Internal medicine
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Case Reports
Successful Treatment of Granulomatous-lymphocytic Interstitial Lung Disease in a Patient with CTLA-4 Deficiency.
Common variable immunodeficiency (CVID) causes granulomatous-lymphocytic interstitial lung disease (GLILD) and has a poor prognosis. We herein report a case of GLILD in a 49-year-old woman with CTLA-4 deficiency-associated CVID. The patient presented with dyspnea that had worsened over the past two years. ⋯ A flow cytometric analysis of blood cells and genetic testing confirmed CTLA-4 deficiency. We performed video-assisted thoracoscopic surgery for the pathological diagnosis of GLILD and to exclude infection and malignancy. Corticosteroid treatment successfully improved the condition of the patient.
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Objectives Migraine is a disease that leads to social loss due to a decrease in productivity since it is a primary headache with a high prevalence and readily occurs in working-age persons. As described in the diagnostic criteria of the International Classification of Headache Disorders, 3rd edition (beta version), migraine causes hypersensitivity, especially photosensitivity, during attacks, suggesting that light is an inducer of headaches. We developed Blue Cut for Night (BCN) glass, which reduces light stimulation to intrinsically photosensitive continental ganglion cells (ipRGCs), photoreceptors that can lead to exacerbation of migraine attacks. ⋯ Results When the 10 patients with migraine wore the BCN glass at night only for 4 weeks, the number of headache days within that time tended to decrease (7.0±4.37 days) compared to before wearing the glasses (8.7±5.03 days). No participants had any side effects. Conclusion BCN glass, which reduces light stimulation to ipRGCs, was suggested to be a tool for reducing migraine attacks.
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In drug-induced lupus (DIL), symptoms similar to those of systemic lupus erythematosus (SLE) usually resolve after discontinuation of the offending drug. A 41-year-old-woman with a history of ulcerative colitis presented with polyarthritis and myositis and was positive for anti-double stranded (ds) DNA IgG antibody. After discontinuation of mesalazine, the symptoms resolved, and the antibody titer decreased. ⋯ Six months later, lupus myocarditis developed. After treatment with glucocorticoids, cyclophosphamide, intravenous immunoglobulin, and an intra-aortic balloon pump, she showed dramatic improvement. Patients with DIL and an immunological predisposition, such as anti-dsDNA antibodies, may have SLE and should be carefully monitored.
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A 75-year-old woman visited our hospital with constipation. Colonoscopy revealed a submucosal tumor in the rectum. She was followed up as a case of mucosal prolapse syndrome. ⋯ Amyloid protein deposition was detected from the submucosa to subserosa. Other organs showed no evidence of amyloidosis; we therefore diagnosed the patient with localized rectal amyloidosis. This is a rare case of symptomatic localized rectal amyloidosis whose long-term progression was able to be endoscopically observed.