A 73-year-old woman with anorectal malignant melanoma developed bilateral panuveitis with VKH-like fundus changes during nivolumab therapy. The patient was positive for HLA-DR4 and showed ocular findings mimicking Vogt-Koyanagi-Harada disease. Ocular inflammation improved with local corticosteroid therapy, including topical corticosteroid drops and sub-Tenon's triamcinolone injection, without systemic immunosuppression, although recurrence occurred after self-discontinuation of the topical treatment. Nivolumab was continued for more than 5 years, with sustained tumor control and preserved visual acuity under ongoing ophthalmological treatment. This case highlights the importance of early recognition and multidisciplinary management of ocular irAEs during immune checkpoint inhibitor therapy.
Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome is a rare overlap syndrome between Behçet's disease and relapsing polychondritis. We report the case of a 39-year-old woman with severe diffuse central airway stenosis and recurrent restenosis despite repeated bronchoscopic dilations and corticosteroid therapy. Bronchoscopy revealed extensive fibrotic airway stenosis with minimal active inflammation, suggesting irreversible airway remodeling. A silicone Dumon Y stent was placed using rigid bronchoscopy, which markedly improved the respiratory symptoms, pulmonary function, and airway patency. The stent was successfully removed after 6 months, without complications. Airway stenting may therefore be effective for severe fibrotic airway stenosis associated with suspected MAGIC syndrome.
Neuromyelitis optica spectrum disorder (NMOSD) can cause extensive brain lesions and severe deficits. A 53-year-old man with aquaporin-4 immunoglobulin G (AQP4-IgG) -positive NMOSD developed rapidly progressive hemiparesis, extensive bilateral cerebral lesions, and impaired communication. Despite intravenous methylprednisolone, his condition worsened, with an Expanded Disability Status Scale (EDSS) score of 9.5. Following plasma exchange and intravenous immunoglobulin, with rituximab introduced for relapse prevention, he gradually regained the ability to walk with a unilateral cane (EDSS 6.0). NMOSD and serum AQP4-IgG testing should be considered in patients with extensive tumefactive cerebral lesions, even without optic neuritis or myelitis.
Objective Accurate assessment of Helicobacter pylori infection status is important for gastric cancer screening. Although current infection can be reliably detected using the stool antigen test (SAT) or urea breath test, distinguishing previously infected individuals from those who have never been infected using noninvasive serological markers remains challenging. This study evaluated the performance of logistic regression (LR) and a neural network (NN) in distinguishing between these two groups.Methods Data from 1,872 participants (1,101 never infected, 39 currently infected, and 732 previously infected) were analyzed. The infection status was determined based on the eradication history, endoscopic findings, and SAT results. For the primary analysis, participants who were currently infected were excluded. Birth year, sex, serum H. pylori antibody level, pepsinogen (PG) I, PG II, and PG I/II ratio were used as the predictors. The classification performance was evaluated using 5-fold cross-validation.Results The LR and NN models showed numerically similar performance, with area under the curve values of 0.85±0.02 and 0.88±0.01 (mean ± standard deviation), respectively. At a probability cutoff of 0.5, the recall for previously infected individuals was 66.8% ±3.6% for LR and 70.7% ±5.0% for NN. Lowering the cutoff to 0.4 improved the recall. At this cutoff, the recall for never-infected and previously infected individuals was 79.6% ±3.7% and 74.5% ±1.8% for LR, and 82.1% ±3.2% and 76.7% ±4.0% for NN, respectively.Conclusion NN and LR models using noninvasive clinical data showed numerically similar performance in distinguishing previously infected from never-infected individuals.
A 62-year-old man with upper gastrointestinal bleeding was diagnosed with monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) based on a duodenal tumor biopsy. After two cycles of SMILE therapy, the patient developed a small bowel obstruction requiring duodenojejunostomy. He achieved complete remission after two additional cycles and underwent autologous stem cell transplantation (ASCT). The patient with MEITL remained in complete remission for 17 months after transplantation until he developed acute myeloid leukemia and died. Standard care for MEITL has not yet been established, and its overall prognosis is extremely poor. ASCT after SMILE may be a promising treatment strategy for this rare and highly aggressive lymphoma.
