Takeshi Kamimura

Characterization of chemokine receptor expression and cytokine production in circulating CD4+ T cells from patients with atopic dermatitis: up-regulation of C-C chemokine receptor 4 in atopic dermatitis.

Background Th2 and Th1 cells have been suggested to express CCR3/CCR4 and CCR5/CXCR3, respectively.

Acute acalculous cholecystitis in systemic lupus erythematosus: a case report and review of the literature

A 27-year-old woman with systemic lupus erythematosus (SLE) was found to have acute acalculous cholecystitis. At the time of admission, the patient was not under corticosteroid or immunosuppressive therapy. Computed tomography (CT) and ultrasonography revealed findings in the gall bladder consistent with acute acalculous cholecystitis. Her abdominal pain completely disappeared following corticosteroid therapy, with dramatic improvement in the images of CT and ultrasonography. Six similar cases of SLE complicated with acute acalculous cholecystitis have been reported in the literature and they were all treated surgically by cholecystectomy or cholecystostomy. This is the first case report in which acute acalculous cholecystitis accompanying SLE was treated successfully by corticosteroid without surgical intervention.

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 …

Protein-losing gastroenteropathy associated with primary Sjögren's syndrome: a characteristic oriental variant.

Protein-losing gastroenteropathy (PLGE) is a rare manifestation of primary Sjögren’s syndrome (SS). We report a case of a 41-year-old Japanese man, who is the first male patient, with PLGE associated with primary SS. Although serum anti-SSA and SSB antibodies were detected, he had no subjective sicca symptoms. He had multiple annular erythema: a characteristic skin manifestation of Asian SS patients. A diagnosis of PLGE was made from results of 99mTc-labelled albumin scintigraphy and a faecal alpha-1-antitrypsin clearance test. Intravenous administration of high-dose glucocorticoid was not effective, but pulse methylprednisolone therapy alleviated disease manifestations. As all cases of PLGE associated with primary SS have been reported from East Asia, this complication could be essentially limited to Asian patients.

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 …

Urinary β2-microglobulin as a sensitive marker for haemophagocytic syndrome associated with collagen vascular diseases

activation, as well as the release of MMPs. ET-1 may lead to NFB stimulation and may subsequently stimulate the production of pro-inflammatory cytokines like IL-6, IL-8 and TNF[10]. The use of an oral ET dual receptor antagonist in our patient led to a rapid remission of ischaemia. This fast and sustained response had probably been achieved by potent vasodilatation. The reversal of the obstructive vasculitis documented by MRA might also at least partially be related to bosentan. The blockade of ET might have caused a down-regulation of pro-inflammatory cytokines and cells by a mechanism mentioned earlier. Corticosteroids were already terminated 4 weeks after the start of the bosentan therapy. Now, 9 months later, there is no evidence of reoccurrence of vasculitis. Bosentan might, therefore, be responsible for sustained remission. This could be interpreted as further piece of evidence of its anti-inflammatory potential in this case. In conclusion, we think that bosentan, in this individual patient, exhibited compelling vasodilatatory and anti-inflammatory effects leading to a rapid and sustained clinical improvement of the ischaemia, probably achieved by antagonization of endothelin. Bosentan might, for this reason, be regarded as therapeutic alternative in ischaemic complications caused by vasculitic syndromes resistant to standard treatment regimes.

Massive intractable pericardial effusion in a patient with systemic lupus erythematosus treated successfully with pericardial fenestration alone

Systemic lupus erythematosus (SLE) is often complicated by pericarditis with effusion, which generally responds well to glucocorticoid. We report herein a Japanese patient with SLE who showed a sign of cardiac tamponade and severe chest and back pain because of massive intractable pericardial effusion. Pulse glucocorticoid and pulse cyclophosphamide gained marginal effects. Pericardial effusion accumulated again soon after ultrasound-guided pericardiocentesis and drainage. Pericardial fenestration performed surgically as a last resort, for draining pericardial fluid into the pleural space, was very effective, and only a much smaller amount of fluid was observed in the space thereafter in comparison with the volume before the surgery. Pathological examination of the retrieved pericardium unfolded intense hyperplasia of small vessels and capillaries. Levels of IL-6 and TNF-α in pericardial effusion were extremely higher than those in serum. Pericardial effusion with extensive capillary hyperplasia in SLE would be resistant to medical treatment and require surgical fenestration.

Resolution of anti-neutrophil cytoplasmic antibody-associated vasculitis after resection of gastric cancer.

We report a case of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis in a 62-year-old patient with gastric cancer. The myeloperoxidase–anti-neutrophil cytoplasmic antibody (MPO–ANCA) level was threefold above normal preoperatively. Vasculitis was seen on renal biopsy. Gastric resection revealed well-differentiated adenocarcinoma and vasculitis. The MPO–ANCA level returned to normal post-operatively. Although ANCA-associated vasculitis occasionally accompanies malignant tumors, this is the first documented case of concurrent gastric cancer-associated and ANCA-associated vasculitis, with post-operative resolution of the vasculitis.

Kikuchi’s disease involving the supraclavicular lymph nodes and associated with transient eruption

A 26-year-old woman presented with high fever, marked supraclavicular lymphadenopathy, and morbilliform eruptions and was diagnosed with Kikuchi’s disease (KD) based on pathologic findings from biopsied lymph nodes. All her manifestations of KD improved, however, without any specific treatment. The picture of transient morbilliform eruptions typified in KD here is seldom shown in the literature. In general, KD would run a benign course of supraclavicular lymphadenopathy.