Risk factors for disease progression in Japanese patients with COVID-19 with no or mild symptoms on admission.

BACKGROUND: Although the risk factors for coronavirus disease 2019 (COVID-19) mortality have been identified, there is limited information about the risk factors for disease progression after hospitalization among Japanese patients with COVID-19 exhibiting no or mild symptoms. METHODS: All 302 consecutive patients who were admitted to our institutions and diagnosed with COVID-19 between March and December 2020 were retrospectively assessed. Ultimately, 210 adult patients exhibiting no or mild symptoms on admission were included in the analysis. They were categorized into the stable (no oxygen needed) and worsened (oxygen needed) groups, and their characteristics and laboratory data were compared. RESULTS: Among 210 patients, 49 progressed to a severe disease stage, whereas 161 did not. The mean patient age was 52.14 years, and 126 (60.0%) patients were male. The mean body mass index (BMI) was 23.0 kg/m2, and 71 patients were overweight (BMI ≥ 25 kg/m2). Multivariate logistic analysis showed that old age, overweight, diabetes mellitus (DM), and high serum ferritin levels were independent risk factors for disease progression. CONCLUSIONS: Clinicians should closely observe patients with COVID-19, especially those with risk factors such as old age, overweight, DM, and high serum ferritin levels, regardless of whether they have no or mild symptoms.

Two Cases of Tuberous Sclerosis Complex Suggestive of Complicating Multifocal Micronodular Pneumocyte Hyperplasia: A Case Report.

Multifocal micronodular pneumocyte hyperplasia (MMPH) is pathologically characterized by multifocal nodular hyperplasia of type Ⅱ pneumocyte-like cells. MMPH is usually complicated with tuberous sclerosis complex (TSC). MMPH patients tend to be asymptomatic or only slightly symptomatic. MMPH tends to progress slowly and needs no treatment. We herein describe two cases of MMPH with its characteristic radiological features and clinical manifestations of TSC. Case 1: a 20-year-old female with definitive TSC in infancy. Chest CT at the age of 18 revealed multiple nodular opacities and ground-glass attenuations in a scattered and random distribution in the bilateral lungs. Case 2: a 44-year-old female with probable TSC at 36 years of age. Chest CT at the age of 43 showed random areas of small ground-glass attenuations, predominantly in the upper lung fields. Case 1 and Case 2 have had no respiratory symptoms or radiographic changes in the recent two years and four years, respectively. Although pathological examinations of the lung were not performed because consent for surgical lung biospies was unobtainable, we considered that these pulmonary manifestations were most likely MMPH with TSC because of these characteristic radiographical findings of multiple nodular opacities and ground-glass attenuations of 10 mm or less in size and their scattered distribution, and because there have been no abnormal laboratory data or changes in their chest radiological findings for years. Neither patient is under treatment for pulmonary lesions. Although MMPH is a rare disease, multiple nodules and ground-glass attenuations on lung imaging findings should be considered as pulmonary manifestations in patients with TSC.

Exogenous lipoid pneumonia caused by herbicide inhalation.

Exogenous lipoid pneumonia is caused by aspiration or inhalation of oily substances. Generally, lipoid pneumonia has non-specific clinical and radiological presentations and may be misdiagnosed as bacterial pneumonia. Our patient, a 68-year-old man who had been diagnosed with pneumonia on three previous occasions, was admitted to our hospital with a fourth similar episode. Computed tomography of the chest revealed extensive consolidations with air bronchograms in lung fields on the right side. The bronchoalveolar lavage fluid (BALF) increased ghost-like macrophages that stained positive for lipid. Our patient reported that he had sprayed herbicide in large quantities without wearing a mask. We analysed the BALF and herbicide by gas chromatography and diagnosed exogenous lipoid pneumonia caused by inhalation of herbicide. Clinicians should be aware of lipoid pneumonia, which may present as infectious pneumonia.

Wegener's granulomatosis in which rheumatoid factor was useful for evaluating the disease status: a case report.

INTRODUCTION: Accurate evaluation of disease status is very important in treatment of Wegener's granulomatosis CASE PRESENTATION: A 73-year-old Japanese man presented with chronic sinusitis and otitis media. He was admitted to our hospital because of bilateral lung nodules. Cytoplasmic antineutrophil cytoplasmic antibody was negative but his rheumatoid factor was high. He was diagnosed with limited Wegener's granulomatosis and received remission induction therapy. His serum rheumatoid factor level correlated with the Wegener's granulomatosis state when he experienced a severe infection and recurrence due to Wegener's granulomatosis. CONCLUSION: We describe a case of Wegener's granulomatosis in which rheumatoid factor was helpful for evaluating the therapeutic effect.

[A case of hearing loss and diffuse alveolar hemorrhage associated with microscopic polyangitis].

We report a rare case of bilateral hearing loss and diffuse alveolar hemorrhage associated with microscopic polyangitis (MPA). A 75-year-old woman complained of hearing loss. Two months later, she was admitted due to rapidly progressing dyspnea. Chest radiography and CT scan showed diffuse bilateral consolidations. Mechanical ventilation was required for respiratory insufficiency. Laboratory data demonstrated anemia and renal failure. Steroid pulse therapy and antibiotics were initiated. On day 2, bronchoalveolar lavage showed fresh blood-like fluid, which suggested diffuse alveolar hemorrhage (DAH). Serum level of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was elevated. Therefore, DAH and rapidly progressive glomerulonephritis associated with MPA were diagnosed. Treatment was also performed with cyclophosphamide pulse therapy and plasmapheresis. Her pulmonary lesion improved dramatically. We emphasize the effectiveness of bronchoalveolar lavage for prompt and accurate diagnoses. Moreover, this case report also suggests that early cyclophosphamide therapy and plasmapheresis may be an effective treatment for MPA with diffuse alveolar hemorrhage. In contrast, hearing loss did not improve after therapy. Some cases reported hearing loss as a rare symptom of MPA. We also suspect that hearing loss may be a complication of MPA. We reported this case because there has been no description of hearing loss accompanying DAH associated with MPA.