Internal medicine
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Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. ⋯ The baseline parameters that were significantly correlated with LOS were the GCS (ρ =-0.665; p <0.001) and SOFA score (ρ =0.670; p <0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ =-0.390; p =0.040). Conclusions GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.
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A 64-year-old man with cirrhosis was diagnosed with unresectable hepatocellular carcinoma and treated with a combination of durvalumab and tremelimumab. The patient had no history of diabetes mellitus. ⋯ The patient was diagnosed with fulminant type 1 diabetes mellitus. Although fulminant type 1 diabetes mellitus is a rare immune-mediated adverse event, it requires prompt attention shortly after the initiation of these agents owing to its severe and emergent nature.
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A 69-year-old woman with left-sided breast cancer developed elevated creatine kinase levels and muscle weakness in her extremities after treatment with pembrolizumab. The patient was diagnosed with immune checkpoint inhibitor (ICI)-related myositis. ⋯ Furthermore, high-resolution manometry showed impaired upper esophageal sphincter opening and absence of esophageal peristalsis, which improved partially after immunotherapy. These findings suggest that esophageal dysfunction may be an unrecognized complication of ICI-related myositis.
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We herein report a 52-year-old woman with anti-aquaporin 4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) and idiopathic multicentric Castleman disease (iMCD) who was successfully treated with tocilizumab, a humanized anti-human interleukin (IL)-6 receptor monoclonal antibody. This is the first report of a case of coexisting NMOSD and iMCD. IL-6 is involved in the pathogenesis of both NMOSD and iMCD, and tocilizumab is effective against both diseases. By treating the patient with tocilizumab, the lung lesions due to iMCD improved, and the neurological symptoms of NMOSD did not recur.
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Non-bacterial thrombotic endocarditis (NBTE) causes myocardial and cerebral infarctions and is associated with advanced stages of malignancy. However, only a few cases of myocardial and cerebral infarctions have been reported in the same patient. We herein report a 47-year-old woman with advanced uterine and ovarian cancer who experienced acute myocardial infarction (MI) after receiving chemotherapeutic intervention for the cancer and hemorrhagic cerebral infarction 1 month after admission for acute MI, attributable to NBTE of the aortic valve. NBTE should be considered in patients with malignancies and life-threatening thromboembolism of important organs.