ISSN 2185-8136
JOURNAL OF HOSPITAL GENERAL MEDICINE
JANUARY 2020 Volume 2-1
Original article
Case report
Intravascular lymphoma concomitant with
gastric cancer associated with extremely
high lactate dehydrogenase levels
a single-center descriptive study・・・・Takaaki Nemoto 10
Dysgeusia in a Psychiatric Patient:
A Case of Chronic Lithium Intoxication
a single-center descriptive study・・・・・・Ko Harada 16
Staphylococcal toxic shock syndrome associated
with inappropriate wound-dressing of a leg
abrasion・・・・・・・・・・・・・・・・・ Kazuya Ura 21
Ovarian vein thrombophlebitis:a potentially
fatal differential of pyelonephritis
a single-center descriptive study・・・Fumiya Komatsu 28
Case report
Clinical characteristics, decision-making capacity,
and resuscitation preference of elderly patients
with acute heart failure in Japan:
a single-center descriptive study
Takahiro Kamio, MD 1) Shunsuke Kojima, MD 1) Junya Arai, MD 1)
Yasuhiro Norisue, MD 2) Toshihiko Suzuki, MD3) Yosuke Homma, MD 4)
Osamu Takahashi, MD, MPH, PhDMD 5)
Kotaro Obunai, MD 6) Hiroyuki Watanabe, MD 6)
1)Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
2)Department of Critical Care and Pulmonary Medicine, Tokyo Bay Urayasu Ichikawa Medical Centere
3)Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center
4)Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
5)Department of Internal Medicine, St Luke’s International Hospital
6)Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
Methods:We retrospectively investigated the characteristics of all patients hospitalized for acute heart failure between April 2013 and March 2015 in our hospital. We obtained data on demographics, comorbidities, laboratory and echocardiography results, social background, decision-making capacity, DNR status, and outcomes (death in the hospital and at 1 year as well as re-hospitalization from acute heart failure after 1 year). Patients were stratified according to age for comparison:elderly patients (≥ 75 years old) and younger patients ( <75 years old).
Result:We analyzed a total of 394 patients (median age, 76 years);the elderly group included 212 patients (54%). The elderly had a higher incidence of anemia, hypertension, aortic stenosis, and preserved ejection fraction;a higher rate of activities of daily living dependency, incomplete or equivocal decision-making capacity, and DNR status;and a higher rate of mortality (in- hospital, 1-year), and 1-year re-hospitalization due to heart failure.
Conclusions:This study was the first to demonstrate the decision-making capacity and DNR status among Japanese patients with heart failure. Elderly heart failure patients had worse outcomes as well as higher prevalence of incomplete decision-making capacity and DNR status.
Key Words:insulinoma, transient amnesia, hypoglycemia
Case report
Intravascular lymphoma concomitant with
gastric cancer associated with extremely high lactate
dehydrogenase levels
Yukitaka Yamasaki 3) Hisashi Nishisako 2)
Hiroyuki Kunishima 3) Takahide Mastuda 2)
1)Infection Control, Kawasaki Saiwai Hospital
2)General Internal Medicine, St. Marianna University
3)Infectious Disease, St. Marianna University
A 64-year-old Japanese man presented with a 2-month history of dyspnea and 1 month of visual disturbance. Laboratory results showed anemia, low platelets, hypoalbuminemia, and elevated lactate dehydrogenase (LDH). Due to high LDH with isozyme II predominance, we suspected intravascular lymphoma (IVL) and performed random skin and bone marrow biopsies, which showed intravascular large B-cell lymphoma with hemophagocytosis. Although nonspecific symptoms are common in IVL, increased serum LDH and hypoalbuminemia are important clinical features. Performing random skin and bone marrow biopsies for Asian patients with IVL is imperative due to the high incidence of bone marrow lesions.
Key Words:intravascular lymphoma, gastric cancer, high lactate dehydrogenase level
Case report
Dysgeusia in a Psychiatric Patient:
A Case of Chronic Lithium Intoxication
Mikako Obika Fumio Otsuka
Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences
A 55-year-old man with a history of bipolar disorder on lithium therapy presented with loss of appetite, tremor and ataxia. The lithium had been increased from 600 mg to 800 mg per day 3 months before. Six weeks after that, he developed a change in taste, loss of appetite and weight loss. Serum lithium and creatinine levels increased from 0.5 mEq/L and 0.8 mg/dL to 2.6 mEq/L and 1. 95 mg/dL, respectively, and chronic lithium intoxication was diagnosed. Our case emphasizes the importance of careful attention to dosing and monitoring of lithium due to its narrow therapeutic index. Clinicians should be aware of taste change as a side effect of lithium therapy because it leads to dehydration and decreased renal function, resulting in chronic lithium intoxication.
Key Words:lithium intoxication, dysgeusia, renal insufficiency
Case report
Staphylococcal toxic shock syndrome associated with
inappropriate wound-dressing of a leg abrasion
Yuki Azuma 2) Tsunehisa Koga 2)
1)Department of General Internal Medicine, Harasanshin Hospital
2)Department of General Internal Medicine, Kyushu Central Hospital
Toxic shock syndrome (TSS) is an acute febrile illness characterized by hypotension, diffuse erythroderma, and multisystem involvement. In severe cases, TSS can cause multiple organ failure or death. TSS is associated with many clinical situations, such as menstruation, postoperative and postpartum recovery, burns, and respiratory infections. However, TSS associated with the use of wound-dressing for an abrasion has not previously been reported.
Here we report a case of staphylococcal TSS associated with the inappropriate use of wound-dressing. A 21-year-old otherwise healthy man visited our hospital complaining of two days of fever, nausea, vomiting, and diarrhea. Four days prior to admission, he fell from his motorcycle and suffered a leg abrasion. The next day, a moist wound-dressing was applied. On admission, his body temperature was 39.7 °C and blood pressure 83/50 mmHg. He had diffuse erythroderma and conjunctival hyperemia. A workup revealed elevated serum creatinine and liver enzyme levels. We suspected TSS, so fluid resuscitation and treatment with antimicrobials were begun. Methicillin-sensitive Staphylococcus aureus, which produced TSST-1, was isolated from the wound exudate. A diagnosis of TSS was made. He was successfully treated through the use of antimicrobials and drainage of the infected wound. He was discharged 14 days after admission without any sequelae.
This is the first report of a case of staphylococcal TSS associated with the inappropriate use of a wound-dressing for an abrasion. TSS caused by wound-dressing may be rare but should be made well-known to both health care providers and the public.
Key Words:toxic shock syndrome, TSST-1, wound-dressing
Case report
Ovarian vein thrombophlebitis:
a potentially fatal differential of pyelonephritis
Department of General Medicine and Emergency Care, Toho University School of Medicine
Ovarian vein thrombophlebitis (OVT) is a potentially fatal disease occurring in the postpartum period. Although OVT can be fatal owing to complications such as pulmonary embolism or sepsis, it is often under-recognised and misdiagnosed as appendicitis or pyelonephritis owing to its rarity. Our paper describes a case of a previously healthy 35-year-old woman with postpartum right OVT. The patient presented with fever and right flank pain for a month, which started a week after an uneventful delivery. Although a gynaecologic consultant made a diagnosis of acute pyelonephritis, several imaging studies supported a diagnosis of postpartum right OVT complicated with thrombus in the inferior vena cava. We treated the patient with ampicillin-sulbactam and anticoagulation with intravenous heparin and subse- quently, oral warfarin. The patient improved without complications. Our experience underpins the importance of precisely taking the gynecological history of patients with acute abdomen and considering OVT as a possible cause of acute abdomen or fever in the postpartum period.
Key Words:venous thrombosis, acute appendicitis, postpartum fever