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Ariga H, Nakashima M, Mikada A, Hashimoto E, Kashimura J. A Case of Atypical Familial Mediterranean Fever With Pseudopolyposis-Like Mucosal Changes in the Ileum. Cureus 2024; 16:e57566. [PMID: 38586232 PMCID: PMC10995751 DOI: 10.7759/cureus.57566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/09/2024] Open
Abstract
A 15-year-old male patient presented with recurrent fever. Three months prior, he experienced repeated fevers of 38°C, headaches, and malaise for three days. He experienced repeated fevers over 38°C for >72 hours two weeks prior to the current visit. A computed tomography scan showed enlarged lymph nodes around the ileum, suggesting familial Mediterranean fever (FMF) or inflammatory bowel disease. Endoscopic examination revealed a deformed Bauhin valve and inflammatory changes in the ileum, making inflammatory bowel disease unlikely. Thus, FMF was suspected, and after a thorough explanation, the patient was treated with colchicine, and his symptoms improved. Genetic testing revealed a mutation in the MEFV gene P369S-R408Q, and atypical FMF was diagnosed.
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Affiliation(s)
- Hiroyuki Ariga
- Department of Gastroenterology, Mito Kyodo General Hospital, Mito, JPN
| | - Maaya Nakashima
- Department of General Medicine, Mito Kyodo General Hospital, Mito, JPN
| | - Akiko Mikada
- Department of General Medicine, Mito Kyodo General Hospital, Mito, JPN
| | - Etaro Hashimoto
- Department of Family Medicine, Mito Kyodo General Hospital, Mito, JPN
| | - Junya Kashimura
- Department of Gastroenterology, Mito Kyodo General Hospital, Mito, JPN
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Hojo K, Furuta T, Komaki S, Yoshikane Y, Kikuchi J, Nakamura H, Ide M, Shima S, Hiyoshi Y, Araki J, Tanaka S, Ozono S, Yoshida A, Nobusawa S, Morioka M, Nishikomori R. Systemic inflammation caused by an intracranial mesenchymal tumor with a
EWSR1
::
CREM
fusion presenting associated with
IL
‐6/
STAT3
signaling. Neuropathology 2022. [DOI: 10.1111/neup.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Keishiro Hojo
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Takuya Furuta
- Department of Pathology Kurume University School of Medicine Kurume Japan
| | - Satoru Komaki
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Yukako Yoshikane
- Department of Pediatrics Fukuoka University Chikushi Hospital Chikushino Japan
| | - Jin Kikuchi
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Hideo Nakamura
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Mizuki Ide
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Saho Shima
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Yusuke Hiyoshi
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Junichiro Araki
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Seiji Tanaka
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Shuichi Ozono
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
| | - Akihiko Yoshida
- Rare Cancer Center National Cancer Center Hospital Tokyo Japan
- Department of Diagnostic Pathology National Cancer Center Hospital Tokyo Japan
| | - Sumihito Nobusawa
- Department of Human Pathology Gunma University Graduate School of Medicine Maebashi Japan
| | - Motohiro Morioka
- Department of Neurosurgery Kurume University School of Medicine Kurume Japan
| | - Ryuta Nishikomori
- Department of Pediatrics and Child Health Kurume University School of Medicine Kurume Japan
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A Case of Cat Scratch Disease with Neuroretinitis in a 16-Month-Old Boy. Case Rep Ophthalmol Med 2022; 2022:2841683. [PMID: 36277508 PMCID: PMC9584725 DOI: 10.1155/2022/2841683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose We report a case of neuroretinitis associated with cat scratch disease (CSD) in young children. Method Case report. Results A 16-month-old boy was admitted for a detailed examination and treatment of a fever of unknown origin. Blood tests revealed no significant findings other than a white blood cell count of 16,100/mm3 and C-reactive protein level of 9.89 mg/dL. Computed tomography revealed no relevant findings to determine the causative disease. Antibiotic therapy with cefotaxime was initiated; however, the fever did not resolve. The patient was referred to our department for further examination to detect the cause of the fever. Fundoscopy revealed neuroretinitis in the right eye. His mother reported a history of breeding cats. Cat scratch disease (CSD) was suspected based on the clinical course and fundus findings. Cefotaxime was discontinued, and azithromycin, rifampicin, and prednisolone were administered, following which the fever disappeared and fundus findings improved. Immunoglobulin G (IgG) and IgM antibodies against Bartonella henselae was positive, leading to a definitive diagnosis of CSD. Conclusion Infants cannot complain of decreased visual acuity; therefore, these findings may be overlooked unless a fundus examination is performed. As in this case, the early detection of neuroretinitis by an ophthalmologist may help in the diagnosis of CSD. It is extremely difficult to capture a photograph of the fundus of an infant, and recording with a smartphone is relatively simple and useful for monitoring continuous changes. Summary. We describe a case of neuroretinitis associated with cat scratch disease (CSD) that was diagnosed on the basis of fundus findings. The findings suggest the importance of an aggressive ophthalmologic examination when CSD is suspected in young children who are unable to describe their symptoms.
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Hu B, Chen TM, Liu SP, Hu HL, Guo LY, Chen HY, Li SY, Liu G. Fever of unknown origin (FUO) in children: a single-centre experience from Beijing, China. BMJ Open 2022; 12:e049840. [PMID: 35296470 PMCID: PMC8928314 DOI: 10.1136/bmjopen-2021-049840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To date, there is no standard diagnostic practice to identify the underlying disease-causing mechanism for paediatric patients suffering from chronic fever without any specific diagnosis, which is one of the leading causes of death in paediatric patients. Therefore, we aimed this retrospective study to analyse medical records of paediatric patients with fever of unknown origin (FUO) to provide a preliminary basis for improving the diagnostic categories and facilitate the treatment outcomes. DESIGN A retrospective study. SETTING Beijing Children's Hospital. PARTICIPANTS Clinical data were collected from 1288 children between 1 month and 18 years of age diagnosed with FUO at Beijing Children's Hospital between January 2010 and December 2017. INTERVENTIONS According to the aetiological composition, age, duration of fever and laboratory examination results, the diagnostic strategies were analysed and formulated. PRIMARY AND SECONDARY OUTCOME MEASURES The statistical analyses were carried out using SPSS V.24.0 platform along with the χ2 test and analysis of variance (p<0.05). RESULTS The duration of fever ranged from 2 weeks to 2 years, with an average of 6 weeks. There were 656 cases (50.9%) of infectious diseases, 63 cases (4.9%) of non-infectious inflammatory diseases (NIIDs), 86 cases (6.7%) of neoplastic diseases, 343 cases (26.6%) caused by miscellaneous diseases and 140 cases (10.9%) were undiagnosed. With increasing age, the proportion of FUO from infectious diseases gradually decreased from 73.53% to 44.21%. NIID was more common in children over 3 years old, and neoplastic diseases mainly occurred from 1 to 6 years of age. Among miscellaneous diseases, the age distribution was mainly in school-aged children over 6 years. Respiratory tract infection was the most common cause of FUO in children, followed by bloodstream infections. Bacterial infection was the most common cause in children with less than 1 year old, while the virus was the main pathogen in children over 1 year old. CONCLUSIONS The diagnosis of neoplastic diseases and miscellaneous diseases-related diseases still depends mainly on invasive examination. According to our clinical experience, the diagnostic process was formulated based on fever duration and the type of disease. This process can provide a guide for the diagnosis and treatment of paediatric FUO in the future.
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Affiliation(s)
- Bing Hu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Tian-Ming Chen
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Shu-Ping Liu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Hui-Li Hu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Ling-Yun Guo
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - He-Ying Chen
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Shao-Ying Li
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
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Nozawa H, Ogura M, Miyasaka M, Suzuki H, Ishikura K, Ishiguro A, Ito S. Ultrasonography as a Diagnostic Support Tool for Childhood Takayasu Arteritis Referred to as Fever of Unknown Origin: Case Series and Literature Review. JMA J 2021; 4:358-366. [PMID: 34796290 PMCID: PMC8580698 DOI: 10.31662/jmaj.2020-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/02/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Childhood Takayasu arteritis (c-TA) often shows nonspecific symptoms, such as fever of unknown origin (FUO). Delay of diagnosis may result in organ dysfunction by arterial occlusion; therefore, early diagnosis is very important. Although ultrasonography is the first-line screening tool for children with FUO, its diagnostic efficacy of evaluation of systemic arteries in c-TA that presents as FUO remains unclear. We evaluated the suitability of ultrasonography evaluation that included systemic vessels for the early diagnosis of c-TA initially presenting as FUO. Methods We review five patients who received a diagnosis of c-TA in our institution and also performed a literature review regarding TA cases with FUO and diagnosed on the basis of initial ultrasonography. Results As in our cases, the median period from onset to diagnosis was 25 days (interquartile range [IQR], 21-35). Comparing the initial ultrasonography findings with later contrast-enhanced computed tomography (CECT) findings in the abdominal aorta, celiac artery, superior mesenteric artery, bilateral renal arteries, and bilateral common carotid arteries, the concordance rate between ultrasonography and CECT was moderate (Kappa coefficient was 0.50). All the patients were successfully treated without severe vascular damage. The literature review revealed 12 articles; although 9 of the 13 patients did not show the characteristic features (such as blood pressure discrepancy, bruit, or pulse deficiency), the median time to diagnosis was still 5 months (IQR, 3-12). Conclusions During initial screening for patients with FUO, ultrasonography including evaluation of systemic vessels could contribute to earlier diagnosis of c-TA.
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Affiliation(s)
- Hisataka Nozawa
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mikiko Miyasaka
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hiromichi Suzuki
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kenji Ishikura
- Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Yoshizato R, Koga H. Comparison of initial and final diagnoses in children with acute febrile illness: A retrospective, descriptive study: Initial and final diagnoses in children with acute fever. J Infect Chemother 2019; 26:251-256. [PMID: 31680036 DOI: 10.1016/j.jiac.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to elucidate the etiologies and diagnostic errors of early-phase pediatric fever without an obvious cause. METHODS This single-center, retrospective, descriptive study included 1334 febrile children hospitalized at Beppu Medical Center in Japan between 2014 and 2018. Eligibility criteria were age ≤12 years, axillary temperature ≥38.0°C, and fever duration ≤7 days at admission. Initial diagnoses on the day of admission and final diagnoses at defervescence were divided into initial fever with identified source (FIS) and initial fever without source (FWS) and final FIS and final FWS, respectively. The etiology of initial FWS and diagnostic discordance between initial FIS and final FIS were investigated. RESULTS Of the 1334 participants, 94 (7.0%) were diagnosed with initial FWS. Among patients with initial FWS, final diagnoses were confirmed in 40 (43%), including Kawasaki disease in 17, urinary tract infection in 5, bacteremia in 4, exanthem subitum in 3, and the others in 11. Among the 1275 patients diagnosed with final FIS, diagnostic discordances between initial and final diagnoses were observed in 131 patients (10%). The multiple logistic regression analysis identified increased serum C-reactive protein value at admission (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.06-1.13), exanthem subitum (OR: 409; 95% CI: 119-1399), and Kawasaki disease (OR: 14.3; 95% CI: 8.7-23.3) as independent risk factors for diagnostic discordance. CONCLUSION Exanthem subitum and Kawasaki disease may be undiagnosed or misdiagnosed in febrile children with fever duration ≤7 days.
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Affiliation(s)
- Rin Yoshizato
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita, 874-0011, Japan.
| | - Hiroshi Koga
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita, 874-0011, Japan.
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Kim YS, Kim KR, Kang JM, Kim JM, Kim YJ. Etiology and clinical characteristics of fever of unknown origin in children: a 15-year experience in a single center. KOREAN JOURNAL OF PEDIATRICS 2017; 60:77-85. [PMID: 28392823 PMCID: PMC5383636 DOI: 10.3345/kjp.2017.60.3.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/23/2016] [Accepted: 10/25/2016] [Indexed: 11/27/2022]
Abstract
Purpose Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. Methods Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ≥38.0℃ for longer than ≥14 days and failure to reach a diagnosis after one week of investigations were included. Results Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). Conclusion Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.
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Affiliation(s)
- Yi-Seul Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ran Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Min Kim
- Department of Pediatrics, Myoungji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kanetaka T, Mori M, Nishimura KI, Nozawa T, Kikuchi M, Sakurai N, Hara R, Yamazaki K, Yokota S. Characteristics of FDG-PET findings in the diagnosis of systemic juvenile idiopathic arthritis. Mod Rheumatol 2015; 26:362-7. [DOI: 10.3109/14397595.2015.1082686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Taichi Kanetaka
- Department of Pediatrics, Yokosuka Kyosai Hospital, Yokosuka, Japan,
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
| | - Masaaki Mori
- Department of Pediatrics, Yokohama City University Medical Center, Yokosuka, Japan
| | - Ken-ichi Nishimura
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
| | - Tomo Nozawa
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
| | - Masako Kikuchi
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
| | - Nodoka Sakurai
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
| | - Ryoki Hara
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
| | - Kazuko Yamazaki
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
| | - Shumpei Yokota
- Department of Pediatrics, Yokohama City University School of Medicine, Yokosuka, Japan, and
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Yamanouchi M, Uehara Y, Yokokawa H, Hosoda T, Watanabe Y, Shiga T, Inui A, Otsuki Y, Fujibayashi K, Isonuma H, Naito T. Analysis of 256 cases of classic fever of unknown origin. Intern Med 2014; 53:2471-5. [PMID: 25366005 DOI: 10.2169/internalmedicine.53.2218] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The causes of fever of unknown origin (FUO) vary depending on the region and time period. We herein present a study of patients with classic FUO where we investigated differences based on patient background factors, such as age and causative diseases, and changes that have occurred over time. METHODS We extracted and analyzed data from the medical records of 256 patients ≥18 years old who met the criteria for classic FUO and were hospitalized between August, 1994 and December, 2012. RESULTS The median age of the patients was 55 years (range: 18-94 years). The cause of FUO was infection in 27.7% of the patients (n=71), non-infectious inflammatory disease (NIID) in 18.4% (47), malignancy in 10.2% (26), other in 14.8% (38), and unknown in 28.9% (74). The most common single cause was human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (n=17). NIID and malignancy were more common in patients ≥65 years old than in patients <65 years old. During 2004-2012, compared to 1994-2003, infections and "other" causes were decreased, whereas NIID, malignancy, and unknown causes were increased. CONCLUSION FUO associated with HIV/AIDS is increasing in Japan. In addition, as in previous studies in Japan and overseas, our study showed that the number of patients in whom the cause of FUO remains unknown is increasing and exceeds 20% of all cases. The present study identified diseases that should be considered in the differential diagnosis of FUO, providing useful information for the future diagnosis and treatment of FUO.
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Affiliation(s)
- Masashi Yamanouchi
- Department of General Medicine, Juntendo University School of Medicine, Japan
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