ISSN 2185-8136
JOURNAL OF HOSPITAL GENERAL MEDICINE
SEPTEMBER 2019 Volume 1-3
Case report
A case of pseudo-pheochromocytoma possibly induced
by a preceding respiratory infection・・・・Hideharu Hagiya 16
Rhabdomyolysis associated with
Campylobacter jejuni infection・・・・・・ Koichi Hoshikawa 21
Peripartum cardiomyopathy with marked
pulmonary edema・・・・・・・・・・・・・・・・Ko Harada 26
A Case of Good’s Syndrome Accompanied
by Agammaglobulinemia and Diarrhea・・・・ Yuichiro Haba 31
Late-onset systemic lupus erythematosus with
nephrotic syndrome and cytopenia ・・・・ Takaaki Nemoto 36
Brief report
The relation between the site of abdominal pain
and the organ involved:A retrospective study of
472 cases ・・・・・・・・・・・・・・・・ Naoko E. Katsuki 41
Fever of unknown origin without increase of serum
C-reactive protein in a patient with acute lymphoblastic
leukemia/lymphoblastic lymphoma ・・・・・・ Kosuke Oka 45
Disseminated Pasteurella multocida infection:
an unexpected cause of pyogenic spondylitis
after septic shock ・・・・・・・・・・・・・・ Masaki Tago 50
Case report
A case of pseudo-pheochromocytoma possibly induced
by a preceding respiratory infection
Hideharu Hagiya 1)2)※ Futoshi Nakagami 1)
Shino Yoshida 1) Motonori Nagawasa 2) Yoichi Takami 1)
Hiroshi Akasaka 1)2)※ Koichi Yamamoto 1)
Fumio Otsuka 2) HIromi Rakugi 1)
1）Department of General Internal Medicine, Osaka University Hospital
2）Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences
A 30-year-old man presented with various manifestations including general malaise, headache, palpitation, and diaphoresis, which occurred ten days after an acute respiratory infection. The patient showed high blood pressure, and an investigation for secondary hypertension demonstrated marked catecholamine elevations, supporting a diagnosis of pheochromocytoma;however, computed tomography and 123I-meta-iodobenzylguanidine scin- tigraphy denied any adrenal tumours or paragangliomas. The catecholamine overproduction spontaneously normalized over time without surgical intervention or chemotherapy. The patient’ s clinical course suggested transient catecholamine overproduction, possibly triggered by the preceding infective event. General practitioners need to be aware of the possibility of a post- infectious condition of pseudo-pheochromocytoma.
Key Words：adrenalitis, transient hyperadrenalism, pheochromocytoma
Case report
Rhabdomyolysis associated with
Campylobacter jejuni infection
Kazuhiro Nasu 2) Tetsuya Yamada 1) Daiki Kikuchi 1)
Tomohiro Takahashi 1) Gaku Takahashi 2) Katsutoshi Terui 2)
Yasuhisa Fujino 2) Yoshihiro Inou 2) Osamu Shimooki 1)
1） Department of Emergency, Disaster and General Medicine,
Division of General Medicine,Iwate Medical University School of Medicinel
2）Department of Emergency, Disaster and General Medicine,
Division of Critical Care Medicine,Iwate Medical University School of Medicine
An 18-year-old woman was admitted to our hospital with fever and malaise. Her body temperature was 39.4 °C, but no abdominal pain was present and the intestinal peristaltic rhythm was normal. She complained of tiredness and bilateral thigh muscle pain at the time of the examination. The blood biochemical test values were as follows:leukocytes, 11, 600/μL; aspartate aminotransferase, 72 U/L;lactate dehydrogenase, 524 U/L;creatine phosphokinase (CPK), 7,263 U/L;creatinine, 0.72 mg/dL;serum myoglobin, 266.0 ng/mL;and C-reactive protein, 0.64 mg/dL. Slightly increased inflammation and increased muscle-derived enzyme levels were observed. The patient was then diagnosed with rhabdomyolysis (RM) with infectious diseases and hospitalized for medical treatment. Immediately after hospitalization, watery diarrhea and vomiting were frequently observed. Campylobacter jejuni was detected in a stool culture. At the time of the admission, the abdominal symptoms were poor and the diagnosis was difficult. Although the serum CPK value was unusually high, acute renal failure was avoided. We concluded that the C. jejuni infection may have been a cause of the RM.
Key Words：rhabdomyolysis, Campylobacter jejuni, infection
Brief report
Peripartum cardiomyopathy with marked
pulmonary edema
Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Peripartum cardiomyopathy (peripartum cardiomyopathy:PPCM) is a secondary cardiomyopathy presenting with heart failure due to left ventricular systolic dysfunction within 1 month before delivery and 5 months after delivery with an estimated incidence of 1 in 20,000 live births in Japan. We report a case of PPCM in a 41-year-old Japanese woman with a history of hypertensive disorder of pregnancy who presented with dyspnea and hypoxia 4 days after cesarean section. Her respiratory rate was 30 breaths/minute with an SpO2 of 80 % (with 10 L/minute of oxygen), and the brain natriuretic peptide level was markedly elevated at 2,282 pg/mL. Chest radiography showed marked pulmonary edema, and echocardiography revealed severely reduced left ventricular function with ejection fraction of 30 %. She was intubated and managed in the intensive care unit. Her left ventricular ejection fraction improved to 49 % on day 16, and the patient was discharged 20 days after admission. This case underlines the importance of careful monitoring of cardiopulmonary symptoms in peripartum women, particularly those with risk factors for PPCM such as hypertensive disorders of pregnancy. Clinicians should also prepare for intensive care including mechanical ventilation and circulatory support.
Key Words：peripartum cardiomyopathy, pulmonary edema, intensive care
Brief report
A Case of Good’s Syndrome Accompanied
by Agammaglobulinemia and Diarrhea
1）Department of General Medicine, Juntendo University School of Medicine
2）Department of Emergency and Disaster Medicine
3）The Medical Training Center for Graduates
A 60-year-old woman with diarrhea was referred to our hospital due to low values for serum total protein, liver dysfunction with elevated biliary enzymes, and abnormal shadows on chest X- ray from a health examination. Computed tomography of the chest showed a mass in the anterior mediastinum, and the specimen from thymectomy revealed type-AB thymoma. We diagnosed Good’ s syndrome, a rare form of acquired immunodeficiency, because of the thymoma concomitant with agammaglobulinemia. Further examinations revealed multiple tumors in the liver indicating metastatic thymoma. Diarrhea disappeared after total thymectomy, but hypogammaglobulinemia persisted. The patient is now receiving immunoglobulin-replacement therapy and has remained well for the two and a half years since the first visit.
Key Words：Good’s syndrome, agammaglobulinemia, diarrhea
Brief report
Late-onset systemic lupus erythematosus with
nephrotic syndrome and cytopenia
Hiroyuki Kunishima 3) Takahide Mastuda 2)
1）Infection Control, Kawasaki Saiwai Hospita
2）General Internal Medicine, St. Marianna University
3）Infectious Disease, St. Marianna University
An 85-year-old Japanese woman with hypertension and diabetes was receiving several medications, including hydrochlorothiazide, and presented with a 3-week history of bilateral leg edema. Laboratory test results indicated renal dysfunction and proteinuria. Further evaluation revealed bicytopenia, and tests for antinuclear antibody and anti-double-stranded DNA were positive. Drug-induced lupus was initially considered, but her condition did not improve following hydrochlorothiazide discontinuation. Thus, late-onset lupus was diagnosed. Late-onset lupus is characterized by an insidious onset with nonspecific manifestations, and it is difficult to diagnose. Unexplained cytopenia in the elderly may be an essential characteristic to consider in late-onset lupus diagnosis.
Key Words：Late-onset lupus, Nephrotic syndrome, Cytopenia
Brief report
The relation between the site of
abdominal pain and the organ involved:
A retrospective study of 472 cases
Naoko Kunam 1) Masaki Hyakutake 1) Shu-ichi Yamashita
Department of General Medicine, Saga University Hospital
1）Department of General Medicine, Juntendo University School of Medicine
2）Department of Emergency and Disaster Medicine
3）The Medical Training Center for Graduates
A 60-year-old woman with diarrhea was referred to our hospital due to low values for serum total protein, liver dysfunction with elevated biliary enzymes, and abnormal shadows on chest X- ray from a health examination. Computed tomography of the chest showed a mass in the anterior mediastinum, and the specimen from thymectomy revealed type-AB thymoma. We diagnosed Good’ s syndrome, a rare form of acquired immunodeficiency, because of the thymoma concomitant with agammaglobulinemia. Further examinations revealed multiple tumors in the liver indicating metastatic thymoma. Diarrhea disappeared after total thymectomy, but hypogammaglobulinemia persisted. The patient is now receiving immunoglobulin-replacement therapy and has remained well for the two and a half years since the first visit.
Key Words：Good’s syndrome, agammaglobulinemia, diarrhea
Brief report
Fever of unknown origin without increase of serum
C-reactive protein in a patient with acute
lymphoblastic leukemia/lymphoblastic lymphoma
Tomofumi Yano 2) Eisei Kondo 1) Fumio Otsuka 1)
1）Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Science
2）Okayama Rosai Hospital
A 28-year-old Japanese man had complained of prolonged fever of unknown origin for 7 months. Because his pancytopenia was mild and serum C-reactive protein (CRP) level was negative, hematologic malignancy had not been suspected. After admission to our hospital, his serum lactate dehydrogenase (LDH) level gradually increased and bone marrow aspiration was performed. B lymphoblasts were detected by flow cytometric analysis, leading to a diagnosis of acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL). Although no increase in serum CRP and slow progression of pancytopenia are rare in ALL/LBL, hematologic malignancy should be suspected in febrile patients with prolonged fever of unknown origin.
Key Words：Acute lymphoblastic leukemia, C-reactive protein (CRP), FDG-PET,
Fever of unknown origin and Lymphoblastic lymphoma
Brief report
Disseminated Pasteurella multocida infection:
an unexpected cause of pyogenic spondylitis
after septic shock
Yoshimasa Oda 2) Masanori Nishiyama 1) Shu-ichi Yamashita 1)
1）Department of General Medicine, Saga University Hospital
2）Department of General Medicine, Yuai-Kai & Foundation Oda Hospital