Hiroyuki Takemura

Necrotizing fasciitis caused by Streptococcus pneumoniae in mixed connective tissue disease

Abstract A 42-year-old man was hospitalized because of chills, fever, and severe polyarthralgia. He had a 5-year history of mixed connective tissue disease (MCTD) with polyarthritis which had been treated with a nonsteroidal anti-inflammatory drug alone. On the second day of hospitalization, necrotizing fasciitis of the right leg developed. Streptococcus pneumoniae was later detected in a blood culture. Pneumococcal infections of the soft tissues are uncommon, and have been reported in immunosuppressed patients and patients with systemic lupus erythematosus. This is the first report of a case of necrotizing fasciitis caused by S. pneumoniae in a patient with MCTD.

An HLA-B27-positive patient diagnosed with ulcerative colitis 15 years after the onset of arthropathy

Abstract A 28-year-old woman had persistent pain of both hip joints since the age of 13 years. X-ray analysis showed destructive changes in both hip joints and ossification of sacroiliitic joints. The patient had mild diarrhea and slight abdominal pain for 8 years. Blood-stained stool was not noticed. Barium enema showed changes consistent with the diagnosis of ulcerative colitis (UC). Inflammatory bowel syndrome should be considered in patients with persistent coxitis, even in the absence of severe abdominal symptoms.

Gelatinous transformation of bone marrow with pancytopenia in an emaciated patient with systemic lupus erythematosus

We report on gelatinous transformation of the bone marrow in a 42-year-old male patient with systemic lupus erythematosus (SLE). Gelatinous transformation of the bone marrow in SLE is rare. This condition is composed of hypocellularity with deposition of hyaluronic acid in the bone marrow and is known to be associated with malnutrition due to cachexia and anorexia nervosa. In this patient we consider that malnutrition caused gelatinous transformation which worsened pancytopenia due to SLE. Pancytopenia improved after methylprednisolone pulse therapy and nutrition therapy.