, Hiroki Sugishita, Yusuke Ogi, Jun Kuwabara, Kazufumi Tanigawa, Satoshi Kikuchi, Hironori Matsumoto, Motohira Yoshida, Shigehiro Koga, Taro Oshikiri","doi":"10.1272/jnms.JNMS.2025_92-504","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-504","url":null,"abstract":"A rectovaginal fistula (RVF) is an abnormal tract between the rectum and vagina, which requires surgical intervention in many cases. Although there are many different therapeutic approaches for RVF depending on the patient's' condition, there are no established guidelines for the care of RVF. This study aimed to evaluate the results of laparoscopic colostomy in advanced cancer patients with RVF, and the safety and efficacy of this surgery. In this study, seven female advanced cancer patients with RVF were hospitalized and successfully treated with laparoscopic colostomy from 2015 to 2018 at our university hospital. Their data were retrospectively evaluated from their medical records. The early use of diverting stomas facilitated timely resumption of cancer treatment and enabled early treatment with chemotherapy or radiotherapy. Although vaginal stool leakage affected three patients, all patients recovered, experiencing neither pain nor infection during their cancer treatment. While colostomy was physically and mentally taxing for the patients, it improved the infection and pain caused by the RVF. We conclude that the early use of diverting stomas had two effects: a significant improvement in infection management and facilitation of the rapid resumption of cancer treatment.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019755","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

Early and Post-Treatment Imaging Findings in Perineural Spread: A Pathway to Diffuse Muscle Metastasis in Recurrent Bladder Carcinoma. 神经周围扩散的早期和治疗后影像学发现：复发性膀胱癌弥漫性肌肉转移的途径。

IF 1.2 4区医学

Journal of Nippon Medical School Pub Date : 2024-07-05 Epub Date: 2023-02-21 DOI: 10.1272/jnms.JNMS.2024_91-301

Yoshimitsu Honda, Tetsuro Sekine, Ryoji Kimata, Norio Motoda, Keigo Takahashi, Aya Yamane, Daisuke Yasui, Eigo Kodani, Taro Ichikawa, Shinichiro Kumita

引用次数: 0

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区医学

Journal of Nippon Medical School Pub 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-18","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

Diagnostic performance of advanced tomosynthesis in patients with metal devices in the affected knee: a case report. 先进断层扫描对患膝关节金属装置患者的诊断效果：病例报告。

IF 1 4区医学

Journal of Nippon Medical School Pub Date : 2024-06-18 DOI: 10.1272/jnms.JNMS.2025_92-101

Yasushi Oshima, Tokifumi Majima

{"title":"Diagnostic performance of advanced tomosynthesis in patients with metal devices in the affected knee: a case report.","authors":"Yasushi Oshima, Tokifumi Majima","doi":"10.1272/jnms.JNMS.2025_92-101","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-101","url":null,"abstract":"Simple radiography is the most frequently and widely available technology to examine bone pathologies. Computed tomography (CT) can evaluate pathologies more accurately in multiple planes and three dimensions; however, radiation exposure is much higher than with simple radiography. In addition, diagnostic ability is decreased for both technologies when metal devices are present. Tomosynthesis is a radiographic technology used to evaluate tissues quasi-three-dimensionally with less radiation exposure. Tomosynthesis technology was recently upgraded to reduce the effects of metal artifacts. This case report compares examination time, medical expense, image resolution, and radiation exposure for upgraded tomosynthesis, simple radiography, CT, and standard tomosynthesis in three patients with metal devices in the affected knees. Examination times were similar for the imaging technologies. Diagnostic performance was better for upgraded tomosynthesis than for simple radiography and standard tomosynthesis, and similar to that for CT. Moreover, radiation exposure and expense were higher for tomosynthesis than for simple radiography but lower than for CT. These findings suggest that upgraded tomosynthesis is the best method for evaluating bone pathology when metal devices are present and radiation exposure must be limited.","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428334","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 4区医学

Journal of Nippon Medical School Pub 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-18","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