Internal medicine
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We herein report a case of IgG4-related autoimmune hepatitis (AIH) in a patient with a history of type 1 autoimmune pancreatitis. A 56-year-old man presented with fatigue and jaundice at our hospital. ⋯ Based on the diagnosis of IgG4-related AIH, prednisolone treatment was initiated, which led to the rapid resolution of liver dysfunction and jaundice. An accurate diagnosis of IgG4-related AIH is crucial to prevent secondary manifestations.
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A 75-year-old man presented with cognitive decline, headaches, and ataxic gait. Magnetic resonance imaging (MRI) revealed acute infarcts in multiple brain regions, and vessel wall MRI (VW-MRI) demonstrated concentric arterial wall thickening and enhancement in some intracranial arteries, initially suggesting primary central nervous system vasculitis (PCNSV). ⋯ A skin biopsy revealed intravascular large B-cell lymphoma (IVLBCL), and autopsy revealed tumor cells in the arterial walls corresponding to the VW-MRI findings. This case highlights the risk of a misdiagnosis of PCNSV based solely on imaging findings and underscores the need for histological confirmation.
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A 72-year-old Japanese woman presented to our hospital with progressive hearing loss and dysphagia. Blood tests revealed elevated C-reactive protein and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). ⋯ She was diagnosed with Garcin syndrome associated with otitis media with ANCA-associated vasculitis (OMAAV) and treated with high-dose glucocorticoid therapy followed by intravenous cyclophosphamide and rituximab. Therefore, OMAAV should be considered in the differential diagnosis of refractory otitis media with unilateral cranial nerve involvement.
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Severe fever with thrombocytopenia syndrome (SFTS) is known to cause gastrointestinal hemorrhaging; however, few reports have so far specified the site of the hemorrhaging or lesion characteristics. A 79-year-old man was admitted to the hospital with fever, anorexia, and diarrhea which was suspected to be due to gastroenteritis. On day 2, the patient developed hematemesis. ⋯ Further physical examination revealed an eschar, and the blood test was positive for SFTS virus nucleic acid. This case suggests that SFTS-associated gastrointestinal hemorrhage may be caused by acute gastritis. SFTS should therefore be considered in cases with fever, gastrointestinal symptoms, and thrombocytopenia.
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Thymic carcinoma (TC) is a rare malignancy with limited treatment options. Lenvatinib, a novel multitarget kinase inhibitor, has recently been used to treat advanced or metastatic thymic carcinoma that cannot be surgically removed. ⋯ We herein report an 85-year-old Japanese woman with localized unresectable thymic carcinoma who was treated with lenvatinib as induction chemotherapy before undergoing radiotherapy. Our findings suggest that lenvatinib may be a viable option for induction chemotherapy in similar clinical scenarios.