Eosinophilic gastroenteritis (EGE) is a rare inflammatory disorder characterized by eosinophilic infiltration of the gastrointestinal tract and its associated symptoms. We report a case of EGE in a patient with idiopathic multicentric Castleman disease and asthma, who developed gastrointestinal symptoms and eosinophilia during tocilizumab therapy. Endoscopy revealed marked gastric mucosal injury and biopsy confirmed eosinophilic infiltration. Despite normal intestinal endoscopic findings, the biopsy specimens revealed eosinophilic infiltration. The discontinuation of tocilizumab and initiation of prednisolone resulted in complete symptom resolution, suggesting that the onset of EGE may have been associated with tocilizumab treatment.

We herein report a rare case of nintedanib-induced glomerular microangiopathy (GMA) in a 77-year-old woman with idiopathic pulmonary fibrosis. The patient developed nephrotic-range proteinuria (5.9 g/gCr) after 29 months of nintedanib therapy. A kidney biopsy confirmed GMA, which was characterized by endothelial injury without immune complex deposition. The discontinuation of nintedanib led to a significant reduction in proteinuria. This case demonstrates that nintedanib-induced GMA can manifest after long-term use. Given the potential for a global underdiagnosis, regular urinalysis testing is therefore essential for the early detection of irreversible renal damage, particularly in elderly patients.

Immune checkpoint inhibitors (ICIs) improve survival in advanced melanoma, but they may accelerate atherosclerosis, particularly in patients with immune-related adverse events (irAEs). A 64-year-old man with stage IV BRAF-wild-type primary thoracic melanoma achieved complete remission after nivolumab plus ipilimumab, but he later developed grade 3 immune-related hepatitis, requiring treatment discontinuation. Three and a half years later, symptomatic peripheral artery disease required revascularization, followed by severe coronary artery disease requiring percutaneous coronary intervention one year later. This case suggests that severe irAEs may be associated with accelerated systemic atherosclerosis, highlighting the importance of long-term cardiovascular surveillance following ICI therapy.

Dedifferentiated chondrosarcoma (DDCS) rarely presents with pleural dissemination or malignant pleural effusion. A 62-year-old man developed massive left pleural effusion with diffuse calcified pleural thickening and nodular lesions. Pleural fluid cell block immunohistochemistry showed cytokeratin AE1/AE3 negativity and SATB2 positivity, suggesting a mesenchymal tumor. Pelvic imaging suggested a chondroid matrix, while a biopsy revealed a high-grade osteoid-producing component with an IDH1 p.R132C mutation. Integrated pleural fluid, imaging, histopathological, and molecular findings supported the diagnosis of DDCS. An institutional review provided descriptive context but could not estimate the DDCS-specific frequency. This case highlights an uncommon pleural presentation and the adjunctive value of a pleural fluid cell block analysis.

Background Obesity is associated with musculoskeletal disorders, impaired mobility, and frailty. While semaglutide induces substantial weight loss, its effects on objectively measured physical function in routine clinical practice are unclear. We investigated the changes in gait speed and physical function during a multidisciplinary obesity management program that included semaglutide.Methods This retrospective observational study included 22 adults with obesity and musculoskeletal disorders who completed a 12-month multidisciplinary obesity management program. The program included nutritional counseling every two months, physical therapist-guided exercise intervention, and semaglutide treatment. The primary outcome was the usual gait speed. The secondary outcomes included body weight, pain score, step count, muscle function, and body composition.Results Body weight decreased significantly from 89.2±18.6 kg to 81.5±17.3 kg (p<0.001). Usual gait speed improved significantly from 0.77±0.20 m/s to 0.91±0.19 m/s (p<0.001). Pain scores also significantly improved (p<0.001). Improvements in gait speed were not associated with weight loss (r=0.22, p=0.32) or pain reduction (r=-0.04, p=0.84). Baseline gait speed was inversely associated with gait speed improvement (r=-0.44, p=0.043), indicating greater gains in participants with poorer baseline mobility.Conclusions A 12-month multidisciplinary obesity management program, including semaglutide, significantly improved gait speed in patients with obesity and musculoskeletal disorders. Greater improvements were observed in participants with impaired baseline mobility. These findings support the evaluation of obesity treatment not only by weight loss, but also by recovery of mobility.

UBTF tandem duplication (UBTF-TD) is a recently identified genetic abnormality in acute myeloid leukemia (AML) that is associated with a poor prognosis. We report a case of an adult patient with UBTF-TD AML who was refractory to daunorubicin and cytarabine but achieved complete hematological remission following venetoclax and azacitidine (VEN/AZA) therapy. A comparison of the complementary DNA and genomic DNA sequences of UBTF-TD revealed a 60-bp insertion associated with aberrant splicing and partial retention of intron 13. This case provides additional evidence supporting VEN/AZA as a potential therapeutic strategy for UBTF-TD AML and suggests a previously unrecognized association between UBTF-TD and aberrant splicing.

Objective To examine the association between atrial fibrillation (AF) and reflux esophagitis (RE).Methods A total of 5,205 adults (3,262 men, 1,943 women; mean age, 54.9±9.8 years) who underwent esophagogastroduodenoscopy (EGD) as part of a routine health checkup were enrolled in this study. AF was defined as AF detected on electrocardiography during the checkup and/or a documented history of the condition. RE was assessed endoscopically according to the Los Angeles classification. The smoking history, habitual alcohol consumption, and use of acid-suppressive agents were also assessed.Results AF was observed in 36 participants (0.7%). Compared with those without AF, participants with AF were more likely to be male, older, have a higher body mass index, and have a history of smoking and acid-suppressive agent use. After excluding participants receiving acid-suppressive medications, RE was significantly more prevalent in patients with AF than in those without AF (39.1% vs. 22.0%, p=0.049). The prevalence of AF was 0.9% among patients with RE and 0.4% among those without RE. However, multiple logistic regression analysis indicated that RE was not independently associated with AF after adjusting for sex, age, and other clinical factors.Conclusion AF may be associated with RE in individuals undergoing routine health checkups. However, this association was attenuated after adjustment for sex, age, and other clinical factors, suggesting that it may be largely explained by shared confounding factors.

Introduction Influenza remains a huge issue, but its prognosis and clinical characteristics are still unclear. This study aimed to clarify the clinical differences between adults hospitalized with influenza between survivors and nonsurvivors.Methods Clinical data of patients who were severely ill with influenza and required hospitalization were gathered and analyzed between September 2019 and August 2025 (six influenza seasons) using an internet surveillance system; patients who did not survive were excluded.Results Of the 490 patients with severe influenza, 32 (6.53%) did not survive and were older than the surviving patients. In the non-surviving patients, very few or none had been vaccinated against influenza or pneumococcal infections. The non-surviving patients had more pure viral pneumonia and more received mechanical ventilation. The male-to-female ratio, underlying diseases, virus type, and use of antibiotics were similar between survivors and non-survivors.Conclusions Non-surviving patients were older and developed more severe respiratory failure due to pure viral pneumonia than surviving patients. Very low vaccination rates for influenza and pneumococcus might be suggested in hospitalized adults with severe influenza.

Neuromyelitis optica spectrum disorder (NMOSD) rarely presents with corticalleptomeningeal involvement. A 47-year-old woman with aquaporin-4 immunoglobulin G (AQP4-IgG)-positive NMOSD developed acute headache, seizures, motor aphasia, and worsening right arm weakness. Brain magnetic resonance imaging revealed a tumefactive-appearing left frontal cortical-subcortical lesion with leptomeningeal enhancement. The clinical and radiological abnormalities improved after immunotherapy. This case illustrates a rare cerebral manifestation of AQP4-IgG-positive NMOSD with cortical-leptomeningeal involvement, seizures, and a tumefactive lesion.

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is associated with high mortality and diagnostic difficulties. We report a fatal case of CAPA with a distinctive cobblestone-like tracheobronchial appearance observed during bronchoscopy. A patient receiving maintenance hemodialysis for chronic kidney disease was admitted with severe COVID-19. Bronchoscopy revealed multiple white tracheobronchial plaques, suggestive of an invasive Aspergillus infection. Despite antifungal therapy, respiratory failure progressed, and repeat bronchoscopy revealed worsening cobblestone-like lesions. The patient died despite receiving intensive treatment. Autopsy confirmed Aspergillus hyphal invasion, corresponding to the bronchoscopic findings, highlighting a rare but diagnostically important airway manifestation of CAPA.

We report two cases of leptomeningeal carcinomatosis (LMC) associated with EGFR exon 19 deletion lung adenocarcinoma, in which the "bloomy rind sign" on magnetic resonance imaging (MRI) provided supportive radiological evidence. In Case 1, the progression of MRI findings paralleled rising cerebrospinal fluid (CSF) carcinoembryonic antigen levels, exceeding serum concentrations despite persistently negative cytology. In Case 2, the sign appeared with recurrent intracranial hypertension and positive CSF cytology results. Despite treatment, both patients deteriorated in their condition. These cases suggest that the bloomy rind sign may raise suspicion of LMC despite unrevealing cytology; in Case 1, serial CSF CEA changes paralleled the clinical course of the patient.

Background Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that affects motor neurons. Bullous pemphigoid (BP) is an autoimmune blistering disease associated with autoantibodies against BP180 and BP230. Previous studies have suggested an increased incidence of BP in patients with ALS. However, the neurological status and disease severity of patients with ALS at the time of BP onset remain insufficiently characterized. This study aimed to investigate the frequency and clinical characteristics of BP in patients with ALS.Methods In this retrospective study, we reviewed the medical records of 1,067 patients with ALS who were admitted to our institution between April 2010 and May 2025. Patients who developed BP after the onset of ALS were identified. BP was diagnosed by dermatologists based on clinical findings and, when available, by immunological or histopathological examinations. Disease severity at BP onset was assessed based on the ambulatory status and ventilatory support requirements.Results Seven of the 1,067 patients (0.66%) developed BP after ALS onset. The median interval between ALS and BP onset was 8.0 years (IQR 5.0-16.5). At BP onset, four patients (57.1%) were bedridden, four (57.1%) required tracheostomy and invasive ventilation, and two (28.6%) required non-invasive ventilation. Five patients (71.4%) required enteral feeding. The median age at BP onset was 68.0 years (IQR, 64.0-72.5). BP180 antibody testing was positive in three of the six patients. The lesions most commonly involved both the extremities and the trunk.Conclusion BP may occur more frequently in ALS patients than in the general population. Clinicians should consider BP when evaluating cutaneous lesions in patients with ALS.

Satralizumab is an anti-interleukin-6 receptor biologic that may mask bacterial infections. We report two patients with neuromyelitis optica spectrum disorder who developed afebrile bacterial infections with normal C-reactive protein levels during satralizumab treatment. During non-infectious periods under satralizumab treatment, the neutrophil count and neutrophil-to-lymphocyte ratio decreased, whereas the neutrophil change ratio, defined as the ratio of present to previous neutrophil counts, did not. At the time of infection, these variables were elevated compared to the intra-individual confidence intervals during non-infectious periods. These cases indicate the utility of neutrophil-related parameters in diagnosing bacterial infections during satralizumab treatment.