Explore the vast range of titles available.

On physical examination, her body temperature was 38.9°C, blood pressure was 100/61 mmHg, and pulse rate was 112 beats/min. Immunohistochemical staining revealed CD20 and Bcl-6 positivity, consistent with diffuse large B-cell lymphoma (Figure 2A,B). The average size of PAL masses has been reported to be 5.5 cm, while other bilateral adrenal masses are generally smaller, often less than 5 cm.4 In addition, in cases of bilateral adrenal masses, adrenal insufficiency has been reported in 57% of PAL and 94% of tuberculosis and is less common in pheochromocytoma and metastasis.4 If bilateral adrenal masses >5 cm are found in a patient with fever and back pain, it is important to consider PAL, evaluate adrenal function, and perform biopsy promptly.

Lupus vasculitis occurs in about 10% of patients with SLE and typically manifests as cutaneous lesions. Palpable purpura are observed in 25% of patients with lupus vasculitis; however, the frequency of palm and sole involvement remains unknown. Because only a limited number of diseases present with rashes on the palms and soles, the location of the rash can serve as a valuable diagnostic clue. The differential diagnosis of purpura on the palms and soles includes small-vessel vasculitis such as Henoch-Schönlein purpura and ANCA-associated vasculitis, and infections such as meningococcal infection, rickettsiosis, toxic shock syndrome, papular purpuric gloves and socks syndrome, and infective endocarditis. Clinicians should consider SLE in the differential diagnosis when purpura are observed on the palms and soles.

Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory disorder without a clear etiology that primarily affects young adults. New-onset disease at > 80 years of age is uncommon. We present the case of an 82-year-old woman with AOSD which developed after receiving a messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccine. COVID-19 vaccines are known to cause overproduction of cytokines, systemic inflammation, and some immune-mediated adverse events, such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, vasculitis, and polymyalgia rheumatica after the vaccination has been reported. A handful of cases of AOSD after the vaccination have also been reported and the median age was 40s. However, AOSD related to COVID-19 vaccination can develop even in older individuals.

Mochi, or rice cake, is a highly adhesive food, and it is known to cause small bowel obstruction and gastric ulcers. However, reports of duodenal involvement due to mochi are rare. We report a case of duodenal obstruction and ulcers caused by mochi. A 64-year-old man with a history of diabetes mellitus presented with abdominal pain and vomiting after consuming mochi. Computed tomography (CT) of the abdomen revealed multiple high-density materials in the duodenum and stomach. Endoscopy identified multiple ulcers in the duodenum and stomach, along with mochi impaction in the duodenum. The obstruction was successfully relieved by endoscopic fragmentation. In patients with diabetes mellitus, impaired gastrointestinal motility may contribute to duodenal obstruction by mochi. When high-intensity material is observed in the stomach or duodenum on CT, confirming dietary intake is crucial for an accurate diagnosis.

Background Allogeneic hematopoietic stem cell transplantation is a potentially curative treatment for acute myeloid leukemia. However, extramedullary relapse of acute myeloid leukemia can occur after hematopoietic stem cell transplantation, causing treatment failure. Extramedullary relapse rarely involves the peripheral nerves, and it is not influenced by the effect of the graft on leukemia. Case presentation We report a case of extramedullary relapse of acute myeloid leukemia in the brachial plexus of a 41-year-old woman treated with allogeneic hematopoietic stem cell transplantation (HSCT). Complete hematological remission was confirmed by bone marrow examination 1 month after HSCT, and she developed no major complications immediately after HSCT. The immunosuppressant was discontinued 5 months later. However, 2 weeks after immunosuppressant withdrawal, the patient developed left arm pain and paresthesia, with subsequent development of a mass in the left brachial plexus. She was initially diagnosed with brachial plexus neuropathy because of concomitant graft-versus-host disease. Despite the administration of immunosuppressive agents, the mass continued to enlarge. The biopsy of the lesion revealed leukemic relapse. Thus, the patient was diagnosed with extramedullary relapse and underwent radiotherapy, resulting in tumor shrinkage. Conclusion Extramedullary relapse should be considered a differential diagnosis in post-transplant patients with leukemia presenting with paresthesia.

This case highlights a 77-year-old woman with polymyalgia rheumatica (PMR) following coronavirus disease 2019 (COVID-19) vaccination without shoulder pain and its characteristic positron emission tomography-computed tomography (PET-CT) findings. Some cases of PMR following COVID-19 vaccination have been reported. However, patients without shoulder pain or PET-CT findings without uptake at the shoulders are not described. Our case suggests that PMR should be considered in the differential diagnosis of patients with neck pain following COVID-19 vaccination, even if they lack shoulder pain.

Wernicke encephalopathy is caused by vitamin B1 deficiency. It presents as a triad consisting of altered mental status, oculomotor dysfunction, and gait ataxia. Early vitamin B1 administration alleviates symptoms. We present a video of gaze‐evoked nystagmus in an elderly patient with Wernicke encephalopathy. It is often difficult to evaluate the mental and ambulatory states of frail elderly patients with dementia. In such cases, nystagmus is the only useful physical finding in the diagnosis of Wernicke encephalopathy.

A 63-year-old man was admitted to an internal medicine service with a 3-week history of gait imbalance. His medical history included alcohol use disorder, immunoglobulin A vasculitis, and hypertension. He consumed approximately 10 standard drinks per day (108 g alcohol) and ate only a small lunch daily. On examination, he was awake and responsive, with no acute cognitive changes. His eyes were nearly fixed in the primary position, with slight preservation of vertical gaze but no horizontal gaze (precluding assessment of horizontal gaze-evoked nystagmus), and vertical gaze-evoked nystagmus was observed on upward and down ward gaze. Truncal ataxia was present without limb weakness. The laboratory testing showed a low serum vitamin B1 level of 30 (reference range 60 to 165) nmol/L. The patient was diagnosed with ophthalmoplegia caused by Wernicke encephalopathy. He was treated with intravenous prosultiamine, a disulfide thiamine derivative, 500 mg 3 times daily for 2 days, followed by 250 mg once daily for 5 days, and then transitioned to oral thiamine 100 mg daily.