Internal medicine
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A 59-year-old woman was admitted to our hospital for an evaluation of a 10-day history of progressive pain and hypoesthesia of the right lower back associated with fever and constipation. Sarcoidosis was confirmed on mediastinal lymph node and skin biopsies. ⋯ The intraepidermal nerve fiber density assessed on a skin biopsy was significantly reduced, suggesting small-fiber neuropathy (SFN). The patient was finally diagnosed with sarcoidosis-induced SFN, and her neurological symptoms were effectively relieved with high-dose steroid therapy.
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Distal renal tubular acidosis (dRTA) is a hyperchloremic metabolic acidosis disorder characterized by a normal anion gap with abnormal urinary hydrogen (H(+)) excretion. At present, there are few available reports regarding the clinical status of primary dRTA. The primary objective of this study was to analyze the clinical features and outcomes of primary dRTA. ⋯ Hypokalemia is the most common clinical manifestation of primary dRTA. Primary dRTA can also be accompanied by proximal tubular dysfunction. Controlling the urine calcium and citrate levels is crucial for the treatment of nephrocalcinosis and/or nephrolithiasis, while restoring the blood pH to the normal level is essential for controlling bone disease.
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This study is the first case report of the treatment of methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis using therapeutic drug monitoring of the serum and wound exudate concentrations of linezolid in a renal dysfunction patient. In the present study, the serum trough concentration of linezolid was maintained between 2 and 7 μg/mL. Therapeutic drug monitoring dosage adjustments may be especially useful in patients with renal dysfunction and severe MRSA infection.
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Case Reports
A Patient with the GLA p.E66Q Mutation Exhibiting Vascular Parkinsonism and Bilateral Pulvinar Lesions.
A 76-year-old man was admitted to our hospital due to gait difficulty. Brain imaging indicated bilateral pulvinar lesions and moderate white matter lesions. The serum α-galactosidase A levels were measured for the differential diagnosis of bilateral pulvinar lesions and were found to be abnormally low. ⋯ A GLA mutation analysis showed the p. E66Q mutation, which is speculated to be a functional polymorphism rather than a disease-causing mutation of Fabry disease. Enzyme replacement therapy did not result in a marked improvement, however, the disease progression stopped.
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Case Reports
Non-occlusive mesenteric ischemia after splenic metastasectomy for small-cell lung cancer.
A 68-year-old man presented with severe abdominal pain. Seven months earlier, he had received systemic chemotherapy for small-cell lung cancer with solitary metastasis to the spleen, followed by splenectomy. Abdominal computed tomography and abdominal arterial angiography showed diffuse ischemia of the mesenteric artery without apparent occlusion. ⋯ Therefore, a diagnosis of non-occlusive mesenteric ischemia (NOMI) induced by septicemia was supposed. Although treatment with antibiotics and papaverine hydrochloride was administered and the necrotic tissue in the intestinal tract was resected, the patient died. Physicians should be aware that patients undergoing splenectomy are likely to be affected by septicemia, which may subsequently induce NOMI.