Internal medicine
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Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells that is often associated with acute myeloid leukemia (AML). We herein report an 81-year-old man who presented with intestinal obstruction due to myeloid sarcoma of the small intestine. ⋯ This case underscores the importance of considering myeloid sarcoma in the differential diagnosis of small-bowel tumors. Highlighting the significance of a histological analysis, even in patients presenting with small bowel obstruction, the early diagnosis and treatment are crucial for improving outcomes, particularly in patients without a history of hematologic malignancies.
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An 83-year-old man presented with persistent fever after intravesical BCG therapy for bladder cancer. Chest computed tomography (CT) and bronchoscopy revealed diffuse ground-glass opacities with multiple micronodules and lymphocyte-predominant bronchoalveolar lavage fluid with a high CD4/CD8 ratio, respectively. ⋯ Fifty days post-admission, Mycobacterium bovis BCG was identified in the initial sputum cultures. Concomitant interstitial pneumonia and BCG infection should be considered in patients with abnormal chest imaging following intravesical BCG therapy.
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Treating patients with latent tuberculosis infection (LTBI) to prevent the development of tuberculosis is a fundamental treatment strategy in daily practice. Isoniazid (INH) therapy for 6-12 months is recommended. However, INH can also cause hepatotoxicity. This report describes the autopsy case of a 65-year-old Japanese man diagnosed with LTBI who died of acute liver failure caused by INH.
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Durvalumab plus platinum-based chemotherapy is the first-line treatment for extensive-stage small-cell lung cancer. Immune checkpoint inhibitors (durvalumab) can cause immune-related adverse events (irAEs). We herein report the first case of fatal sepsis with anti-interleukin-6 autoantibody production following durvalumab administration. ⋯ She developed severe sepsis during maintenance durvalumab therapy; however, her serum CRP level did not increase. The serum tested positive for anti-interleukin-6 autoantibodies, which can cause CRP-less infections. Anti-interleukin-6 autoantibody production and subsequent sepsis without serum CRP elevation are possible irAEs.