ABSTRACT
<p><b>Objective:</b> Parsonage-Turner syndrome is a peripheral neuropathy characterized by acute onset shoulder pain, myalgia, and sensory disturbances. The present report discusses a rare case of Parsonage-Turner syndrome and highlights the importance of accurate history recording and thorough physical examination for the diagnosis of the disease in rural areas.</p><p><b>Patient:</b> A 28-year-old woman presented to our clinic with acute bilateral shoulder pain and difficulty moving her right arm. A diagnosis of Parsonage-Turner syndrome was suspected based on the progression of symptoms, severity of pain, and lack of musculoskeletal inflammation. The diagnosis was confirmed by neurological specialists, and the patient was treated with methylprednisolone, after which her symptoms gradually improved.</p><p><b>Discussion:</b> The differential diagnosis of shoulder pain is complicated due to the wide variety of conditions sharing similar symptoms. Accurate history recording and thorough physical examination are required to differentiate among conditions involving the central nerves, peripheral nerves, and nerve plexuses.</p><p><b>Conclusion:</b> Although the symptoms of Parsonage-Turner syndrome vary based on disease progression and the location of impairment, proper diagnosis of acute shoulder pain without central neurological symptoms can be achieved in rural areas via thorough examination.</p>
ABSTRACT
<p><b>Objective:</b> To clarify the scope of practice on rural islands of Okinawa.</p><p><b>Patient:</b> A 59-year-old man presented to our clinic with shortness of breath. He was intubated due to acute respiratory failure caused by severe pneumonia. We could not transfer him owing to bad weather, and had to continue patient care in the clinic for more than 24 hours.</p><p><b>Discussion:</b> In remote regions, rural physicians may require a broad scope of practice from primary to tertiary care, in addition to preventive and end-of-life care.</p><p><b>Conclusion:</b> This case illustrates the current state of emergency care and unique scope of practice on rural islands of Okinawa.</p>
ABSTRACT
<p><b>Objective:</b> To report the first case of ciguatera-associated rheumatoid arthritis in Japan.</p><p><b>Patient:</b> A 53-year-old man presented to our clinic with morning stiffness and pain in the fingers and wrists.</p><p><b>Results:</b> For six months, he had suffered from chronic pain in both hands and shoulders caused by ciguatera poisoning. He was referred to a local general hospital and diagnosed with RA.</p><p><b>Conclusion:</b> When synovitis becomes evident in chronic ciguatera poisoning, reevaluation is necessary, including investigation of chronic arthritis, which might be associated with the onset of RA.</p>
ABSTRACT
22q11.2 deletion syndrome (22qDS) resulting from a microdeletion of 22q11.2, is usually diagnosed in the postnatal period, and generally manifests as various combinations of cardiac defects, hypoparathyroidism, facial dysmorphism, palate deformity and cellular immunodeficiency. We report a case of a 32-year-old woman presenting with seizures and hypocalcemia, who was diagnosed with 22qDS, along with a literature review of adult cases. Physicians should recognize the 22qDS in adults presenting with any combinations of hypocalcemia, hypothyroidism, cardiac defects and psychiatric disorders. Pathognomonic facial dysmorphism or short stature can be the key to diagnosis.