著者

Hiroki Mizuno Naoki Sawa Akinari Sekine Noriko Inoue Yuki Oba Daisuke Ikuma Masayuki Yamanouchi Eiko Hasegawa Tatsuya Suwabe Hisanori Suzuki Junichi Hoshino Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9624-22, (Released:2022-05-31)

参考文献数

12

被引用文献数

1

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A 79-year-old man was admitted with a compression fracture of the first lumbar vertebra. His alkaline phosphatase (ALP) level was 35 IU/L, and his dual energy X-ray absorptiometry T score was -3.7 standard deviations, indicating osteoporosis. A genetic analysis showed a mutation of the alkaline phosphatase biomineralization-associated gene encoding tissue-nonspecific alkaline phosphatase. Hypophosphatasia-related osteoporosis was diagnosed. Alendronate, teriparatide, and minodronate were administered in that order. The ALP level increased during teriparatide use. A bone biopsy performed after three years of teriparatide treatment showed that cancellous bone was adynamic. In cortical bone, tetracycline double-labeling indicates enhanced bone formation. Teriparatide may thus be a viable treatment option even in patients with hypophosphatasia.

著者

Makoto Fukuda Naoki Sawa Daisuke Ikuma Yuki Oba Hiroki Mizuno Masayuki Yamanouchi Akinari Sekine Eiko Hasegawa Tatsuya Suwabe Junichi Hoshino Kei Kono Keiichi Kinowaki Kenichi Ohashi Hiromichi Tamaki Motoaki Miyazono Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.62, no.1, pp.81-85, 2023-01-01 (Released:2023-01-01)

参考文献数

9

被引用文献数

2 3

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A 43-year-old Japanese woman with rheumatoid arthritis treated by infliximab and methotrexate for 11 years was admitted for proteinuria and purpura. A kidney biopsy revealed endothelial damage-dominant nephritis with IgA deposition. Infliximab and methotrexate were discontinued, and tocilizumab was started; however, proteinuria persisted. Therefore, tocilizumab was discontinued, and oral prednisolone and methylprednisolone pulse therapy were administered. After 6 months, urinary protein was less than 0.1 g/day, and purpura subsided. To our knowledge, this is the first case of endothelial damage-dominant nephritis related to IgA vasculitis involving the skin and kidney after long-term use of infliximab and methotrexate.

著者

Atsuhiko Suenaga Naoki Sawa Daisuke Ikuma Yuki Oba Akinari Sekine Masayuki Yamanouchi Eiko Hasegawa Hiroki Mizuno Tatsuya Suwabe Kei Kono Yukako Shintani-Domoto Keiichi Kinowaki Kenichi Ohashi Yoshiyuki Suzuki Motoaki Miyazono Tamiko Takemura Yutaka Yamaguchi Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1121-22, (Released:2023-02-01)

参考文献数

8

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We performed 3 kidney biopsies in a 71-year-old man. At the first biopsy, we made the diagnosis of immunoglobulin G4 (IgG4)-related interstitial nephritis characterized by the simultaneous presence of IgG4-positive plasma cells and characteristic fibrosis with a bird's-eye pattern. At the second biopsy, rather than finding fibrosis as a post-inflammatory scar, we noted that steroid treatment had caused the simultaneous disappearance of IgG4-positive plasma cells and fibrosis and had restored the normal tubular structure. The third biopsy showed the recurrence of the disease with inflammatory cells accompanied by fibrosis. These findings suggest that IgG4-positive plasma cells and fibrosis occur simultaneously.

著者

Atsuhiko Suenaga Naoki Sawa Katsuyuki Miki Takayoshi Yokoyama Yasuo Ishii Hiroki Mizuno Daisuke Ikuma Yuki Oba Akinari Sekine Masayuki Yamanouchi Eiko Hasegawa Tatsuya Suwabe Kei Kono Keiichi Kinowaki Kenichi Ohashi Kazuho Honda Motoaki Miyazono Yuki Nakamura Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0813-22, (Released:2023-02-01)

参考文献数

16

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We experienced a 36-year-old man with lupus nephritis and antiphospholipid syndrome (APS) who received a donor kidney from his father. Twenty-two months after transplantation, at a time of poor adherence to immunosuppressants and warfarin, the patient developed sudden graft loss due to hemolytic uremic syndrome with rapid deterioration of renal function, thrombocytopenia, and hemolytic anemia. A kidney biopsy showed thrombotic microangiopathy (TMA) related to platelet thrombus formation; however, there was no recurrence of lupus and no findings suggestive of post-transplant rejection, so acute TMA associated with APS was thought to be the cause of the graft loss. This case highlights the importance of instructing patients with lupus nephritis to adhere to treatment with warfarin, a therapeutic drug for APS.

著者

Yoshito Nishimura Asami Nishikori Haruki Sawada Torrey Czech Yuki Otsuka Midori Filiz Nishimura Hiroki Mizuno Naoki Sawa Shuji Momose Kumiko Ohsawa Fumio Otsuka Yasuharu Sato

出版者

The Japanese Society for Lymphoreticular Tissue Research

雑誌

Journal of Clinical and Experimental Hematopathology (ISSN:13464280)

巻号頁・発行日

pp.21038, (Released:2022-03-05)

参考文献数

38

被引用文献数

4

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Idiopathic multicentric Castleman disease (iMCD) is a systemic disorder characterized by systemic inflammation and organ dysfunction associated with an increase in pro-inflammatory cytokines. Some patients with iMCD are positive for autoantibodies, although their significance and relationship with specific associated autoimmune diseases are unclear. This study retrospectively analyzed the clinicopathological features of iMCD patients focusing on autoantibodies. Among 63 iMCD patients in our database, 19 were positive for at least one autoantibody. Among the 19, we identified five with plasma cell type (PC)-iMCD lymph node histopathology and positive anti-phospholipid antibodies. These patients were likely to have thrombocytopenia, anasarca, fever, reticulin fibrosis or renal insufficiency, organomegaly (TAFRO) symptoms, and thrombotic events. The present study suggests that patients with undiagnosed or atypical autoimmune diseases, including anti-phospholipid syndrome (APS), were treated for iMCD. APS may present with thrombocytopenia or even multi-organ failure, which overlap with clinical presentations of iMCD. Due to differences in the treatment regimen and follow-up, recognition of the undiagnosed autoimmune disease process in those suspected of iMCD is essential. Our study highlights the importance of complete exclusion of differential diagnoses in patients with iMCD in their diagnostic workup.