Internal medicine
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A Case of Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy Caused by Influenza A Infection.
Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a new spectrum of autoimmune inflammatory nervous system disorders associated with infection, neoplasm, or drug use. We present the first pediatric case of GFAP astrocytopathy caused by an influenza A infection. ⋯ Methylprednisolone pulse therapy led to a good prognosis. In cases of progressive atypical complications of influenza infection, immunotherapy-reactive GFAP astrocytopathy should be considered as a differential diagnosis for prompt treatment.
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Anemia is not known to cause intermittent claudication. We herein present the case of a 74-year-old male patient with intermittent claudication, in whom the primary symptom was severe iron-deficiency anemia. ⋯ This case highlights the need to consider anemia in the differential diagnosis of patients presenting with intermittent neurogenic claudication. A comprehensive evaluation, including tests to rule out anemia, is crucial for making an accurate diagnosis and carrying out the appropriate management of intermittent claudication.
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Idiopathic multicentric Castleman disease (iMCD) accompanied by thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal insufficiency, and organomegaly (TAFRO) frequently develops into prolonged severe thrombocytopenia and multiorgan dysfunction, which is associated with a high mortality rate. We herein describe three cases of iMCD-TAFRO in which serum soluble interleukin-2 receptor (sIL-2R) levels varied in relation to disease activity following the initiation of treatment. Thrombocytopenia persisted for several weeks to months after the normalization of the patients' C-reactive protein levels, whereas their sIL-2R levels normalized 10-47 days prior to platelet recovery (≥100×109/L). The serum sIL-2R measurement may therefore be an effective method for evaluating the disease activity in iMCD-TAFRO patients with prolonged thrombocytopenia.