Life-course immunization extends vaccination beyond childhood by creating repeated opportunities according to age, disease, immune status, pregnancy, occupation, travel, and social context. This approach is particularly relevant to internal medicine because older adults, patients with chronic diseases, immunocompromised hosts, and adults with incomplete records experience substantial morbidity due to vaccine-preventable diseases. In Japan, adult vaccination remains fragmented due to incomplete records, distinctions between routine and voluntary vaccination, variable municipal subsidies, and limited integration into routine care. This narrative review proposes seven recurrent, non-sequential clinical turning points operationalized through an Assessment-Connection-Documentation workflow: assess need and provide a clear recommendation, connect the patient to an accountable completion pathway, and document and share vaccination history and future plans. The framework is intended as a practical implementation model rather than a vaccination schedule and requires prospective evaluation in clinical practices.

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is an extra-articular manifestation that affects the patient outcomes. Published guidelines and consensus documents on RA-ILD or systemic autoimmune rheumatic disease/connective tissue disease-associated ILD have updated drug selection for RA-ILD; however, their meanings differ because they were developed using different methodologies for distinct clinical contexts. We compared these documents. Methotrexate (MTX)-associated acute/subacute pneumonitis should be distinguished from its effects on the development or progression of chronic fibrotic RA-ILD. Recent documents no longer consider RA-ILD alone a uniform contraindication for MTX, although severe, newly developed, or progressive ILD and the risk of drug-induced lung injury require reassessment. Abatacept and rituximab are often favored among biologic/targeted synthetic disease-modifying antirheumatic drugs, whereas the use of interleukin-6, Janus kinase, and tumor necrosis factor inhibitors varies. Drug selection should distinguish RA activity control from ILD-directed therapy and be individualized through multidisciplinary discussions considering the RA activity, ILD severity/progression and imaging, pulmonary toxicity, infection risk, and alternatives.

Thoracic central venous obstruction (TCVO) can cause facial and upper extremity edema and it is often associated with malignancies. We herein report a rare case of cervical esophageal squamous cell carcinoma complicated by TCVO type 2 during chemoradiotherapy. Approximately 1 week after starting 5-fluorouracil plus cisplatin with radiotherapy, the patient developed acute painful swelling of the left arm. Contrast-enhanced computed tomography revealed thrombosis of the left internal jugular vein with extrinsic compression of the ipsilateral subclavian vein by a cervical tumor. Symptoms improved after anticoagulation therapy while chemoradiotherapy was continued, although the improvement was likely multifactorial.

Sarcopenia is a progressive systemic condition characterized by a reduced skeletal muscle mass, strength, and physical function. In gastrointestinal diseases, it is increasingly recognized as a clinically relevant factor associated with symptom burden, treatment tolerance, postoperative complications, quality of life, and survival. Its development reflects not only aging but also disease-related malnutrition, anorexia, malabsorption, chronic inflammation, cachexia, altered gut motility, defecatory dysfunction, dysbiosis, and reduced physical activity levels. Conversely, sarcopenia can impair swallowing, mastication, abdominal pressure generation, pelvic floor function, mobility, bowel function, and nutritional status, creating a bidirectional vicious cycle. This review summarizes the shared pathophysiology linking gastrointestinal diseases and sarcopenia, disease-specific clinical implications in esophageal, gastric, colorectal, inflammatory bowel, constipation-related, and functional gastrointestinal disorders, and practical approaches to assessment and multidisciplinary intervention in older patients in gastroenterology practice.

We report the case of a 70-year-old woman with chronic kidney disease, hyperthyroidism, and Sjögren's syndrome who exhibited a marked discrepancy between creatinine-based and cystatin C-based estimated glomerular filtration rates(eGFRs). A kidney biopsy revealed chronic tubulointerstitial nephritis with lymphoplasmacytic infiltration, and electron microscopy showed focal subendothelial widening without electron-dense deposits. Methimazole improved the thyroid function and reduced discrepancies between eGFR estimates. Proteinuria and tubular injury markers improved after corticosteroid therapy. A correction of dehydration and an improvement in the nutritional status may also have influenced the clinical outcomes. These findings highlight the need to consider thyroid dysfunction when interpreting the renal biomarker levels.

A man in his 70s had a history of immunoglobulin G4 (IgG4)-related lung disease. Abdominal ultrasonography revealed smooth wall thickening with a preserved layered structure in the gallbladder neck. The fundus showed irregular wall thickening and layered structure loss. These findings suggest the existence of two pathological entities within the gallbladder. Malignancy could not be ruled out. A cholecystocolonic fistula developed, and radical cholecystectomy and partial transverse colon resection were performed. A histopathological examination revealed IgG4-related sclerosing cholecystitis (IgG4-CC) of the neck and body and xanthogranulomatous cholecystitis (XGC) of the fundus. The fistula originated from the XGC lesion.

Hepatic cysts are common benign incidental findings, whereas cystic liver metastases are rare findings. We report a case of p16-positive oropharyngeal squamous cell carcinoma in which a hepatic lesion initially presumed to be a benign hepatic cystic lesion was subsequently identified to be cystic metastasis. During surveillance after chemoradiotherapy, the lesion demonstrated progressive enlargement, increasing internal heterogeneity, and subsequent wall thickening, raising suspicion of malignancy. Surgical resection confirmed the diagnosis of metastatic squamous cell carcinoma. This case underscores that cystic liver metastasis may mimic a benign hepatic cystic lesion and thus requires careful longitudinal imaging assessment.

Hemophagocytic lymphohistiocytosis (HLH) is rare in patients with multiple myeloma (MM), and its significance during anti-CD38-based therapy remains unclear. We report the case of a 76-year-old man diagnosed with MM and treated with daratumumab, lenalidomide, and dexamethasone who developed HLH before an aggressive clinical relapse. Autopsy revealed diffuse extramedullary plasma cell infiltration, despite the minimal morphological evidence of hemophagocytosis. This case highlights the fact that HLH during immune-modifying therapy should be recognized as a critical clinical harbinger of rapid disease progression in patients with CLL. The early identification of HLH is vital for detecting imminent disease progression and initiating immediate intervention before massive systemic involvement occurs.

A 96-year-old woman was brought to the emergency department with impaired mobility and generalized edema. She appeared drowsy, and blood glucose testing demonstrated severe hypoglycemia (38 mg/dL). Chest radiography showed an opacity in the right lower lung field, and computed tomography revealed a large intrathoracic mass. Laboratory testing revealed low serum insulin and C-peptide levels, suggesting non-islet cell tumor hypoglycemia. She had previously been diagnosed with a solitary fibrous tumor via a percutaneous biopsy at another hospital. Corticosteroids and glucose supplementation resolved the recurrent hypoglycemia. In patients with hypoglycemic episodes without diabetes and abnormal chest radiographic opacities, Doege-Potter syndrome should be considered.

A 55-year-old man was admitted with a right frontal headache and low-grade fever. The initial neuroimaging and cerebrospinal fluid findings were normal, and giant cell arteritis was suspected. After administering prednisolone therapy, he developed a cerebral infarction and multiple cerebral arterial stenoses. Blood cultures were positive for the Streptococcus anginosus group, and the cerebrospinal fluid findings were consistent with bacterial meningitis. Echocardiography revealed no valvular vegetations. Although antibiotic therapy improved the patient's symptoms, intracerebral hemorrhage developed thereafter. The patient was discharged with residual neurological deficits. This case suggests that Streptococcus anginosus group infections can cause cerebral arteritis.

A 68-year-old long-term welder was referred for the evaluation of a right lower lobe opacity after a fever and cough had resolved. Chest CT revealed a mass-like lesion in the right lower lobe with heterogeneous high-attenuation areas and centrilobular nodular opacities in both upper lobes. A transbronchial biopsy of the mass-like lesion showed hemosiderin deposits with fibrosis and mild inflammation, without any findings strongly suggestive of infection or malignancy. The lesion partially regressed following a reduction in welding fume exposure, suggesting a possible association with chronic occupational exposure and a transient non-specific pulmonary insult.The recognition of occupational exposure and short-term follow-up may help avoid unnecessary invasive procedures in the future.

Differentiation syndrome (DS) is rarely observed before treatment in patients with acute promyelocytic leukemia (APL). A 35-year-old man with high-risk APL and influenza A presented with multiple organ failure (MOF). Initially attributed to influenza, the DS-like symptoms rapidly worsened after the initiation of all-trans retinoic acid. Despite intensive care and continuous hemodialysis, the patient developed a cerebral hemorrhage. Consequently, dose-adjusted arsenic trioxide (ATO; 0.1 mg/kg/day) was administered. He achieved complete remission (CR) on day 28 and maintained molecular CR for 16 months without sequelae. Concurrent infections can mask DS-like symptoms prior to treatment. Reduced-dose ATO is an effective salvage option for patients with APL and severe MOF.

Diphyllobothrium balaenopterae infection is a zoonosis mainly reported in Japan and it is associated with raw fish consumption. The reported cases in Japan show geographical clustering, mainly in the Pacific coastal areas and in western Japan. Reports from the Tohoku region are scarce, resulting in limited clinical awareness of this disease among local practitioners in Japan. A man in his 20s, residing in the Pacific coastal area of the Tohoku region, presented with diarrhea and the anal expulsion of string-like material. He had no notable past medical history but reported frequent consumption of raw juvenile Japanese anchovy 2-3 months prior to onset. Although taeniasis was clinically suspected, a fecal examination for ova was negative, thus complicating the diagnosis. GastrografinⓇ (amidotrizoate meglumine and sodium solution) spraying into the duodenum via endoscopy enabled the recovery of a 2.0-m immature tapeworm. A molecular biological analysis targeting the mitochondrial cox1 gene of the worm confirmed the diagnosis of a Diphyllobothrium balaenopterae infection. No further proglottid discharge or gastrointestinal symptoms occurred during the six-month clinical follow-up. This case highlights the clinical significance of considering D. balaenopterae, even in non-endemic areas, recognizing the limitations of stool ova testing in immature infections, and preserving the worm for molecular identification.