Castleman Disease in an Older Patient With the Onset of Right Pleural Effusion.

Castleman's disease (CD) is an uncommon lymphoproliferative disorder with various presentations in different age groups. Although CD predominantly affects younger individuals, cases in older people are rare. The presentation of CD can range from asymptomatic to severe. We present the case of a 91-year-old male who reported dyspnea and was subsequently diagnosed with right-sided pleural effusion. The patient's condition deteriorated despite an initial provisional diagnosis of tuberculous pleurisy and multiple interventions. A cervical lymph node biopsy later revealed a diagnosis consistent with the plasma cell type of CD. Considering the patient's age and atypical presentation, this case adds a unique perspective to the limited literature on CD in elderly patients. Its presentation can be highly variable, and pleural effusion is rare. Our case highlights the heterogeneity of CD presentation, particularly in older age groups. The diagnosis of CD requires high suspicion, particularly in non-traditional populations. Clinicians should be aware of the varied presentations of CD, including in older patients. Unexplained pleural effusion, even in older patients, should prompt a broad differential diagnosis, including rare conditions such as CD.

Peritoneal Cancer Mimicking Sclerosing Mesenteritis: A Case Report.

Peritoneal cancer is a rare disease that typically affects middle-aged women. Sclerosing mesenteritis can have a benign or malignant etiology. Although computed tomography (CT) scan and magnetic resonance imaging have been used to differentiate these two diseases, the findings are not always conclusive. Here, we report the case of an older woman who presented with acute abdominal pain. She was initially diagnosed with sclerosing mesenteritis, but the final diagnosis was peritoneal cancer. The initial treatment included antibiotics, non-steroidal anti-inflammatory drugs, and prednisolone. Tamoxifen was administered due to persistent symptoms, which were alleviated. However, the patient's cancer antigen 125 levels were elevated, and there were changes in the peritoneal CT findings. The patient was diagnosed with primary peritoneal cancer based on further investigation of the peritoneum using positron emission tomography-CT and a biopsy. This case report describes the diagnostic process regarding the differentiation between sclerosing mesenteritis and primary peritoneal cancer when the CT findings mimic those of sclerosing mesenteritis in general medicine.

Effects of Shopping Rehabilitation on Older People's Daily Activities.

In an aged society, the deterioration of physical and cognitive functions is prevalent. To motivate the rehabilitation of older persons, an initiative known as "shopping rehabilitation" incorporates shopping as an element of a nudge. The purpose of this study was to clarify motor function changes and cognitive functions of participants during shopping rehabilitation, through a semi-experimental study. We measured changes in the Kihon Checklist score before and after rehabilitation interventions. A paired t-test was used to analyze changes in the overall score of the basic checklist before and after the rehabilitation intervention. In December 2020, 59 participants answered the Kihon Checklist after their shopping rehabilitation intervention. During the 6-month intervention period, the number of participants with a checklist score of 8 or higher was significantly reduced after the intervention (p = 0.050). In the sub-analysis, the score improved significantly for the group with families (p = 0.050). Improvement was observed in the group living alone, but the difference was not significant (p = 0.428). The shopping rehabilitation intervention improved the Kihon Checklist score. Continuous observations and research are necessary to measure the long-term effects of shopping rehabilitation and the mechanisms that foster their maintenance and effects.

Intercostal Muscle Abscesses in Infective Endocarditis Associated With Migratory Deposition of Calcium Pyrophosphate.

Infective endocarditis (IE) is caused by vegetations, consisting of platelets, fibrin, inflammatory cells, and microcolonies of bacteria, fungi, rickettsia, chlamydia, and viruses, that form in the heart valves, endocardium, and large vessel intima. Staphylococcus aureus endocarditis is highly tissue destructive, usually follows an acute course, and tends to become severe due to valve destruction, surrounding abscesses, and distant seeding. The main complications of IE due to S. aureus are heart failure due to destruction of tendon cords and valves, perivalvular abscesses and fistulas, and the dissemination of septic emboli to various organs including the brain, kidney, spleen, and lungs. The most common deep tissue abscess formed is an iliopsoas abscess; however, a few publications have described the formation of superficial muscle abscesses due to S. aureus bacteremia. For muscles near joints, deposition of calcium pyrophosphate crystals, as seen in pseudogout, can lead to pseudo-abscess formation and increase susceptibility to infection. This has been previously recognized in the iliopsoas muscle, in particular. We report a case of IE and intercostal muscle abscesses caused by S. aureus bacteremia in an 86-year-old man. Careful follow-up is required in patients with IE, due to the possibility of abscess formation. Furthermore, calcium pyrophosphate deposition in muscles around joints can trigger abscess formation when there is concurrent bloodstream infection.

A Case of Complicated Pneumonia Caused by Klebsiella ozaenae.

Klebsiella ozaenae, a subtype of K. pneumonia, causes chronic upper respiratory tract infections, such as rhinitis and rhinoscleroma, and can also cause lethal infections. We report the case of a patient who developed pneumonia caused by K. ozaenae. An 87-year-old man presented to our hospital with fever and chills. Physical examination revealed no findings other than bilateral crackles in the lower lung fields. Chest computed tomography (CT) showed infiltrative shadows in the lower left lung field. Moreover, K. ozaenae was detected in blood cultures. Based on the examination results, including radiography and blood culture, the patient was diagnosed with pneumonia caused by K. ozaenae. On admission, the patient was treated with intravenous ceftriaxone (CTRX), but he did not recover. After determining the antibiotic susceptibility of K. ozaenae, we stopped administering CTRX and started ampicillin/sulbactam (ABPC/SBT) treatment for two weeks. During the ABPC/SBT administration, a second chest CT showed a new infiltrative shadow in the upper left lung field. Despite these findings, the patient was discharged from the hospital as his vital signs were stable and his general condition was good. After two weeks of ABPC/SBT treatment, the patient was switched to minocycline and followed up. Although infections caused by K. ozaenae are rare, they can be life-threatening. K. ozaenae identification in a patient's blood culture indicates a potentially impaired immune system, prompting physicians to evaluate the patient's immune system.

Herpes Simplex Virus Pneumonia Mimicking Legionella Pneumonia in an Elderly Patient With Heart and Liver Failure.

The diagnosis of viral pneumonia is often difficult because of its varied presentations. Regarding the serological diagnosis of viral infections, it is difficult to perform a viral DNA test in general medical facilities, especially in rural settings. Among viral pneumonia cases, herpes simplex virus (HSV) pneumonia can occur in immunocompromised hosts. However, when the clinical course of HSV pneumonia is acute, and the features of pneumonia are not distinct, the diagnosis can be challenging. We report the case of a 69-year-old man who visited the hospital with complaints of dyspnea and cough for two days. Although the patient had no fever and the urine was negative for Legionella antigen, we suspected Legionella pneumonia based on the clinical course, Gram stain of sputum, and CT findings. After undergoing treatment with antibiotics, his condition worsened, with dyspnea and an increase in the demand for oxygen at 5 L. The patient also had complications related to the heart and liver. The sputum culture was negative, and the HSV serum test revealed that HSV IgM level was elevated to 1.16 (reference value: ≤0.80) and IgG level at admission and at follow-up 21 days later was elevated to 28.1 and 60.0 respectively (reference value: ≤2.0); accordingly, the patient was diagnosed with HSV pneumonia. In cases of pneumonia with atypical courses, the coexistence of multiple diseases, and immunosuppression, HSV pneumonia should be included in the differential diagnosis. In rural settings, viral pneumonia should be investigated using antibodies against viruses due to the limited availability of other medical resources. When a patient is judged to be immunosuppressed in the treatment of pneumonia of unknown cause, it is important to consider the possibility of HSV infection and take prompt action. Furthermore, it is essential to consider the possibility of multi-organ failure secondary to HSV infection, which requires systemic management.

A Case of Cast Nephropathy Found as the Cause of Severe Renal Failure.

Cast nephropathy is rare kidney disease with slow progression. It is associated with multiple myeloma (MM). In this study, we report a case of cast nephropathy in an 86-year-old woman who was previously independent in her activities of daily living (ADLs). However, she was found to have severe renal impairment after vomiting and a decrease in her ADLs. Blood and urine tests revealed the renal disorder. The patient was immediately treated with hemodiafiltration. IgG, IgA, and IgM levels were decreased by immunoelectrophoresis. A kidney biopsy showed crystals and periodic acid-Schiff stain (PAS)-negative urinary casts in the tubules. Bence Jones protein-lambda type M protein was detected in the urine. The patient was diagnosed with cast nephropathy due to MM. Hemodialysis was continued. The patient's family and the patient did not wish to initiate chemotherapy. The decision was made to follow the patient's progress. In this case, a patient who was originally independent in her ADLs developed severe renal failure with an acute course. This case suggests the importance of differentiating MM based on renal failure, even if the presentation is not typical, as elderly patients may have an atypical presentation of the disease, which can avoid invasive procedures such as renal biopsy.

ε subunit of Bacillus subtilis F1-ATPase relieves MgADP inhibition.

MgADP inhibition, which is considered as a part of the regulatory system of ATP synthase, is a well-known process common to all F1-ATPases, a soluble component of ATP synthase. The entrapment of inhibitory MgADP at catalytic sites terminates catalysis. Regulation by the ε subunit is a common mechanism among F1-ATPases from bacteria and plants. The relationship between these two forms of regulatory mechanisms is obscure because it is difficult to distinguish which is active at a particular moment. Here, using F1-ATPase from Bacillus subtilis (BF1), which is strongly affected by MgADP inhibition, we can distinguish MgADP inhibition from regulation by the ε subunit. The ε subunit did not inhibit but activated BF1. We conclude that the ε subunit relieves BF1 from MgADP inhibition.