Internal medicine
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We herein report a 64-year-old man with KRASG12C-mutated advanced lung adenocarcinoma previously treated with immune checkpoint inhibitors (ICIs). One month after starting second-line sotorasib treatment, the patient experienced a progressive decline in serum hemoglobin levels. Anemia was accompanied by markedly elevated serum erythropoietin levels and decreased reticulocyte levels. ⋯ No secondary causes other than medication use were identified. Suspected causative drugs were sotorasib and ICIs. Discontinuation of sotorasib for one week improved his anemia; therefore, the causative drug was identified as sotorasib.
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Immune checkpoint inhibitors (ICIs) improve the outcomes of several types of cancer. However, they are also associated with various immune-related adverse events including myocarditis. ⋯ In both cases, additional immunosuppressive therapies, such as intravenous immunoglobulin and tacrolimus, successfully resolved myocarditis. Given the corticosteroid-refractory nature of these cases, we suggest that prompt addition of other immunosuppressive drugs to corticosteroid therapy should be considered in the treatment of ICI-induced myocarditis.
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Objective Triple-vessel disease (TVD) is a well-established prognostic factor for patients with acute myocardial infarction (AMI). However, there is a paucity of literature regarding the risk factors for in-hospital death in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and TVD. In this retrospective study, we examined the determinants of in-hospital death in patients with NSTEMI and TVD who underwent percutaneous coronary intervention (PCI) for culprit lesions. ⋯ In the multivariate logistic regression analysis, in-hospital death was inversely associated with the SBP at admission (odds ratio [OR] 0.984, 95% confidence interval [CI] 0.970-0.999, p<0.035) and eGFR (OR 0.966, 95% CI 0.939-0.994, p=0.019) and was associated with cardiopulmonary arrest (CPA) before PCI (OR 8.448, 95%CI 1.863-38.309, p=0.006). Conclusion In-hospital death was associated with CPA before PCI and inversely associated with the SBP at admission and eGFR in patients with NSTEMI and TVD who underwent PCI for the culprit lesion. It may be important to recognize these high-risk features in order to improve the clinical outcomes of patients with NSTEMI and TVD.
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Angiosarcoma is a rare malignancy that can arise from chronic pyothorax. We herein report a 75-year-old Japanese man with a history of tuberculosis who presented with left-sided chest pain that had persisted for 4 months. ⋯ Chemotherapy with paclitaxel (80 mg/m2 weekly) was ineffective and was discontinued after 3 months. Our findings emphasize that physicians should inform patients with chronic tuberculous pyothorax about malignant complications for which chest pain is the initial symptom, in addition to highlighting the need for careful follow-up.