Internal medicine
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Case Reports
Inflammatory Thoracic Aortic Aneurysm in a Patient with Advanced Lung Adenocarcinoma Treated with Pembrolizumab.
A 57-year-old man with lung adenocarcinoma was treated with chemotherapy and immune checkpoint blockade. After two cycles of carboplatin, pemetrexed, and pembrolizumab, he developed a persistent fever. Chest computed tomography (CT) suggested inflammation of the aortic wall. ⋯ After four cycles of carboplatin, pemetrexed, and pembrolizumab, chest CT showed an aneurysm in the ascending aorta. We diagnosed him with inflammatory thoracic aortic aneurysm induced by pembrolizumab and performed surgical replacement of the ascending aorta. Although this might be a very rare case, we should be aware of aortitis as a potential adverse effect of pembrolizumab.
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A 49-year-old woman presented with nephrotic-range proteinuria, microhematuria, and moderate renal dysfunction. Diuretic-resistant refractory ascites associated with nephrotic syndrome were observed. ⋯ Cell-free and concentrated ascites reinfusion therapy (CART) performed to treat the refractory ascites improved the ascites and anasarca. Rituximab successfully treated the PGNMID, while CART effectively treated the refractory ascites associated with nephrotic syndrome.
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Case Reports
Fulminant Myocarditis 24 Days after Coronavirus Disease Messenger Ribonucleic Acid Vaccination: A Case Report.
A 60-year-old Japanese woman was hospitalized for cardiogenic shock 24 days after receiving the second dose of the coronavirus disease 2019 BNT162b2 vaccine. Impella CP left ventricular assist device implantation and venoarterial peripheral extracorporeal membranous oxygenation were immediately initiated along with inotropic support and steroid pulse therapy, as an endomyocardial biopsy specimen showed myocarditis. Three weeks later, her cardiac function had recovered, and she was discharged. An immune response associated with the presence of spike protein in cardiac myocytes may be related to myocarditis in the present case because of positive immunostaining for severe acute respiratory syndrome coronavirus 2 spike protein and C4d in the myocardium.
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KMT2B-related dystonia (DYT28, DYT-KMT2B) is an inherited dystonia that generally begins in the lower limbs during childhood and evolves into generalized dystonia. We herein report a case of adult-onset DYT28 with dystonic tremor. ⋯ Although the disease generally develops during childhood, we diagnosed the woman with DYT28, as genetic testing revealed a mutation in KMT2B. Adult-onset patients with DYT28 might also show uncommon symptoms as well as DYT-TOR1A (DYT1).
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Case Reports
Case report of Community-acquired Pseudomonas aeruginosa Osteomyelitis Caused by an Injury from a Dishwasher.
A 70-year-old healthy woman came to our hospital with right index finger pain and swelling after an injury incurred due to a commercial dishwasher. X-ray of the hand showed osteolysis around the distal interphalangeal joint. A further examination revealed Pseudomonas aeruginosa in the unexposed pus, so the patient was treated with a total of 10 weeks of cefepime, followed by levofloxacin and debridement twice. While this may have been a case of bacterial replacement, we should still consider P. aeruginosa infection in healthy adults when faced with an episode of waterborne injury.