Amiodarone is used to treat life-threatening ventricular arrhythmias and atrial fibrillation; however, it frequently causes liver damage. We report the case of a 72-year-old hemodialysis patient who developed nausea, ano...Amiodarone is used to treat life-threatening ventricular arrhythmias and atrial fibrillation; however, it frequently causes liver damage. We report the case of a 72-year-old hemodialysis patient who developed nausea, anorexia, and constipation, accompanied by elevated liver enzymes and a progressive increase in hepatic CT attenuation, which led to the diagnosis of amiodarone-induced liver damage. Abdominal symptoms and the liver function improved after drug discontinuation. Although reports on dialysis patients are limited, understanding this risk and performing periodic CT in addition to blood tests may facilitate early detection and improve the prognosis.
Adult-onset human parechovirus (HPeV) encephalitis is extremely rare. We report the first case of HPeV encephalitis in Japan in an 82-year-old man with diabetes, who presented with an impaired consciousness and status ep...Adult-onset human parechovirus (HPeV) encephalitis is extremely rare. We report the first case of HPeV encephalitis in Japan in an 82-year-old man with diabetes, who presented with an impaired consciousness and status epilepticus (SE). A cerebrospinal fluid (CSF) analysis revealed a normal cell count with elevated protein levels. Magnetic resonance imaging showed hyperintense signals in the thalamus and parietal lobe, and HPeV type 3 was detected in the CSF. SE resolved following antiepileptic treatment, and the patient's cognitive function recovered. Adult HPeV encephalitis may present with SE, an absence of pleocytosis, and "reversible" cognitive deficits, highlighting the diagnostic utility of multiplex polymerase chain reaction testing in encephalitis without pleocytosis.
Masui M, Matsuno H, Okumura M
… +14 more, Kida H, Motegi H, Komatsu T, Sakuta K, Sakai K, Mitsumura H, Kashiwagi Y, Obata S, Maeda K, Shinohara A, Iwauchi A, Sato M, Sekijima Y, Iguchi Y
A 72-year-old woman, previously diagnosed with wild-type transthyretin amyloidosis (ATTRwt) based on amyloid deposits in specimens from carpal tunnel release, was admitted for an evaluation of gait disturbance. She was d...A 72-year-old woman, previously diagnosed with wild-type transthyretin amyloidosis (ATTRwt) based on amyloid deposits in specimens from carpal tunnel release, was admitted for an evaluation of gait disturbance. She was diagnosed with spinal canal stenosis and underwent cervical laminoplasty, followed by anterior-posterior lumbar fusion with partial laminectomy. Histopathology revealed transthyretin-positive amyloid in the hypertrophied ligamentum flavum of both the cervical and lumbar spines, as well as in a bulging lumbar intervertebral disc. This case represents a rare instance of amyloid deposition in the intervertebral disc of a patient with ATTRwt, suggesting a potential role of amyloid in intervertebral disc degeneration.
Varicella-zoster virus (VZV) myelitis is a rare neurological infection that often results in long-term effects on the central nervous system. Myelitis is generally observed in immunocompromised individuals, and such case...Varicella-zoster virus (VZV) myelitis is a rare neurological infection that often results in long-term effects on the central nervous system. Myelitis is generally observed in immunocompromised individuals, and such cases have scarcely been reported; therefore, no established treatment currently exists. We herein report our experience with the successful treatment of a 46-year-old female patient with VZV myelitis and disseminated herpes zoster using antiviral drug administration and steroid pulse therapy. In addition, as the patient developed myelitis despite only mild cellular immunosuppression, we discussed the etiology of the disease and measures for preventing VZV reinfection and relapse.
Suzuki T, Onozawa M, Kanaya M
… +13 more, Kondo T, Sugimura S, Nagai J, Yokoyama K, Saito Y, Yoshida S, Harada S, Suto K, Hasegawa Y, Ara T, Goto H, Hashimoto D, Teshima T
We report a rare case of acute myeloid leukemia (AML) harboring an MOZ::TIF2 fusion gene with a previously unreported breakpoint. A 36-year-old man was diagnosed with AML involving inv(8)(p11.2q13). Reverse transcriptase...We report a rare case of acute myeloid leukemia (AML) harboring an MOZ::TIF2 fusion gene with a previously unreported breakpoint. A 36-year-old man was diagnosed with AML involving inv(8)(p11.2q13). Reverse transcriptase-polymerase chain reaction (RT-PCR) initially failed to detect the conventional MOZ exon16::TIF2 exon14 fusion associated with inv(8)(p11.2q13); however, further sequencing identified a novel breakpoint of MOZ exon14::TIF2 exon12, with an additional shorter transcript lacking TIF2 exon13. MOZ::TIF2-positive AML is extremely rare, with only eight cases previously reported, and adult cases appear to have particularly poor outcomes. Our case highlights the diagnostic challenges and aggressive clinical behavior associated with MOZ::TIF2-rearranged AML.
Matsumoto S, Takigawa Y, Sato K
… +10 more, Shinno Y, Ichikawa T, Inoue T, Matsuoka S, Nishimura J, Watanabe H, Kudo K, Hirami Y, Fujiwara K, Shibayama T
A 66-year-old man presented with dyspnea and severe hypoxemia, requiring mechanical ventilation. Computed tomography revealed an obstruction of the left main bronchus by a bronchial tumor, thus prompting airway intervent...A 66-year-old man presented with dyspnea and severe hypoxemia, requiring mechanical ventilation. Computed tomography revealed an obstruction of the left main bronchus by a bronchial tumor, thus prompting airway intervention to relieve the stenosis. A histopathological examination of the tumor revealed clear cytoplasm and hyalinized stroma, and rearrangement of EWSR1 was detected by a fluorescence in situ hybridization analysis. Comprehensive genomic profiling was performed because of the rarity of this case. GenMineTOP, capable of detecting the EWSR1::ATF1 fusion, contributed to a definitive diagnosis of hyalinizing clear cell carcinoma. Bronchoscopic airway intervention can serve as both a therapeutic and diagnostic procedure; GenMineTOP was useful in establishing a definitive diagnosis.
We report a case of adrenomyeloneuropathy caused by a novel ABCD1 variant complicated by recurrent herpes simplex virus type 2 meningitis, with no evidence of either any clinical or radiological progression. Given previo...We report a case of adrenomyeloneuropathy caused by a novel ABCD1 variant complicated by recurrent herpes simplex virus type 2 meningitis, with no evidence of either any clinical or radiological progression. Given previous reports describing temporal associations between infections and the recognition of cerebral adrenoleukodystrophy (ALD), careful continuous observation of the present case with attention to the development of cerebral ALD is required. The early recognition of cerebral ALD is mandatory to achieve better outcomes with hematopoietic stem cell transplantation.
Matsumoto H, Yamashina T, Masaki M
… +11 more, Nakata H, Takayama S, Takayama T, Nakagawa T, Toyonaga H, Orino M, Saito N, Takeo M, Fukata N, Shimatani M, Naganuma M
Objective Endoscopic submucosal dissection (ESD) requires prolonged and stable sedation. Although midazolam combined with dexmedetomidine (MDZ+DEX) is widely used, delayed postoperative awakening and hemodynamic instabil...Objective Endoscopic submucosal dissection (ESD) requires prolonged and stable sedation. Although midazolam combined with dexmedetomidine (MDZ+DEX) is widely used, delayed postoperative awakening and hemodynamic instability remain concerns, particularly in elderly patients. This study aimed to compare the efficacy and safety of remimazolam (RMZ) with MDZ+DEX for sedation during ESD. Methods This single-center retrospective study was conducted in Japan. The primary outcome was the quality of postoperative awakening. The secondary outcomes included procedural outcomes and sedation-related adverse events, such as hypotension, bradycardia, and hypoxemia. Patients A total of 195 patients who underwent ESD between January 2023 and October 2025 were analyzed. The patients were divided into the RMZ group (n=69) and the MDZ+DEX group (n=126). Results The baseline patient and procedural characteristics were comparable between the two groups. The Postprocedural Richmond Agitation-Sedation Scale scores did not differ significantly. However, poor postoperative awakening was significantly less frequent in the RMZ group than in the MDZ+DEX group (27.5% vs. 76.2%, p<0.01). A propensity score matching analysis created 54 matched pairs, yielding a significantly lower rate of poor awakening in the RMZ group (27.8% vs. 68.5%, p<0.01). In patients aged ≥65 years, the incidence of hypotension was significantly lower in the RMZ group, accompanied by more favorable postoperative recovery profiles. No intraoperative perforations occurred in the RMZ group. Conclusion Remimazolam was associated with improved postoperative awakening and a lower incidence of hemodynamic adverse events compared with MDZ+DEX, particularly in elderly patients. Therefore, RMZ may be a useful alternative sedation strategy for ESD.
Introduction Steatotic liver disease is increasingly prevalent, and individuals with steatotic liver disease and high Fibrosis-4 (FIB-4) index levels are at a higher risk of liver-related or non-liver-related mortality....Introduction Steatotic liver disease is increasingly prevalent, and individuals with steatotic liver disease and high Fibrosis-4 (FIB-4) index levels are at a higher risk of liver-related or non-liver-related mortality. Therefore, we investigated the factors associated with a high FIB-4 index (a surrogate marker of liver fibrosis) in patients with hepatic steatosis and progression to a high FIB-4 index with hepatic steatosis during 5 years of follow-up after undergoing health checkups. Patients and Methods This study included 5,434 participants with hepatic steatosis diagnosed by ultrasonography in 2018 and analyzed the aforementioned factors. Results The 5,434 study participants were classified into a high-risk group (FIB-4 index ≥2.67; n=139) and a low-risk group (FIB-4 index <2.67; n=5, 295). A multivariate logistic regression analysis was performed. Hypertension (odds ratio: 3.210, p<0.001) was associated with the high-risk group. Of the initial participants, 173 with a high FIB-4 index and hepatic steatosis in 2018 and loss of FIB-4 index data in 2023 were excluded. Of the remaining 5,261 participants with available FIB-4 index data in 2023, 87 were classified into the high-risk group after 5 years. A multivariate logistic regression analysis identified hypertension (odds ratio: 2.190, p=0.002) as a factor associated with a high FIB-4 index with hepatic steatosis after 5 years from baseline. Conclusions Hypertension was associated with a high FIB-4 index with hepatic steatosis and progression to s high FIB-4 index with hepatic steatosis, which is linked to a poor prognosis.
Hayasaka Y, Ohno Y, Umeki Y
… +11 more, Nakagawa Y, Adachi N, Matsuoka N, Yoshida S, Matsunaga H, Watanabe S, Matsui T, Oka K, Hayama M, Sekiguchi M, Ueda S
A 64-year-old man presented with postnasal drip, nasal obstruction, peripheral blood eosinophilia (34%), and paranasal sinus mucosal thickening, suggesting eosinophilic chronic rhinosinusitis (ECRS). However, a nasal pol...A 64-year-old man presented with postnasal drip, nasal obstruction, peripheral blood eosinophilia (34%), and paranasal sinus mucosal thickening, suggesting eosinophilic chronic rhinosinusitis (ECRS). However, a nasal polyp biopsy showed minimal eosinophil infiltration. A blood examination revealed polyclonal hypergammaglobulinemia and elevated serum immunoglobulin (Ig) G4 levels (5060 mg/dL). A paranasal sinus mucosa biopsy confirmed IgG4-positive plasma cell infiltration. Therefore, IgG4-related rhinosinusitis was diagnosed. Positron emission tomography showed typical organ involvement and paranasal sinus lesions, suggesting sinonasal involvement in systemic IgG4-related disease (RD). We concluded that eosinophilia may occur in IgG4-RD, and the IgG4 levels may support the diagnosis in not only refractory ECRS, but also in unexplained eosinophilia.
We report a case of pseudo-acute kidney injury (AKI) caused by a bladder rupture following chemoradiotherapy for uterine cancer. Bladder perforation can lead to urinary ascites, resulting in elevated renal function param...We report a case of pseudo-acute kidney injury (AKI) caused by a bladder rupture following chemoradiotherapy for uterine cancer. Bladder perforation can lead to urinary ascites, resulting in elevated renal function parameters via peritoneal reabsorption. Owing to nonspecific symptoms, this condition is often difficult to differentiate from true AKI or acute abdomen. In our case, although temporary hemodialysis was initiated, the renal parameters improved after urethral catheter drainage. A bladder rupture should be suspected early in patients with a history of pelvic radiotherapy who present with ascites and renal dysfunction.
Lupus myocarditis (LM) is a rare but potentially life-threatening manifestation of systemic lupus erythematosus. We report the case of a 36-year-old woman who presented with fulminant heart failure refractory to standard...Lupus myocarditis (LM) is a rare but potentially life-threatening manifestation of systemic lupus erythematosus. We report the case of a 36-year-old woman who presented with fulminant heart failure refractory to standard therapy. Concomitant nephrotic syndrome, hypocomplementemia, and positive anti-double-stranded DNA antibodies supported the diagnosis of LM. Given her rapid hemodynamic deterioration, high-dose intravenous steroid therapy was promptly initiated, leading to a rapid recovery of her cardiac function without mechanical circulatory support. An endomyocardial biopsy demonstrated mononuclear inflammatory cell infiltration and mild fibrosis, consistent with LM, with prominent tenascin-C deposition.
Pure red cell aplasia (PRCA) secondary to chronic lymphocytic leukemia (CLL) is extremely rare. We report a case of a 58-year-old woman with concurrent PRCA at the initial diagnosis of CLL. Acalabrutinib monotherapy achi...Pure red cell aplasia (PRCA) secondary to chronic lymphocytic leukemia (CLL) is extremely rare. We report a case of a 58-year-old woman with concurrent PRCA at the initial diagnosis of CLL. Acalabrutinib monotherapy achieved a partial response in CLL; however, her anemia did not improve. In contrast, the subsequent addition of obinutuzumab resulted in prompt recovery of reticulocytes and a marked improvement in anemia, accompanied by a substantial reduction in CLL cells. This clinical course, characterized by a prompt reticulocyte recovery occurring in parallel with deep clearance of the CLL clone after adding obinutuzumab, supports the concept that the effective eradication of the underlying CLL may be required for PRCA resolution in some patients with CLL-associated PRCA.
Meningitis caused by Klebsiella oxytoca (K. oxytoca) is rare, and to the best of our knowledge, no case of bacterial meningitis following cystoscopy has ever been reported. We herein report a case of meningitis caused by...Meningitis caused by Klebsiella oxytoca (K. oxytoca) is rare, and to the best of our knowledge, no case of bacterial meningitis following cystoscopy has ever been reported. We herein report a case of meningitis caused by K. oxytoca that developed following cystoscopy. A 74-year-old man underwent cystoscopy for hematuria, and radiation-induced cystitis was suspected. Two days after cystoscopy, he developed K. oxytoca meningitis, from which he recovered following treatment with ceftriaxone. It was speculated that cystoscopy triggered bacteremia from the bladder lesion, which led to the development of K. oxytoca meningitis. Caution should be exercised when performing cystoscopy, as it may result in bacterial meningitis.
Drug-induced acute interstitial nephritis (DI-AIN) is a common cause of acute kidney injury (AKI), particularly in patients receiving multiple medications. We report a case of AKI in a 47-year-old man with lung squamous...Drug-induced acute interstitial nephritis (DI-AIN) is a common cause of acute kidney injury (AKI), particularly in patients receiving multiple medications. We report a case of AKI in a 47-year-old man with lung squamous cell carcinoma who was treated with carboplatin, paclitaxel, and tazobactam/piperacillin (TAZ/PIPC). A renal biopsy revealed acute tubulointerstitial nephritis with eosinophilic infiltration and non-caseating epithelioid granulomas. The drug lymphocyte stimulation test was positive for TAZ/PIPC, thus supporting a diagnosis of drug-associated DI-AIN. The discontinuation of TAZ/PIPC and corticosteroid therapy led to a recovery of the renal function, thereby allowing for the safe resumption of chemotherapy.
Iatrogenic lymphomas can be caused by a variety of immunosuppressive agents. Methotrexate-associated lymphomas are the most prevalent, and methotrexate termination often leads to lymphoma regression. However, for many ot...Iatrogenic lymphomas can be caused by a variety of immunosuppressive agents. Methotrexate-associated lymphomas are the most prevalent, and methotrexate termination often leads to lymphoma regression. However, for many other immunosuppressants, the association with lymphomagenesis is less well established, and whether drug termination will lead to lymphoma regression remains unclear. We report a case of Epstein-Barr virus-negative diffuse large B-cell lymphoma in which azathioprine cessation led to lymphoma remission. A literature review revealed seven other cases of azathioprine-associated lymphomas in which drug cessation led to a spontaneous remission. An observational approach with azathioprine termination may be an optimal management method for cases in which chemotherapy can be deferred.
We present the case of a young, immunocompromised woman with invasive listeriosis who initially presented with respiratory symptoms after being diagnosed with COVID-19. She had a 6-day history of nasal discharge, malaise...We present the case of a young, immunocompromised woman with invasive listeriosis who initially presented with respiratory symptoms after being diagnosed with COVID-19. She had a 6-day history of nasal discharge, malaise, and headache, with positive COVID-19 PCR results. A blood culture revealed Listeria monocytogenes with an elevated initial cerebrospinal fluid pressure, pleocytosis, and reduced glucose levels. On presentation, she was alert and successfully treated with intravenous ampicillin for three weeks, with no neurological sequelae.
We describe a treatment-naïve 30-year-old man with an advanced HIV infection who experienced virologic failure on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) despite complete adherence. Initially, resis...We describe a treatment-naïve 30-year-old man with an advanced HIV infection who experienced virologic failure on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) despite complete adherence. Initially, resistance testing revealed non-nucleoside reverse transcriptase inhibitor mutations but no baseline resistance to BIC/FTC/TAF. Despite an initial viral decline, rebound viremia occurred by day 77, accompanied by the emergence of the M184I mutation, which confers resistance to FTC. Switching to darunavir/cobicistat/TAF/FTC, followed by intensification with dolutegravir, achieved partial viral suppression. This case suggests a possible contribution of transmitted drug resistance or minority variants undetectable at baseline, with selective outgrowth under therapeutic pressure.