- 著者
- Hiroe Sato Noriaki Iino Riuko Ohashi Takako Saeki Tomoyuki Ito Maki Saito Yutaka Tsubata Suguru Yamamoto Shuichi Murakami Takeshi Kuroda Yoshinari Tanabe Junichi Fujisawa Takehiro Murai Masaaki Nakano Ichiei Narita Fumitake Gejyo
- 出版者
- The Japanese Society of Internal Medicine
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- vol.51, no.4, pp.425-429, 2012 (Released:2012-02-15)
- 参考文献数
- 24
- 被引用文献数
- 6 13 2
Hypogammaglobulinemia is a reduction or absence of immunoglobulin, which may be congenital or associated with immunosuppressive therapy. In addition to infectious diseases, autoimmune diseases have also been reported in patients with hypogammaglobulinemia. A 26-year-old man with hypogammaglobulinemia had multiple joint pain and swelling with erosive changes in the proximal interphalangeal joint of the right middle finger on X-ray film, mimicking rheumatoid arthritis (RA). As polyarthritis remained after immunoglobulin replacement therapy and there was no finding indicating any infection at that time, a diagnosis of RA was made. Prednisolone and etanercept were started. However, his polyarthritis did not improve and he developed meningitis and massive brain ischemia. Finally, a diagnosis of disseminated Mycoplasma hominis infection was made. The differential diagnosis of polyarthritis in patients with hypogammaglobulinemia should strictly exclude Mycoplasma infection by culture with special media or longer anaerobic culture, and molecular methods for mycoplasma.
- 著者
- Hiroe Sato Yoko Wada Eriko Hasegawa Yukiko Nozawa Takeshi Nakatsue Tomoyuki Ito Takeshi Kuroda Takako Saeki Hajime Umezu Yoshiki Suzuki Masaaki Nakano Ichiei Narita
- 出版者
- 一般社団法人 日本内科学会
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- pp.8473-16, (Released:2017-08-10)
- 参考文献数
- 27
- 被引用文献数
- 25
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder that generally occurs in children and predominantly affects the long bones with marginal sclerosis. We herein report two cases of adult-onset CRMO involving the tibial diaphysis bilaterally, accompanied by polyarthritis. Magnetic resonance imaging (MRI) showed both tibial osteomyelitis and high intensity of the extensive lower leg muscles. Anti-interleukin-6 therapy with tocilizumab (TCZ) effectively controlled symptoms and inflammatory markers in both patients. High intensity of the lower leg muscles detected by MRI also improved. These cases demonstrate that CRMO should be included in the differential diagnosis of adult patients with bone pain, inflammation, and high intensity of the muscles detected by MRI. TCZ may therefore be an effective therapy for muscle inflammation of CRMO.
- 著者
- Shinichi Nishi Naofumi Imai Kazuhiro Yoshita Yumi Ito Mitsuhiro Ueno Takako Saeki
- 出版者
- 一般社団法人 日本内科学会
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- vol.54, no.2, pp.147-153, 2015 (Released:2015-01-15)
- 参考文献数
- 27
- 被引用文献数
- 7
Objective Ultrastructural studies of IgG4-related kidney disease (IgG4-RKD) characterized by tubulointerstitial nephritis (TIN) are limited in previous reports due to the rarity of the condition. In the present report, we performed ultrastructural examinations and assessed the pathogenesis of this disease. Patients Clinicopathological studies were conducted in eight patients diagnosed with IgG4-RKD. Routine light, immunofluorescence and electron microscopy examinations and immunohistochemical assessments of IgG4 were performed using renal biopsy samples. Results Hypocomplementemia, positive anti-nuclear antibodies and eosinophilia were confirmed in more than half of the cases. Electron dense deposits (EDDs) were frequently found in the glomeruli and interstitium. The rate of deposition was 62.5% in both mesangial areas and Bowman's capsule. EDDs were frequently detected on the tubular basement membrane (TBM) (87.5% of patients). The interstitium also contained EDDs on collagen fibers in 87.5% of the cases and on basement membrane-like materials in areas of fibrosis in 37.5% of the cases. The creatinine clearance levels were significantly lower in the patients with the latter pattern. Meanwhile, the rate of immunoglobulin and/or complement deposition on the TBM was observed in less than 37.5% of patients, and these findings were not entirely coincident with the cases of EDDs on the TBM. Conclusion EDDs are frequently found in the glomeruli and interstitium in patients with IgG4-RKD; however, immunohistological studies do not provide evidence that IgG4-RKD involves TIN with immune complex nephropathy. The presence of interstitial EDDs may be related to the progression of interstitial fibrosis in the setting of IgG4-RKD.
- 著者
- Takako SAEKI Kensuke SUZUKI Hajime YAMAZAKI Syoji MlYAMURA Hiroshi KOIKE Hideo MORISHITA Fumitake GEJYO
- 出版者
- The Japanese Society of Internal Medicine
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- vol.42, no.10, pp.1011-1015, 2003 (Released:2006-03-27)
- 参考文献数
- 32
- 被引用文献数
- 6 10
Although pheochromocytoma in a patient with endstage renal disease (ESRD) is considered extremely rare, we recently encountered 4 ESRD patients with pheochromocytoma. Three were symptomatic, and in the fourth patient the tumor was discovered as an adrenal incidentaloma. Plasma catecholamine levels were significantly increased in two patients. In each case, 131I-MIBG scintigraphy showed accumulation of the radionuclide in the adrenal tumor, which was identified by MRI or CT scanning, and adrenalectomy was conducted without serious complications. Although paroxysmal hypertension is a common symptom in patients with ESRD, pheochromocytoma must be eliminated by careful evaluation.(Internal Medicine 42: 1011-1015, 2003)