Fatal hemoperitoneum due to rupture of mesenteric artery in remission state of microscopic polyangiitis, concomitant with severe hypertension and posterior reversible encephalopathy syndrome: an autopsy case report.

Microscopic polyangiitis (MPA) is a type of necrotizing vasculitis associated with high levels of myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA). While generally associated with renal dysfunction, MPA can also cause intraabdominal hemorrhage in rare cases. A 66-year-old man was admitted to our hospital for renal dysfunction, numbness, and weight loss for 3 months. He had no significant medical history. Renal biopsy revealed crescentic glomerulonephritis with necrotizing vasculitis, which was associated with a high serum titer of MPO-ANCA, leading to a diagnosis of MPA. Remission-induction treatment with glucocorticoids and rituximab was initiated, which improved the patient's general condition and renal failure. His blood pressure was elevated and was controlled by amlodipine treatment. Two months after discharge, he visited the emergency department because of chest pain. A diagnosis of acute cardiovascular syndrome was suggested; however, his cardiac artery was not stenotic. The patient's blood pressure was high despite antihypertensive therapy, and he developed posterior reversible encephalopathy syndrome (PRES). Despite intensive treatment, the patient died 3 days later. An autopsy revealed that the cause of death was hypovolemic shock due to massive intra-abdominal hemorrhage from the ruptured mesenteric artery involved in vasculitis. In cases of MPA with sudden-onset chest or abdominal pain, a ruptured intra-abdominal artery should be considered. Secondary hypertension associated with vasculitis should be carefully managed to prevent hemorrhagic complications and PRES.

[A case of post-cardiac arrest syndrome presenting with lateralized periodic discharges evolving to a cyclic seizure pattern on electroencephalogram].

A 53-year-old man with hypertension experienced sudden cardiopulmonary arrest. Ambulance crews detected ventricular fibrillation that responded to defibrillation. Cardiopulmonary resuscitation resulted in return of spontaneous circulation (ROSC) after 30 minutes. At admission to our hospital, he was in a comatose state. Therapeutic hypothermia was performed for two days with other supportive care. However, despite these therapies, he remained comatose, and a diagnosis of post-cardiac arrest syndrome (PCAS) was made. On the sixth hospital day, an electroencephalogram (EEG) showed lateralized periodic discharges (LPDs) in the right occipital area evolving to electrographic seizures. Over roughly 15 minutes, this evolution process repeated 10 times, demonstrating a cyclic seizure pattern. Intravenous administration of 10 mg diazepam resulted in temporal attenuation of the high-amplitude discharges followed by LPDs re-emergence accompanying a low-amplitude fast rhythm on the background activity (LPDs+). Antiepileptic drugs administration was continued, along with supportive care. He opened his eyes on the 11th hospital day, after which his general conditions showed a good recovery. He was discharged on the 30th day without any sequelae.

Successful treatment of primary cardiac lymphoma with atrioventricular nodal block.

A 69-year-old female suffering from third-degree atrioventricular block with syncope underwent permanent pacemaker implantation. However, she developed shortness of breath 2 months after the implantation. Blood tests revealed elevated levels of LDH, CRP, BNP, and SIL-2R. Transthoracic echocardiography showed thickened left and right atrial walls with mild pericardial effusion. A diagnosis was made based on a CT scan and histology. Although most primary cardiac malignant lymphomas are associated with a poor prognosis, the patient was treated successfully with chemotherapy.