Internal medicine
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Case Reports
Pulmonary tumor thrombotic microangiopathy with circulatory failure treated with imatinib.
Pulmonary tumor thrombotic microangiopathy is a lethal, yet difficult to diagnose, complication of gastrointestinal carcinoma. Even if properly diagnosed, there is no treatment, especially after a circulatory collapse. ⋯ Pulmonary hypertension was dramatically ameliorated and the patient was able to be weaned from percutaneous cardiopulmonary support within 20 days of treatment. Imatinib may be effective for ameliorating pulmonary hypertension that is caused by pulmonary tumor thrombotic microangiopathy.
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To assess longitudinal changes in the clinical features of patients with amyotrophic lateral sclerosis (ALS), we performed a retrospective hospital-based study covering 35 years. ⋯ Our findings demonstrate that, among patients with sporadic ALS, the age at disease onset, the proportion of patients with disease onset at 70 years of age or higher, the proportion of patients with dementia and the proportion of patients with bulbar onset ALS have increased significantly over the past 35 years. The longitudinal changes observed in the clinical features of ALS may reflect the increasing age at disease onset.
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Thrombocytopenia is frequently observed during bloodstream infection (BSI); however, little is known about the trends in platelet size during BSI. The aim of this study was to investigate trends in platelet indices during BSI and to determine the relationship between the mean platelet volume (MPV) levels and the prognosis of BSI patients. ⋯ Changes in the MPV levels after BSI may therefore be a useful prognostic marker for BSI.
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Case Reports
Methemoglobinemia induced by trimethoprim-sulfamethoxazole in a patient with systemic lupus erythematosus.
We herein report a case of methemoglobinemia induced by trimethoprim-sulfamethoxazole (TMP/SMX). A 41-year-old woman with systemic lupus erythematosus (SLE) received TMP/SMX for prophylaxis of pneumocystis pneumonia (PCP) on the 7th day of hospitalization. ⋯ We diagnosed the patient with methemoglobinemia induced by TMP/SMX. Methemoglobinemia should be considered in cases of sudden dyspnea following TMP/SMX administration.
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DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is a severe reaction triggered by drugs that manifests as pyrexia and eosinophilia with involvement of the skin and internal organs. We herein describe the case of a patient who developed hyperuricemia after receiving treatment for tuberculosis, then took allpurinol and developed DRESS syndrome with a contextual coma and right hemisyndrome. ⋯ The cerebral vasculitis responded to treatment, showing clinical and instrumental remission. In cases such as this, allergic cerebral vasculitis should be considered in the differential diagnosis because it can be treated if recognized early, thus leading to remission without the development of any sequelae.