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Drug-induced sarcoidosis-like reaction three months after BNT162b2 mRNA COVID-19 vaccination:A case report and review of literature

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World Journal of Clinical Cases 2023年第1期11卷 177-186页

作者： Soo Ryang Kim Soo Ki Kim Takako Fujii Hisato Kobayashi Toyokazu Okuda Takanobu Hayakumo Atsushi Nakai Yumi Fujii Ryuji Suzuki Noriko Sasase Aya Otani Yu-ichiro Koma Motoko Sasaki Tsutomu Kumabe Osamu Nakashima Department of Gastroenterology Kobe Asahi HospitalKobe 6530801HyogoJapan Department of Radiology Kobe Asahi HospitalKobe 6530801HyogoJapan Department of Clinical Laboratory Kobe Asahi HospitalKobe 6530801HyogoJapan Department of Pharmacy Kobe Asahi HospitalKobe 6530801HyogoJapan Division of Pathology Department of PathologyKobe University Graduate School of MedicineKobe 6530801HyogoJapan Department of Human Pathology Kanazawa University Graduate School of MedicineKanazawa 9208640IshikawaJapan Department of Gastroenterology Kumabe ClinicKumamoto 8611331KumamotoJapan Laboratory Services Center St.Mary's HospitalKurume 830-8543FukuokaJapan

BACKGROUND A 70-year-old man with hepatitis C virus-related recurrent hepatocellular carcinoma was admitted for further diagnosis of a 1 cm iso-hyperechoic nodule in segment(S)5.CASE SUMMARY Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(EOB-MRI)revealed the nodule in S5 with a defect at the hepatobiliary phase,hyperintensity on diffusion weighted imaging(DWI)and hypointensity on apparent diffusion coefficient(ADC)map.Contrast-enhanced computed tomography revealed hypervascularity at the early phase,and delayed contrast-enhancement was observed at the late phase.Contrast-enhanced ultrasound(US)revealed incomplete defect at the late vascular phase.Inflammatory liver tumor,lymphoproliferative disease,intrahepatic cholangiocarcinoma(small duct type)and bile duct adenoma were suspected through the imaging studies.US guided biopsy,however,showed a noncaseating hepatic sarcoid-like epithelioid granuloma(HSEG),and histopathological analysis disclosed spindle shaped epithelioid cells harboring Langhans-type multinucleated giant cells.One month after admission,EOB-MRI signaled the disappearance of the defect at the hepatobiliary phase,of hyperintensity on DWI,of hypointensity on ADC map,and no stain at the early phase.CONCLUSION That the patient had received BNT162b2 messenger RNA(mRNA)coronavirus disease 2019 vaccination 3 mo before the occurrence of HSEG,and that its disappearance was confirmed 4 mo after mRNA vaccination suggested that the drug-induced sarcoidosis-like reaction(DISR)might be induced by the mRNA vaccination.Fortunately,rechallenge of drug-induced DISR with the third mRNA vaccination was not confirmed.

关键词： Drug-induced sarcoidosis-like reaction BNT162b2 mRNA COVID-19 vaccine Noncaseating granuloma Ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging Th1/Th2 profile Case report

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Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy

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World Journal of Gastroenterology 2017年第11期23卷 2060-2067页

作者： Fumiaki Kawara Tsuyoshi Fujita Yoshinori Morita Atsushi Uda Atsuhiro Masuda Masaya Saito Makoto Ooi Tsukasa Ishida Yasuyuki Kondo Shiei Yoshida Tatsuya Okuno Yoshihiko Yano Masaru Yoshida Hiromu Kutsumi Takanobu Hayakumo Kazuhiko Yamashita Takeshi Hirano Midori Hirai Takeshi Azuma Division of Gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Department of Pharmacy Kobe University Hospital

AIM To elucidate the factors associated with residual gastroesophageal reflux disease(GERD) symptoms in patients receiving proton pump inhibitor(PPI) maintenance therapy in clinical practice.METHODS The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD(FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale(GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were analyzed.RESULTS The FSSG scores ranged from 1 to 28 points(median score: 7.5 points), and 19 patients(48.7%) had a score of 8 points or more. The patients' GSRS scores were significantly correlated with their FSSG scores(correlation coefficient = 0.47, P < 0.005). In erosive esophagitis patients, the FSSG scores of the CYP2C19 rapid metabolizers(RMs) were significantly higher than the scores of the poor metabolizers and intermediate metabolizers(total scores: 16.7 ± 8.6 vs 7.8 ± 5.4, P < 0.05; acid reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P < 0.005). In contrast, the FSSG scores of the CYP2C19 RMs in the non-erosive reflux disease patients were significantly lower than those of the other patients(total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01). CONCLUSION Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms.

关键词： Gastroesophageal reflux disease CYP2C19 FSSG Residual symptoms Proton pump inhibitor

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Distant metastasis of hepatocellular carcinoma to Meckel’s cave and cranial nerves:A case report and review of literature

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World Journal of Hepatology 2021年第6期13卷 709-716页

作者： Soo Ki Kim Takako Fujii Ryouhei Komaki Hisato Kobayashi Toyokazu Okuda Yumi Fujii Takanobu Hayakumo Kanako Yuasa Masahiro Takami Aya Ohtani Yuka Saijo Yu-Ichiro Koma Soo Ryang Kim Department of Gastroenterology Kobe Asahi HospitalKobe 653-0801HyogoJapan Division of Neurology Kobe University Graduate School of MedicineKobe 650-0017HyogoJapan Department of Radiology Kobe Asahi HospitalKobe 653-0801HyogoJapan Department of Pharmacy Kobe Asahi HospitalKobe 653-0801HyogoJapan Department of Pathology Kobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less common metastatic site.CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus,Meckel’s cave,and the petrous bone involving multiple cranial nerves in an 82-year-old woman.At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(MRI)revealed multiple HCC nodules in both right and left lobes.Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC.Molecular targeted therapy with Lenvatinib(8 mg/d for 94 d,per os)and Ramucirumab(340 mg/d and 320 mg/d,two times by intravenous injection)were administered for 4 mo,resulting in progression of the disease.Three months after the start of molecular target therapy,the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye,indicating disturbances in the right trigeminal and abducens nerves.Brain MRI disclosed a mass involving the cavernous sinus,Meckel’s cave and the petrous bone.Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus,Meckel’s cave,and the petrous bone was made based on neurological findings and imaging studies including MRI,but not on histological examinations.Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.

关键词： Meckel’s cave Abducens nerve Trigeminal nerve Hepatocellular carcinoma Magnetic resonance imaging Case report

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