Idiopathic segmental anhidrosis in an older patient presenting with recurrent dizziness.

Dizziness is one of the most common complaints encountered in the outpatient clinic, which is difficult to diagnose, especially in older patients because of the multifactorial nature of the disease. Although not commonly recognised, anhidrosis can also cause dizziness.We report a case of a woman in her 70s who presented with long-term recurrent dizziness. She had a history of frequent hospitalisations for heatstroke. Physical examination revealed markedly less sweating in the left axilla and soles than in the right. Minol test revealed that most of the left side of her body, including the face, was anhidrotic. She was diagnosed with idiopathic segmental anhidrosis. We administered steroid pulse therapy without observing any significant effects.Although anhidrosis is a rare disorder, a careful interview and physical examination should be conducted to confirm a history of heatstroke and the absence of sweating to avoid missing the disease.

Parvovirus B19 Infection: A Vasculitis Masquerade in an Elderly Patient.

BACKGROUND The profound ability of viral infections to convincingly mimic vasculitis, thereby pathologically influencing vessels of any caliber, is undeniably significant. Notably, adult patients with B19V infection frequently experience joint pain and cutaneous eruptions, which are ostensibly immune responses to the infection and necessitate careful differentiation from autoimmunity. Conversely, vasculitis syndromes represent an amalgamation of diseases characterized by vascular inflammation, predominantly classified based on the impacted vessels' size and location. Although the expedited diagnosis and therapeutic management of vasculitis are paramount, many conditions, including infectious diseases, can potentially masquerade as vasculitis, necessitating rigorous differential diagnosis. CASE REPORT A 78-year-old male patient presented with fever, bilateral leg edema, skin rash, and foot numbness to the outpatient department. Blood investigations showed elevated inflammatory parameters, and urinalysis showed proteinuria and occult blood presence. We considered SVV, particularly microscopic polyangiitis, which causes acute renal injury, as the provisional diagnosis. Blood investigations, including auto-antibodies and a skin biopsy, were performed. However, his clinical symptoms resolved spontaneously before these investigation results were reported. Subsequently, the patient was diagnosed with B19V infection based on B19V immunoglobulin M antibody positivity. CONCLUSIONS B19V infection mimics vasculitis. Even in geriatric patients, particularly during B19V infection outbreaks, clinicians should conduct thorough interviews and examinations while contemplating the likelihood of B19V infection as a potential vasculitis mimic.

Delayed Diagnosis of Pancreatic Tail Cancer Presenting With Chronic Scrotal Pain.

In most cases, diagnosing pancreatic cancer (PC) in a timely manner is challenging owing to the lack of a specific set of symptoms, especially for cancer originating in the pancreatic tail. A patient presented to our hospital with the primary complaint of bilateral scrotal pain caused by metastatic pancreatic tail cancer. Although he had a family history of PC, there were no other risk factors. Here, we discuss the challenges associated with early diagnosis of malignant PC, particularly when it presents in the tail of the organ, and spermatic cord metastasis caused by pancreatic tail cancer.

Guillain-Barre Syndrome Caused by Mycoplasma pneumoniae Infection in an Elderly Patient Initially Misdiagnosed As Frailty.

A 73-year-old man with a history of hypertension was referred to our department because of progressive frailty while being treated for acute heart failure. Physical examination revealed loss of tendon reflexes in the lower extremities and muscle weakness in all extremities. After close examination, he was diagnosed with Guillain-Barre syndrome (GBS), which was preceded by a Mycoplasma pneumoniae infection. He was given high-dose intravenous immunoglobulin (IVIg) therapy, and his muscle weakness improved. This case suggests that symptoms of neurological disorders in the elderly may be viewed as frailty. Being elderly is a poor prognostic factor for GBS; therefore, early diagnosis and consultation with a neurologist are necessary. Physical examination is essential to differentiate frailty from neurological disorders, and deep tendon reflexes are instrumental in making a diagnosis of GBS.

Thymoma-Associated Pure Red Cell Aplasia Following Femoral Neck Fracture.

Pure red cell aplasia (PRCA) is a rare hematopoietic disease presenting with severe anemia and a marked decrease in reticulocytes and bone marrow erythroblasts. Thymomas are the most common underlying cause of chronic PRCA and have been implicated in the development of other autoimmune diseases. However, the pathogenesis and mechanisms underlying the development of thymoma-associated PRCA remain unclear. Herein, we present a case of thymoma-associated PRCA in a patient who developed progressive anemia after a femoral neck fracture. The absence of severe anemia and the rapid progression of anemia over a two-month period suggested that the fracture and subsequent surgery may have triggered thymoma-associated PRCA. The patient was treated with cyclosporine and Primobolan but remained dependent on red blood cell transfusion.

Erythromelalgia Caused by Polycythemia Vera Combined with Primary Aldosteronism.

A 61-year-old woman with a history of primary aldosteronism caused by unilateral hyperplasia of the adrenal gland presented with a 2-week history of redness and severe pain in the right thumb and thenar regions. She had initially visited a dermatologist and was diagnosed with cellulitis and treated with cefditoren pivoxil for 5 days, but there was no improvement. The pain worsened and was accompanied by a burning sensation. The dermatologist prescribed famciclovir for 5 days owing to suspicion of herpes zoster. The patient was then referred to our department because her symptoms persisted. Physical examination showed no abnormalities other than the redness in the right thumb and thenar regions and spontaneous moderate pain present throughout the right thumb. Investigations revealed normal blood chemistry and coagulation factor levels, except for elevated haemoglobin (18.2 g/dl). Further investigations revealed an erythropoietin level of 2.3 IU/ml and Janus kinase 2 mutation. Hence, we diagnosed the patient with erythromelalgia caused by polycythemia vera. In this report, we discuss the treatment of polycythemia causing erythromelalgia, and the aetiology of primary aldosteronism and polycythemia vera. LEARNING POINTS: Polycythemia can cause erythromelalgia, which should be treated with aspirin.Primary aldosteronism causes secondary erythropoiesis through activation of the renin-aldosterone system, but the mechanism is not clear.Erythropoiesis may be promoted by concurrent primary aldosteronism and polycythemia vera, resulting in secondary erythromelalgia.

Epstein-Barr Virus-induced Meningitis-Retention Syndrome.

Meningitis-retention syndrome (MRS) is a rare disorder where aseptic meningitis is accompanied by urinary retention, which can be easily misdiagnosed as urinary tract infection. We present the case of a 55-year-old man with fever and dysuria. At the time of hospitalization, the patient had no symptoms of meningitis, but signs of meningeal irritation appeared later during the course of the disease. Investigation revealed that this was a case of MRS due to Epstein-Barr virus. We have to consider MRS when examining patients with fever and urinary retention, as dysuria may precede meningitis symptoms. LEARNING POINTS: Meningitis-retention syndrome (MRS) is a rare disorder where aseptic meningitis is accompanied by urinary retention, which can be easily misdiagnosed as urinary tract infection.MRS should be considered when examining patients with fever and urinary retention, as dysuria may precede the meningitis symptoms.The presence of Epstein-Barr virus can also complicate MRS.

Repetitive cerebral blood flow measurements using laser speckle imaging in a transient cerebral ischemic mouse model.

Using laser speckle imaging (LSI), which can visualize quadratic distribution of blood flow, we measured blood flow changes in transient cerebral ischemic mice, and compared these results with data obtained using laser Doppler flowmetry (LDF). In addition, we examined the relationship between ischemic damage and blood flow change. ICR mice (n = 22) were subjected to transient middle cerebral artery occlusion using a 6-0 monofilament under general anesthesia. LSI was performed before -ischemia, during ischemia, and 30 min, 3 h, 24 h, 7 days, and 28 days after ischemia. LDF was monitored continuously from pre-ischemia to 10 min after ischemia commenced. The level of cerebral blood flow (CBF) measured by LSI was less than that using LDF. LSI was able to measure CBF quantitatively and repeatedly. Blood flow -measurements using LSI revealed that recovery of cerebral cortical blood flow after ischemia in mice without cortical infarction was earlier than that seen in mice with cortical infarction. This study indicates that LSI is a -useful technique for analyzing the relationship between -tissue damage and cerebral blood flow change following cerebral ischemia.

Cyclophilin-D inhibition in neuroprotection: dawn of a new era of mitochondrial medicine.

Traumatic brain injury and ischemia can result in marked neuronal degeneration and residual impairment of cerebral function. However, no effective pharmacological treatment directed at tissues of the central nervous system (CNS) for acute intervention has been developed. The detailed pathophysiological cascade leading to -neurodegeneration in these conditions has not been elucidated, but cellular calcium overload and mitochondrial dysfunction have been implicated in a wide range of animal models involving degeneration of the CNS. In particular, activation of the calcium-induced mitochondrial permeability transition (mPT) is considered to be a major cause of cell death inferred by the broad and potent neuroprotective effects of -pharmacological inhibitors of mPT, especially modulators of cyclophilin activity and, more specifically, genetic inactivation of the mitochondrial cyclophilin, cyclophilin D. Reviewed are evidence and challenges that could bring on the dawning of mitochondrial medicine aimed at safeguarding energy supply following acute injury to the CNS.

[Organ protective effects of volatile anesthetics and perioperative outcomes].

Anesthetic agents, especially, volatile anesthetics are considered to exert organ toxicity such as nephrotoxicity and hepatotoxicity; however, recent aggressive researches explored the beneficial effects of volatile anesthetics as an organ protectant. Ischemic preconditioning is a phenomenon in which single or multiple brief periods of ischemia have been shown to protect the myocardium and brain against prolonged ischemic insult. General anesthesia showed the protection against both ischemic myocardial and brain reperfusion injuries. This phenomenon is called anesthetic preconditioning. Regarding the organ protection, anesthetic preconditioning is one of the useful ways to diverse the organ protective effects not only to heart but also brain. Nowadays, ischemic postconditioning, consisting of repeated brief cycles of ischemia-reperfusion performed immediately after reperfusion following a prolonged ischemic insult, dramatically reduces infarct size in experimental models and such clinical studies are reported. Both preconditioning and postconditioning share the same signal transduction pathway and inhibit the mitochondrial permeability transition (MPT) that leads to either apoptosis or necrosis of myocardium and neuronal cell. Both phenomena look very promising, but we still lack the real evidence for human reserach in terms of the clinical outcome and further analysis is necessary. Neurotoxicities of anesthetic agents are very crucial problems for the patient and they are considered to be due to the activation of IP3 receptor in ER after exposure to volatile anesthetics. Massive release of Ca2+ from ER induces Ca2+ overload leading to mitochondria permeability transition (MPT) and induces apoptosis in the brain or aggravates the neurodegenerative disease. Susceptible mechanisms and beneficial treatment for the toxicity of general anesthesia is considered as a critical subject to discuss and challenge to solve for our future.