ABSTRACT
Contrast-enhanced computed tomography revealed spontaneous spinal epidural hematoma, which mimicked aortic dissection.
ABSTRACT
Diffuse panbronchiolitis (DPB) is an idiopathic chronic inflammatory pulmonary disease clinically characterized by cough, sputum, and chronic sinusitis. Although the average age of onset is 40 years, DPB occasionally occurs in children and is often misdiagnosed as asthma. Long-term therapy with macrolide antibiotics significantly improves survival in DPB. Herein, we report the case of a 16-year-old man who had been treated for asthma and was referred to our department as transition from the Department of Pediatrics. Adequate auscultation to detect squawks and history taking of purulent sputum led to the correct diagnosis and appropriate treatment, which improved his quality of life.
Subject(s)
Giant Cell Arteritis , Polymyalgia Rheumatica , Humans , Cough/diagnosis , Cough/etiologyABSTRACT
Palmar fasciitis and polyarthritis syndrome (PFPAS) is a rare paraneoplastic rheumatic disease with characteristic features. We herein report a 77-year-old man with lung adenocarcinoma and contralateral pulmonary metastasis receiving chemotherapy who presented with progressive symmetrical flexion contractures associated with palmar fascial thickening and arthritis of both hands and shoulders. He was diagnosed with PFPAS as paraneoplastic manifestations. Salazosulfapyridine was not effective, but 15 mg/day of oral prednisolone improved his symptoms. Physicians should consider PFPAS and rule out malignancy in patients with arthritis in the extremities and flexion contractures associated with palmar fascial thickening.
Subject(s)
Adenocarcinoma of Lung , Arthritis , Contracture , Fasciitis , Lung Neoplasms , Paraneoplastic Syndromes , Adenocarcinoma of Lung/complications , Aged , Arthritis/complications , Arthritis/diagnosis , Fasciitis/complications , Fasciitis/diagnosis , Fasciitis/drug therapy , Humans , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Male , Paraneoplastic Syndromes/diagnosis , Paraneoplastic Syndromes/etiologyABSTRACT
OBJECTIVES: To investigate the impact of switching from tenofovir disoproxil fumarate (TDF)- to tenofovir alafenamide (TAF)-containing regimens on bone, kidney, serum lipids and body weight among Asian patients. METHODS: A prospective, multicentre, observational cohort study was conducted at three centres for HIV infection in Japan during 2017-2019. HIV-infected adults previously treated with TDF-containing regimens and scheduled to switch to TAF-containing regimens were included. Bone mineral density (BMD), renal markers, lipids and weight were measured consecutively from 12 months before to 12 months after the switch. RESULTS: Among 118 patients evaluated, the mean percentage change to spine BMD during 1 year of TAF treatment was higher than that during 1 year of TDF treatment (mean difference = 1.9%; 95% confidence interval (CI): 0.8-3.1). Urine protein and ß2 -microglobulin levels decreased significantly after the switch, while low-density lipoprotein cholesterol and triglycerides increased. During the TDF and TAF periods, the mean weight gains were 0.2 and 1.9 kg, respectively (mean difference = 1.6 kg; 95% CI: 0.9-2.3). Subgroup analysis revealed a significant difference between the mean body weight change associated with an integrase inhibitor (INSTI) (+2.8 kg) and that associated with a non-INSTI (+1.2 kg) third agent treatment only during the TAF period. CONCLUSIONS: Among predominantly Japanese HIV-infected patients, BMD and renal tubular markers improved, while lipid profiles worsened significantly after the switch. Weight gain during the TAF period was larger than that during the TDF period. Concurrent use of INSTI with TAF may act synergistically to gain body weight.
