Internal medicine
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We herein report a 48-year-old man with neurosyphilis manifesting as limbic encephalitis, initially suspected to be autoimmune limbic encephalitis. The patient exhibited rapid behavioral changes, and magnetic resonance imaging showed high-intensity lesions in both medial temporal lobes. ⋯ This case highlights the diagnostic challenges in differentiating neurosyphilis from autoimmune limbic encephalitis, given the increasing atypical presentation. A markedly elevated immunoglobulin G index may serve as a valuable diagnostic indicator for neurosyphilis in such cases.
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Erdheim-Chester disease (ECD) is a rare type of non-Langerhans cell histiocytosis, characterized by the infiltration of disease-specific foamy histiocytes, polymorphic granulomas, and fibrosis. Although cardiovascular involvement is observed radiologically in approximately half of ECD patients, only a few reports have described its pathological features. ⋯ Autopsy revealed the pathological association of coronary and renal arterial stenosis with the BRAFV600E gene mutation. BRAF mutations should be considered in patients with ECD, especially in those with arterial lesions.
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We herein report three patients with Fontan-associated liver disease (FALD) who developed hepatocellular carcinoma (HCC). All three patients had very high serum alpha-fetoprotein (AFP) concentrations, and their HCCs were located in the peripheral areas of the liver. ⋯ This review revealed that FALD-HCC is generally located in the peripheral areas of the liver and AFP concentrations are usually high. Thus, it is important that follow-up of patients with FALD include repeated AFP concentrations and abdominal imaging.
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A 61-year-old woman who had been taking olmesartan for 7 years complained of epigastric pain, diarrhea, loss of appetite, and weight loss. Esophagogastroduodenoscopy revealed roughened mucosa and erosions in the stomach and duodenum. An endoscopic biopsy failed to identify the cause of the mucosal disorder. ⋯ After the discontinuation of olmesartan, the symptoms and gastric mucosal findings improved. A final diagnosis of olmesartan-associated gastritis was confirmed. Olmesartan-associated gastritis should be considered in patients taking olmesartan for upper gastrointestinal symptoms.