Case report: Five patients with myocarditis after mRNA COVID-19 vaccination.

Objectives: To describe clinical features and laboratory data of myocarditis after the mRNA COVID-19 vaccine in children. Methods: We reviewed patients younger than 18 years of age, who visited our hospital because of myocarditis within 1 week after BNT162b2 from June 2021 to January 2022. Results: We identified five male patients aged 12-16 years who presented to our hospital with myocarditis within 2-3 days after the second dose of BNT162b2 COVID-19 vaccination between June 2021 and January 2022. All patients experienced chest pain, and fever, pain other than chest pain, and shortness of breath were present in two, three, and two patients, respectively. The serum troponin I level was increased in all patients except one, and electrocardiogram (ECG) showed ST elevation in all patients. Echocardiography revealed pericardial effusion and decreased ejection fraction in three and one patients, respectively. In accordance with the Japanese guidelines for myocarditis, the patients were treated with colchicine and aspirin. Chest pain improved within a few days with no hemodynamic instability. The patients were discharged with no sequelae. Conclusions: ST changes on ECG and elevated troponin I levels may aid the diagnosis of myocarditis after mRNA COVID-19 vaccination.

Multiple evanescent white dot syndrome following vaccination for COVID-19: A case report.

RATIONALE: Multiple evanescent white dot syndrome (MEWDS) is an acute, usually unilateral, retinal disorder of unknown etiology that predominantly occurs in healthy young women. We report a case of bilateral asymmetric MEWDS that developed following the first vaccination for coronavirus-19 and worsened after a second vaccination. PATIENT CONCERNS: A 30-year-old Japanese woman was examined in an eye clinic for blurred vision in her left eye for 1 week duration. Thirteen days before her examination, she had received her first BNT162b2 mRNA SARS-CoV-2 vaccination. Her best-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed multiple yellowish-white spots in the perifoveal area of both eyes. Visibility of the spots gradually decreased during the following week. She was then vaccinated with a second dose, and 3 days later, her vision worsened in her left eye. She was then referred to our hospital because of worsened vision and the appearance of white spots on other parts of the retina. Ophthalmological examination revealed a best-corrected visual acuity of 30/20 both eyes. DIAGNOSIS: The flare value in the anterior chamber was elevated in both the eyes. Fundus examination showed multiple white spots in the perifoveal area of both eyes, but they were more prominent in the left eye. Fundus fluorescein angiography revealed early hyperfluorescent spots located circumferentially around the fovea in both eyes. We concluded that the patient had MEWDS, which was most likely due to mRNA COVID-19 immunization. INTERVENTIONS: The patient was treated with topical betamethasone sodium phosphate/fradiomycin sulfate 0.1% thrice daily for 2 months. OUTCOMES: Two months after treatment, her blurry vision resolved with the disappearance of the fundus lesions. LESSON: Clinicians should be aware of potential adverse ocular events following similar vaccinations.

Clinical and Genetic Features of Tubulointerstitial Nephritis and Uveitis Syndrome with Long-Term Follow-Up.

PURPOSE: To investigate the clinical manifestations, prognosis, and HLA-type of tubulointerstitial nephritis and uveitis syndrome (TINU) with long-term follow-up. METHODS: Clinical data of five patients with TINU were retrospectively reviewed. RESULTS: The mean age was 15.8 years. The mean follow-up periods were 54.0 months. The initial subjective symptoms were bulbar injection (100%), ocular pain (80%), and blurred vision (60%). The medical department that the patients visited first was ophthalmology in 4 (80%) cases. Urinalysis showed the characteristic increase of the ß2 microglobulin in all (100%) patients. Uveitis and nephritis were diagnosed within 1 week from each other. Although two showed recurrences, the topical and systemic steroid treatment with mean duration of 14.1 months brought the resolution of nephritis and uveitis in all patients. Recurrence-free periods ranged from 12 to 71 months. The final visual outcome was 20/20 or better in all cases. HLA-DR4 or the allele of DRB1∗04 was present in all (100%) patients. CONCLUSIONS: TINU should be considered in the differential diagnosis in young patients with uveitis of unknown origin and renal dysfunction. Urinary ß2 microglobulin level and HLA typing may help in the diagnosis of TINU. The prognosis for patients with TINU is generally good with steroid treatment.

Long-term use of a once-a-day fentanyl citrate transdermal patch in lung cancer patients.

Transdermal fentanyl is widely administered as an analgesic therapy for cancer patients. Recently, a novel fentanyl citrate transdermal patch was developed in Japan, which is the first such patch that requires changing only once a day. The patch releases more stable serum fentanyl concentrations and results in less frequent adverse skin symptoms compared with the conventional 72-h transdermal fentanyl patch. A previous study has reported the short-term analgesic effects and safety of this transdermal patch. However, the long-term efficacy has yet to be determined. Therefore, the present study retrospectively investigated the adverse effects and outcomes of treatment with this product in 46 lung cancer patients. In total, 35 (76%) patients were able to continue the treatment until the end of the observation period, including 32 (69%) who succumbed to the disease and three (7%) who were transferred from Nagoya City University Hospital to a hospice. Of the 11 (24%) discontinued cases, six were changed to a course of injectable opioids for the palliation of terminal symptoms, including dyspnea. Adverse effects were observed in 11 (24%) cases, but discontinuation due to adverse effects occurred in only four cases. Therefore, the present study indicates that palliative treatment with the once-a-day fentanyl citrate transdermal patch is well-tolerated by lung cancer patients.

Cascading time evolution of dissipative structures leading to unique crystalline textures.

This article reports unique pattern formation processes and mechanisms via crystallization of materials under external flow fields as one of the general problems of open nonequilibrium phenomena in statistical physics. The external fields effectively reduce step-by-step the exceedingly large free energy barriers associated with the reduction of the enormously large entropy necessary for crystallization into unique crystalline textures in the absence of the fields. The cascading reduction of the free energy barrier was discovered to be achieved as a consequence of a cascading evolution of a series of dissipative structures. Moreover, this cascading pattern evolution obeys the Ginzburg-Landau law. It first evolves a series of large-length-scale amorphous precursors driven by liquid-liquid phase separation under a relatively low bulk stress and then small-length-scale structures driven by a large local stress concentrated on the heterogeneous amorphous precursors, eventually leading to the formation of unique crystalline textures which cannot be developed free from the external fields. Here the multi-length-scale heterogeneous structures developed in the amorphous precursors play a dominant role in the triggering of the crystallization in the local regions subjected to a large stress concentration even under a relatively small applied bulk stress.

Discrepancy of in-vitro data and clinical efficacy of micafungin against Candida tropicalis endophthalmitis.

We report findings for a 74-year-old woman with Candida tropicalis endophthalmitis for whom an increase in b-D-glucan level and worsening of endophthalmitis were observed after intravenous injection of micafungin, an echinocandin antifungal agent. Endogenous endophthalmitis caused by C. tropicalis developed in both eyes. On the basis of her surgical history, laboratory data,and lesions, tentative diagnosis of fungal endophthalmitis was made. She was then treated with fluconazole and itraconazole, but the b-D-glucan level did not decrease, and there was no improvement of the endophthalmitis. The fluconazole was discontinued and replaced by micafungin.Unexpectedly, the level of b-D-glucan increased and endophthalmitis did not improve. The micafungin was immediately stopped and replaced by intravenous fluconazole with amphotericin B syrup, but the itraconazole was continued. Marked resolution of the vitreous inflammation was observed in both eyes, and the serum b-D-glucan level was reduced. Because active macular infiltrates were observed in the right eye, vitrectomy was performed. The micafungin minimum inhibitory concentration against the C. tropicalis strain isolated from our patient was 0.03 lg/ml. This paradoxical effect of micafungin should be remembered, and b-D-glucan level should be frequently monitored after intravenous injection of micafungin.

Identification and sensitivity of two rare fungal species isolated from two patients with Fusarium keratomycosis.

We report two cases of Fusarium keratomycosis in which molecular analysis was used to identify two rare causative Fusarium species. A 65-year-old woman was diagnosed with Fusarium keratomycosis caused by F. equiseti, confirmed by sequencing the internal transcribed spacer (ITS) region and morphological characteristics. She was initially treated with topical corticosteroid but the keratitis did not improve. Even after aggressive antifungal treatment, there was a severe reduction of vision. In the end, the eye perforated. Our second case was a 75-year-old man who had diabetes mellitus. He developed keratitis after his cornea was injured by corn stalks. The ITS region identified the causative organism as F. verticillioides. Unlike the first case, he had good visual recovery after early antifungal therapy. Our findings demonstrate that both ITS and morphological characteristics can be used to identify the exact Fusarium species causing Fusarium keratomycosis. This allowed us to determine the sensitivity of these species to antifungal drugs that can be used to treat patients with these species of Fusarium.

[A case of eosinophilic pneumonia which occurred after bone marrow transplantation for acute myeloid leukemia].

A 37-year-old woman with acute myeloid leukemia received allogeneic bone marrow transplantation (BMT) after systemic chemotherapy and total body irradiation. Soon after BMT both cutaneous and gastrointestinal graft-versus-host disease (GVHD) developed, but she was successfully treated with corticosteroids and tacrolimus. Thereafter, about 6 months after BMT a dry cough developed, and chest computed tomography (CT) showed a consolidated shadow in the right lower lobe which was resistant to antibiotics, and we finally diagnosed eosinophilic pneumonia based on a bronchoalveolar lavage analysis of the eosinophilia. The eosinophilic pneumonia in this case might have been associated with GVHD, because cutaneous GVHD simultaneously recurred. We report the details of this case because only a few such reports of eosinophilic pneumonia associated with GVHD have been previously described, and such cases may increase with the growing use of transplantations.

[An eight-year review of sensitivity to antimicrobials against isolated microorganisms from ocular infections].

OBJECTIVE: To obtain data beneficial for future treatment by observing the circumstances relating to microorganisms isolated in external ocular infections and drug sensitivity, along with changes in drug-resistant bacteria. SUBJECTS AND METHODS: For an eight-year period from April 1998 to March 2006, the cultivation and identification of secretions from conjunctival sac and drug sensitivity tests were conducted at JA Gifu Koseiren Chuno General Hospital involving 3,876 patients (1,809 males and 2,067 females; average age: 44.2 +/- 29.3 years old, ranging from 0-99 years old) diagnosed with external ocular infections by the Department of Ophthalmology. Sensitivity test results were evaluated based on the US CLSI standards. RESULTS: Of the 5,002 samples, 3,447 tested positive for cultures (isolation rate: 68.9%). A total of 4,537 strains were isolated. In descending order, the microorganisms isolated were 1,706 strains of coagulase negative Staphylococcus (CNS), including Staphylococcus epidermidis (37.6%), 936 strains of Corynebacterium spp. (20.6%), 635 strains of Staphylococcus aureus (14.0%), 412 strains of Haemophilus influenzae (9.1%), and 246 strains of Streptococcus pneumoniae (5.4%). CNS, Corynebacterium and S. aureus were isolated in relatively large numbers in patients of all ages. H. influenzae and S. pneumoniae were common in children six and under and from winter to spring. At the sametime, resistant bacteria (PRSP or PISP: 166 strains; 2000 onward, BLNAR: 192 strains; and BLPACR: 6 strains) were detected more frequently than sensitive bacteria. H. influenzae was hypersensitive to cefotaxime (CTX) and levofloxacin. Almost no toleration of CTX was observed in S. pneumoniae. DISCUSSION AND CONCLUSION: There are distinctions in the isolated bacteria according to age and season, and the use of drugs that are appropriate to the antibiograms of each facility should be considered.

Effects of corneal thickness on intraocular pressure measured with three different tonometers.

PURPOSE: To compare intraocular pressure (IOP) measured by a Goldmann applanation tonometer (GAT), a noncontact tonometer (NCT), and a portable noncontact tonometer (PNCT) in eyes of healthy volunteers, and to determine if a significant correlation exists between the IOP and the central corneal thickness (CCT). METHODS: A total of 144 healthy participants were randomly assigned to one of two groups; in the first group, IOP was measured first with the NCT and then with the GAT. In the second group, IOP was measured first with the PNCT and then with the GAT. Subsequently, the CCT of all subjects was measured with an ultrasonic pachymeter. RESULTS: The IOPs determined by the GAT and NCT and were strongly correlated, as were those determined by the GAT and PNCT, in both groups. However, a Bland-Altman plot showed that the correlations between the GAT and NCT and between the GAT and the PNCT measurements were not significant. With all three instruments, the IOP readings varied with the CCT. The mean IOPs obtained with the GAT increased by 0.23 mmHg with each 10-microm increase in CCT (0.23 mmHg/10 microm). The comparable value for the NCT was 0.29 mmHg/10 microm, and that for the PNCT was 0.31 mmHg/10 microm. CONCLUSIONS: For measurements of IOP in normal eyes, the GAT is the tonometer least affected by the CCT, compared with the PNCT and NCT. A PNCT is more likely to be affected by variations in CCT than the GAT.

Detection of staphylococcus species by polymerase chain reaction in late-onset endophthalmitis after cataract surgery and posterior capsulotomy.

We report a case of late-onset endophthalmitis that developed 5 years after an uneventful phacoemulsification with implantation of a posterior chamber intraocular lens. Posterior capsulotomy was performed with by Nd:YAG laser 1 month after the cataract surgery. Polymerase chain reaction with agarose gel electrophoresis identified a Staphylococcus species in a sample from the aqueous humour. The endophthalmitis was responsive to medical therapy including antibiotic agents, and it resolved without any surgical intervention.

Improvement of scotopic electroretinograms and night blindness with recovery of serum zinc levels.

BACKGROUND: We sought to determine the cause of reduced scotopic and photopic electroretinograms (ERGs) and night blindness in a 46-year-old man with liver dysfunction but no history of alcoholism. CASE: A 46-year-old Japanese man with a complaint of visual difficulties in dim light for 1 month. OBSERVATIONS: By electrophysiological investigation, the patient was found to have low levels of serum zinc and vitamin A on admission. The rod b wave was unrecordable, and the bright-flash ERGs were reduced, with the a wave > b wave. The amplitudes of the cone and 30-Hz flicker responses were also reduced, and their implicit times were prolonged. Three weeks after admission, the patient's serum zinc level recovered to normal levels, but his serum vitamin A level was still low. The symptoms of night blindness were gone, and the rod ERGs and single bright-flash responses were within normal limits. However, the cone ERGs and 30-Hz flicker responses were still depressed. CONCLUSIONS: The recovery of scotopic function together with the recovery of zinc but not vitamin A levels suggests that the ERG changes were most likely related to low zinc levels.