Internal medicine
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We herein report a 52-year-old woman with anti-aquaporin 4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) and idiopathic multicentric Castleman disease (iMCD) who was successfully treated with tocilizumab, a humanized anti-human interleukin (IL)-6 receptor monoclonal antibody. This is the first report of a case of coexisting NMOSD and iMCD. IL-6 is involved in the pathogenesis of both NMOSD and iMCD, and tocilizumab is effective against both diseases. By treating the patient with tocilizumab, the lung lesions due to iMCD improved, and the neurological symptoms of NMOSD did not recur.
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A 64-year-old man with cirrhosis was diagnosed with unresectable hepatocellular carcinoma and treated with a combination of durvalumab and tremelimumab. The patient had no history of diabetes mellitus. ⋯ The patient was diagnosed with fulminant type 1 diabetes mellitus. Although fulminant type 1 diabetes mellitus is a rare immune-mediated adverse event, it requires prompt attention shortly after the initiation of these agents owing to its severe and emergent nature.
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Non-bacterial thrombotic endocarditis (NBTE) causes myocardial and cerebral infarctions and is associated with advanced stages of malignancy. However, only a few cases of myocardial and cerebral infarctions have been reported in the same patient. We herein report a 47-year-old woman with advanced uterine and ovarian cancer who experienced acute myocardial infarction (MI) after receiving chemotherapeutic intervention for the cancer and hemorrhagic cerebral infarction 1 month after admission for acute MI, attributable to NBTE of the aortic valve. NBTE should be considered in patients with malignancies and life-threatening thromboembolism of important organs.
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There are no clear strategies for non-insulin-dependent slowly progressive type 1 diabetes mellitus (SPIDDM). We herein report a 25-year-old man with SPIDDM in whom appropriate diet therapy and exercise improved the initial insulin secretion without medication. ⋯ These improvements were maintained over five years with continuous lifestyle interventions. Patients with non-insulin-dependent SPIDDM may recover and retain their insulin secretion through lifestyle interventions.
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A woman in her late 70s presented with a fever, rashes, and marked proximal muscle weakness. Noninfectious conditions, including myositis and vasculitis, were initially considered. ⋯ A skin biopsy revealed leukocytoclastic vasculitis with immune complex deposition, suggesting muscle damage due to immune complexes. This case underscores the need to consider JSF in patients with atypical symptoms and initiate timely treatment to prevent severe complications.