Internal medicine
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We herein report a 48-year-old man with neurosyphilis manifesting as limbic encephalitis, initially suspected to be autoimmune limbic encephalitis. The patient exhibited rapid behavioral changes, and magnetic resonance imaging showed high-intensity lesions in both medial temporal lobes. ⋯ This case highlights the diagnostic challenges in differentiating neurosyphilis from autoimmune limbic encephalitis, given the increasing atypical presentation. A markedly elevated immunoglobulin G index may serve as a valuable diagnostic indicator for neurosyphilis in such cases.
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It is difficult to distinguish idiopathic multicentric Castleman disease (iMCD) from immunoglobulin G4-related disease (IgG4-RD). A 47-year-old man was diagnosed with venous thrombosis in the right lower extremity. Multiple lymphadenopathies and splenomegaly were incidentally detected. ⋯ He was initially diagnosed with IgG4-RD and was administered prednisolone 30 mg/day; however, inflammation and IgG4 persisted. The patient was rediagnosed with iMCD and treated with tocilizumab, which led to an improvement of his condition. When diagnosing IgG4-RD, it is therefore important to consider iMCD in the differential diagnosis.
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Anti-GM1 antibodies are associated with Guillain-Barré syndrome (GBS), primarily peripheral neuropathy. However, there are cases of anti-GM1 IgG antibody-positive GBS with upper motor neuron (UMN) signs. We herein report a case of gastrointestinal infection followed by subacute gait disturbance with predominant signs of UMN on a neurological examination. ⋯ No MRI abnormalities were observed. The symptoms improved with treatment, which was accompanied by decreased antibody titers. This case highlights the fact that anti-GM1 IgG-associated disorders may present with predominant UMN involvement.
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A 67-year-old man with a history of heart failure (HF) secondary to ischemic cardiomyopathy, atrial fibrillation, and left atrial appendage occlusion (LAAO) developed worsening HF secondary to severe functional mitral regurgitation. Consequently, transcatheter edge-to-edge repair (TEER) was performed. ⋯ Thrombus formation may be related to changes in the blood stream in the LA, endothelial injury by septal puncture, and an insufficient anti-thrombotic regimen. This case highlights the potential for the development of subacute LA thrombosis following TEER, even in patients with prior LAAO.
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Objective To determine the clinical background factors of patients with type 2 diabetes who showed deterioration of defecation status after hospitalization. Methods The defecation status of 128 patients with type 2 diabetes who were admitted to our department for diabetes education was evaluated for 7 days after hospitalization. New-onset constipation was diagnosed when patients without constipation before hospitalization met the criteria for constipation after hospitalization. ⋯ In the multivariate logistic regression analyses, albuminuria was the only factor that showed a significant association with the deterioration of defecation status after hospitalization. Conclusion Constipation is highly prevalent among hospitalized patients with type 2 diabetes. Paying attention to albuminuria is useful for facilitating an appropriate response to the deterioration of defecation status in patients with type 2 diabetes after hospitalization.