A case report on refractory ulcerative stomatitis associated with acute lymphoblastic leukemia

症例は難治性潰瘍性口内炎を契機に判明した急性リンパ性白血病の 1 例である．患者は 60 歳台，女性．下口唇に難治性潰瘍を認め紹介となった．血液検査にて汎血球減少を認めたため，血液疾患を疑った．骨髄検査にて，Ph 染色体陰性急性 B 細胞性リンパ性白血病と診断され，初診の 4 日後からステロイド療法が開始された．なお，下口唇生検の病理組織には明らかな白血病細胞の浸潤は認めなかった．口腔症状が白血病の初発症状となることがあり，これを主訴に受診した白血病患者を早期診断することは大変重要である．しかし，口腔病変の原因は多彩であり，さまざまな科が対応することが多く，各科が連携して診療にあたることが重要と考える．We herein report a case on refractory ulcerative stomatitis associated with acute lymphoblastic leukemia. The female patient in her 60s showed refractory ulcer on her lower lip ; and the referral was made. Since pancytopenia was found by a blood test, hematologic disease was suspected. Bone marrow examination presented the diagnosis of Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia. Based on this diagnosis, steroid therapy had been initiated from four days after the first visit. On biopsy of lower lip, the pathological tissue did not show obvious infiltration of leukemia cells. Since oral manifestation may sometimes be an initial symptom of leukemia, an early diagnosis on leukemia patient with main complaint of oral symptom is critically important. Oral lesions, however, have various causes, and it thus often requires care of various clinical department. Based on this, it is considered to be important to implement treatment with cooperation among each clinical department

Idiopathic first bite syndrome improved by Rikkosan : A case report

ファーストバイト症候群（first bite syndrome：以下、FBS）は、食事開始時に耳下腺部痛を生じ数回の咀嚼により徐々に軽快することを特徴とする。手術既往や腫瘍性疾患がない FBS は特発性 FBS と分類される。特発性 FBS に対する治療法として少数ではあるが立効散の内服が報告されており、本症例でも立効散が奏功した。特発性 FBS の治療法は未確立であり、有害事象の少ない立効散は食事療法と並んでまず考慮すべき治療法であると考える。First bite syndrome (FBS) is characterized by severe paroxysmal pain in the parotid region at the first bite of a meal, which gradually decreases as mastication continues. When FBS occurs with no history of head and neck surgery and no evidence of a tumor, it is classified as idiopathic. The effectiveness of Rikkosan has been reported by several studies, and we also experienced a case in which idiopathic FBS improved with Rikkosan. There is no established treatment method for idiopathic FBS. Rikkosan, which is associated with few adverse events, should be considered as a first-line treatment, along with diet therapy

Acute sensorineural hearing loss after using a privately imported PDE-5 inhibitor : A case report

個人輸入した PDE-5 阻害薬内服後に急性感音難聴を生じた症例を経験したため報告する。症例は 40 代、男性。インターネット経由で購入したバルデナフィルを使用後に、感音難聴を生じた。プレドニゾロンの全身投与を行い、バルデナフィルを中止したところ、聴力はおおむね改善した。PDE-5 阻害薬は難聴との関連が指摘されているが、わが国では十分に周知されていない。PDE-5 阻害薬はインターネットで簡単に個人輸入できる一方で、偽造薬も数多く出回っており、健康被害も生じている。また、個人輸入薬は処方薬に比して服薬歴の把握が難しい場合があり、薬剤性難聴を疑う場合は詳細な問診を心掛ける必要がある。We herein report a case of acute sensory deafness that occurred immediately after taking a privately imported phosphodiesterase-5 inhibitor. A man in his 40s developed sensorineural hearing loss after using vardenafil purchased over the Internet. He received systemic prednisolone and discontinued vardenafil, which generally improved his hearing. Although it has been pointed out that phosphodiesterase-5 inhibitors are associated with deafness, this fact is not well known in Japan. It is easy to import phosphodiesterase-5 inhibitor for personal use via the Internet. However, many counterfeit drugs of phosphodiesterase-5 inhibitor are distributed online, causing health hazards. We should always be alert for any medications that need to be discontinued

HIV infection diagnosed from delayed wound healing after tonsillectomy : A case report

HIV（human immunodeficiency virus）は感染すると宿主の免疫能を低下させ、進行すると AIDS（acquired immunodeficiency syndrome）を引き起こす。HIV 感染症は多彩な症状を呈することが知られており、創傷治癒遅延もその一つである。今回われわれは口蓋扁桃摘出術後の創傷治癒遅延から HIV 感染症と判明した症例を経験した。HIV 感染症は早期の治療開始が予後改善のために推奨されており、早期発見が重要である。手術前 HIV スクリーニング検査は創傷治癒遅延を防ぐ意味でも重要と考えられるが、現行の保険制度上は認められない場合があり、保険適用範囲の拡大が望まれる。HIV (human immunodeficiency virus) lowers the immune capacity of the host and causes AIDS (acquired immunodeficiency syndrome) when it progresses. HIV infection is known to have a variety of symptoms, and it is often diagnosed based on the occurrence of various otorhinolaryngological conditions. We experienced a case in which an HIV infection was diagnosed based on delayed wound healing after tonsillectomy. The early initiation of treatment for HIV infection is known to be effective for controlling progression, so it is important to detect HIV infection as early as possible. Preoperative HIV screening tests may lead to the early detection of HIV, and such tests are also important to prevent delayed wound healing. In Japan, it remains a problem that preoperative HIV screening is sometimes not allowed under by the Japanese National health insurance system