Internal medicine
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Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. ⋯ The baseline parameters that were significantly correlated with LOS were the GCS (ρ =-0.665; p <0.001) and SOFA score (ρ =0.670; p <0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ =-0.390; p =0.040). Conclusions GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.
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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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Objective Intravascular large B-cell lymphoma (IVLBCL) is a critical cause of fever of unknown origin (FUO). While a pathological analysis is essential for diagnosing IVLBCL, the indications for an invasive procedure may be ascertained using easy, non-invasive tests. The lymphocyte-to-monocyte ratio (LMR) can reportedly predict the diagnosis of malignant lymphoma in patients with lymphadenopathy; however, its clinical utility in predicting an IVLBCL diagnosis in patients with FUO remains to be elucidated. ⋯ A receiver operating characteristic analysis demonstrated that a WBC ≤7,200 and LMR ≤3.0 predicted the diagnosis with a sensitivity of 88.2% and 100%, and a specificity of 65.0% and 43.3%, respectively. In addition, the probability of IVLBCL increased to 71.4% in patients with both variables but was 0% in those with neither variable, indicating its potential utility in determining the need for an invasive procedure. Conclusion The WBC count and LMR predicted an IVLBCL diagnosis in patients presenting with FUO.
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A 69-year-old woman with left-sided breast cancer developed elevated creatine kinase levels and muscle weakness in her extremities after treatment with pembrolizumab. The patient was diagnosed with immune checkpoint inhibitor (ICI)-related myositis. ⋯ Furthermore, high-resolution manometry showed impaired upper esophageal sphincter opening and absence of esophageal peristalsis, which improved partially after immunotherapy. These findings suggest that esophageal dysfunction may be an unrecognized complication of ICI-related myositis.
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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.