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Yoshimoto K, Kaneda S, Asada M, Taguchi H, Kawashima H, Yoneima R, Matsuoka H, Tsushima E, Ono S, Matsubara M, Yada N, Nishio K. Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature. Medicina (Kaunas) 2023; 59:2127. [PMID: 38138230 PMCID: PMC10744572 DOI: 10.3390/medicina59122127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/21/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
Giant cell arteritis (GCA) is a chronic vasculitis that primarily affects the elderly, and can cause visual impairment, requiring prompt diagnosis and treatment. The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been substantial. Although vaccination programs have been a key defense strategy, concerns have arisen regarding post-vaccination immune-mediated disorders and related risks. We present a case of GCA after COVID-19 vaccination with 2 years of follow-up. A 69-year-old woman experienced fever, headaches, and local muscle pain two days after receiving the COVID-19 vaccine. Elevated inflammatory markers were observed, and positron emission tomography (PET) revealed abnormal uptake in the major arteries, including the aorta and subclavian and iliac arteries. Temporal artery biopsy confirmed the diagnosis of GCA. Treatment consisted of pulse therapy with methylprednisolone, followed by prednisolone (PSL) and tocilizumab. Immediately after the initiation of treatment, the fever and headaches disappeared, and the inflammation markers normalized. The PSL dosage was gradually reduced, and one year later, a PET scan showed that the inflammation had resolved. After two years, the PSL dosage was reduced to 3 mg. Fourteen reported cases of GCA after COVID-19 vaccination was reviewed to reveal a diverse clinical picture and treatment response. The time from onset of symptoms to GCA diagnosis varied from two weeks to four months, highlighting the challenge of early detection. The effectiveness of treatment varied, but was generally effective similarly to that of conventional GCA. This report emphasizes the need for clinical vigilance and encourages further data collection in post-vaccination GCA cases.
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Affiliation(s)
- Kiyomi Yoshimoto
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Saori Kaneda
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
- Department of General Medicine, Uda City Hospital, Uda 633-0298, Nara, Japan
| | - Moe Asada
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Hiroyuki Taguchi
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Hiromasa Kawashima
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Ryo Yoneima
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Hidetoshi Matsuoka
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Emiko Tsushima
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Shiro Ono
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Masaki Matsubara
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Noritaka Yada
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
- Department of General Medicine, Uda City Hospital, Uda 633-0298, Nara, Japan
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Ono S, Yoshimoto K, Nishimura N, Yoneima R, Kawashima H, Kobayashi T, Tai Y, Miyamoto M, Tsushima E, Yada N, Nishio K. Complete Resolution of a Case of TAFRO Syndrome Accompanied by Mediastinal Panniculitis, Adrenal Lesion, and Liver Damage with Hyperbilirubinemia. Intern Med 2021; 60:1303-1309. [PMID: 33191324 PMCID: PMC8112990 DOI: 10.2169/internalmedicine.5850-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
TAFRO syndrome is a systemic inflammatory, lymphoproliferative disorder, but the pathophysiology of the disease is unknown. It is typically characterized by thrombocytopenia, anasarca, a fever, reticulin fibrosis, renal dysfunction, and organomegaly. However, other manifestations have been also reported. We encountered a 43-year-old man with TAFRO syndrome who showed mediastinal panniculitis, liver damage, and adrenal lesions in addition to the core signs. He achieved complete remission with combination therapy of corticosteroids, tocilizumab, and cyclosporin, and remission was maintained even after drug discontinuation at 15 months. Atypical manifestations and complete remission of TAFRO syndrome were remarkable features of our case.
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Affiliation(s)
- Shiro Ono
- Department of General Medicine, Nara Medical University, Japan
| | | | | | - Ryo Yoneima
- Department of General Medicine, Nara Medical University, Japan
| | | | | | - Yoshiaki Tai
- Department of General Medicine, Nara Medical University, Japan
| | - Makiko Miyamoto
- Department of General Medicine, Nara Medical University, Japan
| | - Emiko Tsushima
- Department of General Medicine, Nara Medical University, Japan
| | - Noritaka Yada
- Department of General Medicine, Nara Medical University, Japan
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University, Japan
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Yada N, Yoshimoto K, Kawashima H, Yoneima R, Nishimura N, Tai Y, Tsushima E, Miyamoto M, Ono S, Matsumoto M, Fujimoto T, Nishio K. Plasma Level of von Willebrand Factor Propeptide at Diagnosis: A Marker of Subsequent Renal Dysfunction in Autoimmune Rheumatic Diseases. Clin Appl Thromb Hemost 2020; 26:1076029620938874. [PMID: 32705883 PMCID: PMC7383728 DOI: 10.1177/1076029620938874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction: Patients with systemic autoimmune rheumatic diseases (SARDs) such as rheumatoid arthritis, systemic lupus erythematosus (SLE), Sjögren syndrome, and systemic sclerosis, which are chronic inflammatory diseases, are prone to develop renal dysfunction, which is related to vascular endothelial cell damage. Material and Methods: We evaluated plasma levels of von Willebrand factor (VWF), VWF propeptide (VWF-pp), disintegrin-like and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), and VWF multimer pattern in patients with SARDs at diagnosis and investigated whether they may serve as markers to identify patients destined to develop renal dysfunction within 1 year. Renal dysfunction was defined as subsequent reduced estimated glomerular filtration rate (eGFR) by >25% or the new appearance of abnormal urine findings such as proteinuria (protein > 30 mg/dL) or hematuria (red blood cells >20/HPF in urine sediments). Overall, 63 patients with SARDs were studied. Results and Conclusions: We observed a significant increase of VWF-pp and a significant decrease of ADAMTS13 in patients with SARDs compared with normal healthy controls. The highest level of VWF-pp was observed in patients with SLE among the groups. The levels of VWF and multimer pattern of VWF were not different compared with normal healthy controls. Von Willebrand factor propeptide predicted a subsequent decrease in eGFR at a cutoff point of 210% (sensitivity, 78.6%; specificity, 73.5%) and new urinary abnormal findings at a cutoff point of 232% (sensitivity, 77.8%; specificity, 77.8%) Using these cutoff points, multivariable analysis revealed that VWF-pp was a significant risk factor for renal dysfunction at an odds ratio of 8.78 and 22.8, respectively, and may lead to a new therapeutic approach to prevent vasculitis and renal dysfunction.
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Affiliation(s)
- Noritaka Yada
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyomi Yoshimoto
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hiromasa Kawashima
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Ryo Yoneima
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Nobushiro Nishimura
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshiaki Tai
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Emiko Tsushima
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Makiko Miyamoto
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Shiro Ono
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Masanori Matsumoto
- Department of Transfusion Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Takashi Fujimoto
- Department of Rheumatology, Nara Medical University, Kashihara, Nara, Japan
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University, Kashihara, Nara, Japan
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Inoue K, Hirao K, Aonuma K, Kimura M, Kumagai K, Miyauchi Y, Tsushima E, Okumra K. P824Modified HAS-BLED, ATRIA bleeding, and ORBIT scores as predictors of bleeding complication of catheter ablation for atrial fibrillation: a sub-analysis of JACRE Registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K. Inoue
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K. Hirao
- Tokyo Medical and Dental University, Heart Rhythm Center, Tokyo, Japan
| | - K. Aonuma
- Tsukuba University Hospital, Cardiovascular Division, Institute of Clinical Medicine, Faculty of Medicine, Tsukuba, Japan
| | - M. Kimura
- Hirosaki University Graduate School of Medicine, Division of Cardiology, Hirosaki, Japan
| | - K. Kumagai
- Fukuoka Sanno Hospital, Heart Rhythm Center, Fukuoka, Japan
| | - Y. Miyauchi
- Nippon Medical School of Chiba, Department of Cardiovascular Medicine Chiba Hokusou Hospital, Chiba, Japan
| | - E. Tsushima
- Hirosaki University, Graduate School of Health Science, Hirosaki, Japan
| | - K. Okumra
- Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan
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Sato Y, Ogasawara K, Narumi S, Sasaki M, Saito A, Tsushima E, Namba T, Kobayashi M, Yoshida K, Terayama Y, Ogawa A. Optimal MR Plaque Imaging for Cervical Carotid Artery Stenosis in Predicting the Development of Microembolic Signals during Exposure of Carotid Arteries in Endarterectomy: Comparison of 4 T1-Weighted Imaging Techniques. AJNR Am J Neuroradiol 2016; 37:1146-54. [PMID: 26846926 DOI: 10.3174/ajnr.a4674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative identification of plaque vulnerability may allow improved risk stratification for patients considered for carotid endarterectomy. The present study aimed to determine which plaque imaging technique, cardiac-gated black-blood fast spin-echo, magnetization-prepared rapid acquisition of gradient echo, source image of 3D time-of-flight MR angiography, or noncardiac-gated spin-echo, most accurately predicts development of microembolic signals during exposure of carotid arteries in carotid endarterectomy. MATERIALS AND METHODS Eighty patients with ICA stenosis (≥70%) underwent the 4 sequences of preoperative MR plaque imaging of the affected carotid bifurcation and then carotid endarterectomy under transcranial Doppler monitoring of microembolic signals in the ipsilateral middle cerebral artery. The contrast ratio of the carotid plaque was calculated by dividing plaque signal intensity by sternocleidomastoid muscle signal intensity. RESULTS Microembolic signals during exposure of carotid arteries were detected in 23 patients (29%), 3 of whom developed new neurologic deficits postoperatively. Those deficits remained at 24 hours after surgery in only 1 patient. The area under the receiver operating characteristic curve to discriminate between the presence and absence of microembolic signals during exposure of the carotid arteries was significantly greater with nongated spin-echo than with black-blood fast spin-echo (difference between areas, 0.258; P < .0001), MPRAGE (difference between areas, 0.106; P = .0023), or source image of 3D time-of-flight MR angiography (difference between areas, 0.128; P = .0010). Negative binomial regression showed that in the 23 patients with microembolic signals, the contrast ratio was associated with the number of microembolic signals only in nongated spin-echo (risk ratio, 1.36; 95% confidence interval, 1.01-1.97; P < .001). CONCLUSIONS Nongated spin-echo may predict the development of microembolic signals during exposure of the carotid arteries in carotid endarterectomy more accurately than other MR plaque imaging techniques.
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Affiliation(s)
- Y Sato
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Ogasawara
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - S Narumi
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - M Sasaki
- Division of Ultra-High Field MRI and Department of Radiology (M.S.), Iwate Medical University School of Medicine, Morioka, Japan
| | - A Saito
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - E Tsushima
- Graduate School of Health Sciences (E.T.), Hirosaki University, Hirosaki, Japan
| | - T Namba
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - M Kobayashi
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Yoshida
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - Y Terayama
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - A Ogawa
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
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Hirooka R, Ogasawara K, Inoue T, Fujiwara S, Sasaki M, Chida K, Ishigaki D, Kobayashi M, Nishimoto H, Otawara Y, Tsushima E, Ogawa A. Simple assessment of cerebral hemodynamics using single-slab 3D time-of-flight MR angiography in patients with cervical internal carotid artery steno-occlusive diseases: comparison with quantitative perfusion single-photon emission CT. AJNR Am J Neuroradiol 2008; 30:559-63. [PMID: 19039042 DOI: 10.3174/ajnr.a1389] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Visualization of the peripheral arteries on single-slab 3D time-of-flight (TOF) MR angiography (MRA) can reflect blood flow velocity. The velocity in the middle cerebral artery (MCA) may correlate with cerebrovascular reactivity (CVR) to acetazolamide, which can be used to assess hemodynamic impairment. The goal of this study was to compare the signal intensity of the MCA on MRA versus CVR quantified by perfusion single-photon emission CT (SPECT). MATERIALS AND METHODS The signal intensity of the MCA on single-slab 3D time-of-flight MRA was graded according to the ability to visualize the MCA in 108 cerebral hemispheres of 87 patients with unilateral or bilateral cervical internal carotid artery (ICA) steno-occlusive diseases. SPECT-CVR was also calculated by measuring cerebral blood flow before and after acetazolamide challenge. Ten healthy subjects were studied to obtain control SPECT-CVR values. All subjects provided written informed consent before the study. RESULTS CVR was significantly lower in cerebral hemispheres with reduced MCA signal intensity than in those with normal intensity (P < .05). When the reduced signal intensity of the MCA on MRA was defined as abnormal, and when a CVR less than the mean--2 SD of healthy subjects was defined as reduced, MRA grading resulted in a 86.2% sensitivity and 69.6% specificity, with 51.0% positive-predictive and 93.2% negative-predictive values to detect reduced CVR. CONCLUSIONS This simple MRA method can assess hemodynamic impairment with a high negative-predictive value.
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Affiliation(s)
- R Hirooka
- Advanced Medical Research Center, Iwate Medical University, Hirosaki University, Japan
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Fukuda S, Saito H, Nakaji S, Yamada M, Ebine N, Tsushima E, Oka E, Kumeta K, Tsukamoto T, Tokunaga S. Pattern of dietary fiber intake among the Japanese general population. Eur J Clin Nutr 2006; 61:99-103. [PMID: 16885928 DOI: 10.1038/sj.ejcn.1602505] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the dietary fiber (DF) intake pattern among the Japanese general population. DESIGN We performed a dietary survey among the general population in northern Japan to evaluate the intake patterns. DF intake was calculated by substituting the DF content of each food in the Dietary Fiber Table for the intake of each food from this dietary survey. SUBJECTS Five hundred and seventy-seven subjects participated in the study, 198 men and 379 women. RESULTS In subjects with higher DF intakes the origins of the DF that were from all food groups, but with the notable exception of rice. The contribution of the seaweed group was of particular interest. From multiple regression analysis, as for food group, seaweeds showed the highest positive correlation with DF intake in both genders, followed by vegetables, pulses, fruits. On the other hand, rice showed the negative correlation with DF intake in both genders. As for life factor, body mass index showed the negative correlation with DF intake in women. CONCLUSION Seaweed, a typical Japanese food, was most related to the increase in DF intake for the Japanese general population, whereas rice, the Japanese staple, had a small influence on decreased DF intake.
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Affiliation(s)
- S Fukuda
- First Department of Internal Medicine, Hirosaki University School of Medicine, Aomori, Japan
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