Hiroyuki Nara

Muscular polyarteritis nodosa as a cause of fever of undetermined origin: a case report and review of the literature

We describe an unusual presentation of a localized form of polyarteritis nodosa (PAN) manifested by fever of undetermined origin (FUO). Biopsies of the gastrocnemius muscle revealed necrotizing arteritis and initiation of prednisolone (PSL) brought rapid response. The PAN localized to muscle is rare; furthermore, this disease presented as FUO is very rare. We want to increase awareness that muscle can be also a single-affected site as well as other well known sites such as appendix, gallbladder, uterus or testis, and skin. Since there is no single appellation for this disease, we would like to propose the term “muscular PAN.”

A case of rheumatoid arthritis with protein losing enteropathy induced by multiple diaphragmatic strictures of the small intestine: successful treatment by bougieing under double-balloon enteroscopy

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most favoured for the treatment of rheumatoid arthritis (RA) but they sometimes induce inflammation and ulceration of the gastrointestinal tract.1 Approximately 75% of patients receiving long term NSAIDs develop inflammation in the small intestine that in rare cases results in protein losing enteropathy.2,3 Furthermore, NSAIDs can bring about diaphragmatic strictures in the small intestine as a consequence of ulcer healing. We report here a patient with RA who had multiple diaphragmatic strictures in the small intestine and subsequent protein losing enteropathy, probably due to long term non-steroidal anti-inflammatory drugs use. Her intestinal stricture and protein losing enteropathy, however, were successfully corrected by bougieing under double balloon enteroscopy without resort to surgical resection. A 57 year old …

Kimura’s Disease Presenting as Steroid-Responsive Thromboangiitis Obliterans

A 60-year-old Japanese man presented with severe numbness in the fingers of both hands, which were cold and pale in appearance. He was found to have marked eosinophilia (leukocyte count 18 500 /μL with 58.3% eosinophils) and was admitted immediately to the nearby hospital. Treatment with intravenous methylprednisolone pulse (1 g for 3 days) was initiated, followed by oral prednisone 60 mg daily. Although his blood eosinophilia normalized rapidly, gangrene developed in his fingers (Figure 1). Bone marrow examination showed no blast cell proliferation. Tests for antinuclear and antiphospholipid antibodies, rheumatoid factor, antineutrophil cytoplasmic antibodies, and cryoglobulins were all negative. Protein S and protein C were within the normal range. After prednisone was tapered gradually and discontinued, he was referred to our hospital with a diagnosis of …

Dermatomyositis and cutaneous necrosis: report of five cases.

Abstract We report on five patients with dermatomyositis (DM) and cutaneous necrosis. Patients presented with classic DM skin eruptions, mild myositis, and a high incidence (4/5) of interstitial pneumonia. Cutaneous necrosis developed independently of steroid therapy, with the majority of lesions being cured following several months of sterilization treatment. In addition, one patient with accompanying cancer presented with multiple necrotic lesions. Topical treatment using gentiana violet against local infection was considered to have been essential in accelerating healing.