Internal medicine
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This is the first report of therapy-related mixed-phenotype acute leukemia (MPAL) characterized by B-cell, T-cell, and myeloid lineage phenotypes. A 68-year-old man, who was in complete remission after chemoradiotherapy for recurrent esophageal cancer, developed bacterial pneumonia with increasing blasts in the peripheral blood, and a subsequent bone marrow biopsy revealed 85.2% blasts. ⋯ After the initiation of venetoclax and azacitidine, the patient achieved complete remission, and cord blood transplantation was performed. This case provides novel insights into the therapeutic options for therapy-related trilineage MPAL treatment.
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A 59-year-old man without risk factors for atherosclerosis was diagnosed with coronavirus disease 2019 (COVID-19). Four days later, he developed dysarthria and gait disturbance. Neurological examination revealed slurred speech, ataxia, and mild cognitive decline. ⋯ A skin biopsy supported the diagnosis. He was treated with cilostazol and after three months of rehabilitation, he regained an independent walking ability. COVID-19 increases the risk of ischemic stroke in CADASIL patients, with bilateral middle cerebellar peduncle infarctions being notable in the present case.
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Cardiac amyloidosis (CA), predominantly caused by amyloid transthyretin (ATTR) or immunoglobulin light chain (AL), has a poor prognosis, and a precise diagnosis is crucial because the optimal treatments differ between the two conditions. However, diagnosing AL-CA is challenging because of the unavailability of effective AL-detecting antibodies, particularly in cases with coexisting AL- and ATTR-CA. This report presents a successfully diagnosed case of complicated AL- and ATTR-CA that was successfully treated with tafamidis for ATTR-CA and combination chemotherapy for AL-CA. This case highlights the importance of a precise diagnosis of CA and supports the efficacy and safety of concurrent treatment for coexisting amyloidosis.
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In 2020, a 56-year-old woman with a history of Helicobacter pylori (H. pylori) eradication 9 years previously presented with a hemorrhagic hyperplastic polyp. Endoscopic and histological findings led to the diagnosis of advanced-stage autoimmune gastritis (AIG). ⋯ Together with the rapid growth of a hyperplastic polyp, these findings suggest a case of AIG that rapidly exacerbated after eradication. To our knowledge, this is the first case report of a rapidly developing hemorrhagic hyperplastic polyp associated with AIG after H. pylori eradication.
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Fabry disease (FD) is a rare X-linked lysosomal storage disorder. Enzyme replacement therapies (ERT), such as agalsidase α and β, are available treatment options. ⋯ We report the case of a female patient with Fabry disease who developed unexpected hypotension after six years of stable treatment with agalsidase α, leading to a switch to agalsidase β. Continuous monitoring may be essential to identify potential IRRs in female patients with Fabry disease receiving long-term ERT.