Internal medicine
-
Diagnostic Pitfalls of the Bleeding Origin after a Percutaneous Renal Biopsy: A Report of Two Cases.
A percutaneous renal biopsy (PRB) is a standard procedure for diagnosing renal disease, but can cause bleeding complications. Bleeding after a PRB can be classified as early- or late-onset, depending on the timing of the onset of the bleeding symptoms (<24 h or ≥24 h). ⋯ In both cases, the origin of the bleeding vessel was misjudged during the first examination. We discuss the diagnostic pitfalls of the origin of bleeding after a PRB and propose measures to avoid falling such pitfalls.
-
The diagnosis of pneumonia is based on respiratory and systemic symptoms, blood test findings, chest radiographic findings, and the condition of the patient. Physicians in aging or aged societies such as Japan carefully evaluate the comprehensive situation of each pneumonia patient with adequate evaluation and treatment according to "the Japanese Respiratory Society guidelines for the management of pneumonia in adults in 2024". ⋯ This review concisely describes the historical evolution of the diagnosis and treatment of pneumonia in elderly societies, including aspiration pneumonia, from multiple perspectives. In addition, it explores the differential diagnoses when antimicrobial treatment for pneumonia is ineffective, highlighting key aspects through chest radiography and computed tomography.
-
A 25-year-old Japanese man developed visual disturbance with eye pain and was diagnosed with optic neuritis associated with anti-myelin oligodendrocyte glycoprotein antibodies. His symptoms improved temporarily after steroid therapy but chronically relapsed many times after tapering the steroid dose. ⋯ Maintenance intravenous immunoglobulin (IVIg) therapy successfully decreased the annual recurrence rate from 1.15 to 0.27 times/year and the maintenance dose of oral prednisolone from 35 to 5 mg/day. Maintenance IVIg therapy is a promising option for preventing disease relapse in such cases.
-
We herein report a case of Takotsubo syndrome in an 80-year-old woman with end-stage renal disease who hesitated to initiate hemodialysis for pulmonary edema. On hospital day 2, the patient experienced cardiac arrest. Coronary angiography after spontaneous return of circulation showed no substantial stenosis. ⋯ On hospital day 3, she developed ventricular fibrillation but was spontaneously resuscitated. Patients with chronic kidney disease and those who postpone dialysis initiation may be at an increased risk of developing Takotsubo syndrome. Early and careful monitoring and adequate shared decision-making are essential for seamless initiation of dialysis.
-
Danon disease (DD) is a rare lysosomal storage disorder resulting from pathogenic variants of the lysosome-associated membrane protein type 2 (LAMP-2) gene. The disease is characterized by severe cardiomyopathy, which rapidly progresses to end-stage heart failure. ⋯ A pathological analysis revealed that only a minority of the samples exhibited autophagic vacuoles with unique sarcolemmal features (AVSFs), which are typical of DD. Importantly, LAMP-2 expression was absent and the myocardial tissue contained a substantial amount of p62-positive aggregates.