[A case of immune-related gastroesophagitis with laryngopharyngitis caused by immune checkpoint inhibitors in nonsmall cell lung cancer].

With the advent of immune checkpoint inhibitors (ICI), cancer treatment options have widened in recent years. However, ICI-specific adverse events (irAEs) have been reported. Lower gastrointestinal lesions, such as colitis and enteritis, account for most gastrointestinal irAEs, and reports of upper gastrointestinal lesions are rare. We report a rare case of gastroesophagitis associated with ICI. The patient was a 64-year-old male. He was diagnosed with lung adenocarcinoma stage IIIB (cT2aN3M0), and pembrolizumab (PEM) was started as a first-line treatment. Severe gastroesophagitis with laryngopharyngitis was confirmed 5 months after PEM administration. These improved after withdrawal of PEM and steroid administration. Reports of ICI-associated gastritis remain limited, especially with laryngopharyngitis;therefore, we consider this case as valuable, in which we confirmed the clinical features of ICI-associated gastroesophagitis and its therapeutic effects.

[A case of amnesia caused by a subcortical hematoma in the left retrosplenial region].

A 54-year-old right-handed woman suffered transient aphasia and persistent amnesia caused by a subcortical hematoma in the left occipital lobe. She appeared to have aphasia, although it disappeared within 3 weeks. It is noteworthy that she had a lesion in the left retrosplenial region but exhibited both verbal and non-verbal memory impairment. However, her intelligence, remote memory and digit span were normal. She had no topographic disturbance. Computed tomography and magnetic resonance imaging revealed a subcortical hematoma in the left occipital lobe including the retrosplenial region. Single photon emission CT showed a low perfusion area in the retrosplenial region and in the left thalamus. We concluded that the retrosplenial amnesia might be caused by the interruption of hippocampal input into the anterior thalamus.

[Stereotyped movements in Wilson's disease: a case report].

A 45-year-old Japanese man was admitted to our hospital because of persistent appearance of repetitive, purposeless stereotyped movements such as clapping the hands behind his back, scrubbing or rubbing movements of the hands. Laboratory examination showed low plasma copper and ceruloplasmin concentration. He was diagnosed as having Wilson's disease. Brain MRI revealed degeneration of the striatum and pallidum as well as atrophy of brainstem. Single photon emission computer tomographic scan (SPECT) showed hypoperfusion in the bilateral frontal lobe as well as basal ganglia. It is rare to see stereotyped movements in patients with Wilson's disease. Stereotyped movements observed in the present patient was not likely to be a simple stereotypy, since appearance of the motor acts was variable and complex. We consider that his stereotyped movement is a type of clonic perseveration induced by dysfunctioning of frontal cortico-basal ganglia-thalamo-cortical loops.