Fulminant type 1 diabetes mellitus associated with Coxsackievirus type B1 infection during pregnancy: a case report.

BACKGROUND: Fulminant type 1 diabetes is characterized by an intrinsic insulin deficiency resulting from the severe destruction of pancreatic ß cells and it rapidly leads to ketoacidosis. However, the association between fulminant type 1 diabetes in pregnancy and specific viral infections has not been reported. CASE PRESENTATION: The patient in this study was a 31-year-old Japanese woman, and at 30 weeks of pregnancy she was admitted with marked fatigue. Fetal bradycardia was noted, and the child was delivered by emergency cesarean section but was stillborn. The maternal blood sugar level was high (427 mg/dL), but the glycated hemoglobin value was 6.2%; therefore, fulminant type 1 diabetes was suspected. Serum antibody testing confirmed a Coxsackievirus B1 infection. The patient in this case had fulminant type 1 diabetes in pregnancy associated with Coxsackievirus B1. CONCLUSION: This case highlights that fulminant type 1 diabetes in pregnancy may be associated with Coxsackievirus B1 infection.

First Case Report of Possible Sarcocystis truncata-induced Food Poisoning in Venison.

Along with the increase in consumption of raw animal meat, the prevalence of food poisoning is increasing. A 67-year-old Japanese man had eaten raw venison 4 hours prior to the beginning of vomiting. Many white cysts were discovered in the venison, with numerous bradyzoites being detected after the cysts were punctured. The presence of the Sarcocystis spp. 18S rRNA gene was detected by polymerase chain reaction, and Sarcocystis truncata was isolated from the venison. Sarcocystis truncata has not previously been identified in sika deer (Cervus nippon) in Japan. This is the first report of possible Sarcocystis truncata-induced food poisoning following consumption of venison.

Capnocytophaga canimorsus sepsis in a methotrexate-treated patient with rheumatoid arthritis.

Capnocytophaga canimorsus is a gram-negative rod that can be transmitted primarily by dog bites. This life-threatening organism commonly causes sepsis in patients with splenectomy or alcoholism. A 53-year-old rheumatoid arthritis male treated with methotrexate (MTX) for 5 years was admitted for a 4-day history of fever and dyspnea. He had been bitten on a finger by the family dog 4 days before onset. Laboratory tests revealed pancytopenia, acute renal failure, and evidence of disseminated intravascular coagulation, and he subsequently developed acute respiratory distress syndrome. Furthermore, blood cultures grew gram-negative bacilli and despite intensive treatment, he died 5 days after admission. Later, C. canimorsus was identified from his culture samples using a species-specific polymerase chain reaction. C. canimorsus infections should be considered in the differential diagnosis of sepsis for immunocompromised hosts following animal bites.

Successful treatment of chronic disseminated intravascular coagulation using recombinant human soluble thrombomodulin in a dialysis patient with dissecting aortic aneurysm.

A 62-year-old man had a history of acute aortic dissection (Stanford type A) and had been diagnosed with polycystic kidney disease three years earlier, and then developed end-stage renal failure. He was referred with chief complaints of difficult hemostasis and consecutive hemorrhagic episodes at the puncture site of the shunt soon after dialysis introduction. We suspected chronic disseminated intravascular coagulation (DIC) due to mild thrombocytopenia and a fibrinolytic system abnormality. Plasma factor XIII activity was decreased, but no inhibitor was detected. In addition, contrast-enhanced computed tomography showed exacerbation of a dissecting aortic aneurysm. We finally diagnosed chronic DIC and secondary factor XIII deficiency associated with the aortic aneurysm. We selected treatment involving recombinant human soluble thrombomodulin (rTM) because he was on maintenance dialysis and required long-term follow-up bofore the operation. Hemostatic function improved with regular administration of rTM, and was well-controlled preoperatively.

Phlegmonous gastritis associated with group A streptococcal toxic shock syndrome.

Phlegmonous gastritis (PG) is a rare, acute, severe infectious disease of the gastric wall that is often fatal due to Streptococcus spp. A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected. The patient expired less than 9 hours after admission despite intensive treatments. Later, an analysis of the blood and gastric juice revealed group A streptococcus (GAS) and virulence factors associated with toxic shock syndrome (TSS). We herein diagnosed a patient with an extremely aggressive course of PG caused by GAS TSS.

Successful bortezomib/dexamethasone induction therapy with lenalidomide in an elderly patient with primary plasma cell leukemia complicated by renal failure and pulmonary hypertension.

Primary plasma cell leukemia (PPCL) is a rare disease that progresses rapidly. In such cases, it is difficult to achieve remission, and early intensive chemotherapy is recommended. We herein describe the case of a 76-year-old man with PPCL complicated by renal failure and pulmonary hypertension. Bortezomib/dexamethasone induction therapy with lenalidomide was administered in association with continuous hemodiafiltration (CHDF). Complete remission was achieved after a single course of treatment, resulting in the cessation of CHDF. With the patient in remission, the administration of beraprost and bosentan resulted in improvements in the pulmonary hypertension. The results of this case report support the use of bortezomib/lenalidomide/dexamethasone combination therapy as an effective treatment for elderly PPCL patients with various complications.

Mild clinical course of severe Fever with thrombocytopenia syndrome virus infection in an elderly Japanese patient.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious and hemorrhagic disease recently described in China and western Japan. A 71-year-old healthy Japanese woman noticed a tick biting her after harvesting in an orchard and removed it herself. She developed diarrhea, anorexia, and chills eight days later. Because these symptoms continued, she visited a primary care physician 6 days after the onset. Laboratory data revealed thrombocytopenia, leukocytopenia, and elevated liver enzymes. She was then referred to our hospital. Although not completely fulfilling the diagnostic criteria used in a retrospective study in Japan, SFTS was suspected, and we detected SFTS virus in the patient's blood using RT-PCR. However, she recovered without intensive treatment and severe complications 13 days after the onset. In this report, we present a mild clinical course of SFTS virus infection in Japan in detail.

Bulky pulmonary mucosa-associated lymphoid tissue lymphoma treated with yttrium-90 ibritumomab tiuxetan.

An 84-year-old woman was admitted to our hospital with nonproductive cough and dyspnea on exertion. Computed tomography (CT) scan revealed extensive consolidation in the right lung. She was diagnosed with pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma using CT-guided lung biopsy. Her pulmonary images and respiratory symptoms did not improve two months after receiving 4 cycles of rituximab weekly; therefore, yttrium-90 ibritumomab tiuxetan was chosen as salvage therapy. The abnormal shadow on her pulmonary images was significantly reduced two months later, and she had no symptoms without nonhematological toxicities. She has had no progression for 18 months. Furthermore, radiation pneumonitis has not also been observed. We herein reported bulky pulmonary MALT lymphoma treated with yttrium-90 ibritumomab tiuxetan.

Fatal diarrheal disease caused by Vibrio cholerae O67 in a patient with myelodysplastic syndrome.

A 71-year-old man with myelodysplastic syndrome (MDS) receiving treatment with azacitidine developed extensive watery diarrhea for three consecutive days. As a result of high-grade dehydration, the patient was urgently admitted to the hospital and fluid replacement therapy was initiated. However, the patient's diarrhea did not improve. Vibrio cholerae non-O1/non-O139 was detected in a fecal culture. On the fourth day, the patient died due to circulatory collapse. An autopsy revealed extensive necrosis of the intestinal mucosa. Vibrio cholerae non-O1/non-O139-induced diarrheal disease often develops in patients with hepatic cirrhosis and has a serious clinical course. We herein report a fatal outcome of Vibrio cholerae O67 infection in an immunocompromised MDS patient.

[A case of metastatic pulmonary cancer from urachal carcinoma that required differentiation from primary lung adenocarcinoma].

A 58-year-old man was given a diagnosis of urachal carcinoma and underwent a partial cystectomy with enbloc removal of the tumor and radical lymphadenectomy in 2006. In April 2009 he was admitted to our hospital because of hemoptysis and left chest pain. Chest CT showed a 4-cm mass shadow in the left S3 and nodular shadows in the right S1 and left S10. Flexible bronchoscopy demonstrated a tumorous lesion at the orifice of the left B3 bronchus. Although the cytological diagnosis suggested high-grade adenocarcinoma, the tumor was producing mucin and consisted of cells with anisonucleosis, which is not typical of primary lung adenocarcinoma. We then performed immunohistochemical and histological examination of a transbronchial lung biopsy specimen. The histological findings of the specimen were very similar to those of the previously resected urachal carcinoma. In addition, the tumor cells were negative for thyroid transcription factor-1 and surfactant precursor protein B, which are specific to primary lung adenocarcinoma. We therefore diagnosed metastatic pulmonary cancer from urachal carcinoma, which is a rare manifestation in bladder cancer. We report a rare case of metastatic pulmonary cancer from urachal carcinoma that required differentiation from primary lung adenocarcinoma in addition to a discussion of the literature.

[A case of intractable pneumothorax in a patient with pulmonary adenocarcinoma during bevacizumab-containing chemotherapy].

The patient was a 70-year-old woman. She was admitted to our hospital complaining of fever and dyspnea. Chest CT scan showed a 50 x 30-mm tumorous shadow in S6 of the left lung and honeycomb lung in both lower lobes. As the result of cytodiagnosis with ultrasonic echo, adenocarcinoma was diagnosed. Clinical stage was IIIA (T3N2M0). We selected carboplatin and paclitaxel with bevacizumab as first-line chemotherapy, but at 7 days after the initiating it, the chest X-ray showed left pneumothorax. A chest drainage tube was placed in the left thoracic cavity. The patient was treated repeatedly pleurodesis with minocycline and OK-432. The pneumothorax required 3 weeks to cure. We selected carboplatin and paclitaxel without bevacizumab for the second course, and the pneumothorax did not recur. Pneumothorax was a serious adverse event associated with bevacizumab-containing chemotherapy. It is necessary to be aware of the possibility of pneumothorax when we treat lung adenocarcinoma with bevacizumab-containing chemotherapy.