Internal medicine
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Case Reports
A Hepatitis B Virus Reactivation Case Potentially Triggered by the Onset of Diffuse Large B Cell Lymphoma.
An 81-year-old man underwent rituximab-containing chemotherapy for chronic lymphocytic leukemia (CLL). Thirteen years after his last chemotherapy, he was diagnosed with hepatitis B virus (HBV) reactivation. He was then treated with entecavir, and improvement was seen in his liver injury. ⋯ Despite chemotherapy, he contracted the coronavirus disease 2019 (COVID-19) and died of COVID-19. We suspect that HBV reactivation was triggered by DLBCL. When HBV reactivation occurs a long time after chemotherapy has concluded, the onset of DLBCL should be considered.
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TAFRO syndrome, a rare systemic inflammatory disorder, commonly develops in an acute or subacute manner, with an aggressive clinical behavior. A substantial number of cases of TAFRO syndrome presenting with abdominal pain, and adrenal abnormalities on imaging have also been reported. A 54-year-old man developed severe acute abdominal pain. ⋯ Although the abdominal pain resolved spontaneously, a fever and anasarca were observed. The patient was eventually diagnosed with TAFRO syndrome, and corticosteroid administration resulted in remission. TAFRO syndrome should be included in the differential diagnosis of acute abdomen and adrenal abnormalities.
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Micrococcus luteus can cause relapsing and refractory peritoneal dialysis infection because it leads to strong biofilm formation. A 69-year-old woman who had undergone peritoneal dialysis (PD) visited the emergency department complaining of cloudy peritoneal dialysate. She was initially given intraperitoneal cefazolin (1 g/day) and ceftazidime (1 g/day). ⋯ We administered antibiotics for 21 days and thereafter identified 2 important clinical issues. Micrococcus species-related peritonitis can sometimes be cured without vancomycin. Furthermore, the provision of three weeks of sufficient treatment may be important.
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We herein report a 76-year-old woman who developed lower cranial dystonia with a peculiar appearance of cheek inflation. The patient showed strong contraction of the orbicularis oris muscles. Consequently, her cheeks were passively inflated by expiration without exit. ⋯ We tentatively named this characteristic dystonia "lower cranial dystonia with inflated cheeks" because of its peculiar appearance of inflated cheeks. This dystonia can cause respiratory failure. Therefore, neurologists should recognize such dystonia as a movement disorder emergency.
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Case Reports
Chronic Expanding Haematoma Causing Stenosis of the Right Ventricular Outflow Tract and Pulmonary Hypertension.
A chronic expanding haematoma (CEH) is an encapsulated mass that gradually increases in size from repeated internal bleeding and neovascularization. We herein report a 69-year-old man who was admitted with dyspnoea on exertion after undergoing thymic carcinoma resection 17 years ago. ⋯ Right cardiac catheterisation revealed pulmonary hypertension that was relieved after resection of the diagnosed CEH mass. This report highlights the mechanism underlying anterior mediastinal CEH-induced stenotic compression of the right ventricle-pulmonary artery outflow and subsequent pulmonary hypertension.