Internal medicine
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Cancer cachexia, which is characterized by weight loss and muscle weakness, is common in patients with pancreatic cancer. Anamorelin, a ghrelin receptor agonist, has shown potential for the management of cachexia in various cancers. ⋯ Cachexia's complex metabolic changes make treatment difficult; however, anamorelin's appetite and weight gain effects highlight its possible role in managing cachexia in pancreatic cancer. Therefore, further research is required in this regard.
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Cardiac amyloidosis (CA), predominantly caused by amyloid transthyretin (ATTR) or immunoglobulin light chain (AL), has a poor prognosis, and a precise diagnosis is crucial because the optimal treatments differ between the two conditions. However, diagnosing AL-CA is challenging because of the unavailability of effective AL-detecting antibodies, particularly in cases with coexisting AL- and ATTR-CA. This report presents a successfully diagnosed case of complicated AL- and ATTR-CA that was successfully treated with tafamidis for ATTR-CA and combination chemotherapy for AL-CA. This case highlights the importance of a precise diagnosis of CA and supports the efficacy and safety of concurrent treatment for coexisting amyloidosis.
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A 59-year-old man without risk factors for atherosclerosis was diagnosed with coronavirus disease 2019 (COVID-19). Four days later, he developed dysarthria and gait disturbance. Neurological examination revealed slurred speech, ataxia, and mild cognitive decline. ⋯ A skin biopsy supported the diagnosis. He was treated with cilostazol and after three months of rehabilitation, he regained an independent walking ability. COVID-19 increases the risk of ischemic stroke in CADASIL patients, with bilateral middle cerebellar peduncle infarctions being notable in the present case.
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Fabry disease (FD) is a rare X-linked lysosomal storage disorder. Enzyme replacement therapies (ERT), such as agalsidase α and β, are available treatment options. ⋯ We report the case of a female patient with Fabry disease who developed unexpected hypotension after six years of stable treatment with agalsidase α, leading to a switch to agalsidase β. Continuous monitoring may be essential to identify potential IRRs in female patients with Fabry disease receiving long-term ERT.
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A Case of Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy Caused by Influenza A Infection.
Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a new spectrum of autoimmune inflammatory nervous system disorders associated with infection, neoplasm, or drug use. We present the first pediatric case of GFAP astrocytopathy caused by an influenza A infection. ⋯ Methylprednisolone pulse therapy led to a good prognosis. In cases of progressive atypical complications of influenza infection, immunotherapy-reactive GFAP astrocytopathy should be considered as a differential diagnosis for prompt treatment.