Disseminated Mycobacterium genavense infection mimicking TAFRO syndrome

TAFRO syndrome is a rare variant of idiopathic multicentric Castleman's disease, for which disseminated non-tuberculous mycobacteria (NTM) infection must be excluded. However, due to the slow and fastidious growth of the organisms, identification of the pathogen is often challenging. We herein describe a case of disseminated Mycobacterium genavence infection, in which manifestations of the patient were confusingly similar to those of TAFRO syndrome. A 69-year-old Japanese man presented with prolonged fever accompanying pain in his back and ribs on the right side. Systemic investigations revealed thrombocytopenia, marked elevation of alkaline phosphatase, anasarca (pleural effusion and ascites), megakaryocytosis in the bone marrow, and hepatomegaly. Magnetic resonance imaging (MRI) showed diffuse, T1-and T2-low-intensity spotted lesions on his vertebral bodies, but biopsy showed inconclusive results. The patient met the diagnostic criteria of TAFRO syndrome and was started on prednisolone, which improved his general condition shortly thereafter. Blood culture after 42 days of incubation revealed the presence of Mycobacterium; however, we considered it a contamination at that time because no organisms grew on conventional agars, and the patient was discharged. Ten weeks after the isolation of Mycobacterium, he developed persistent fever and was readmitted. This time, vertebral bone mallow biopsy demonstrated a large amount of mycobacterium, which was later successfully identified as M. genavense by sequencing analysis. Under a final diagnosis of disseminated M. genavense infection, we treated the patient with clarithromycin, rifampicin, and ethambutol. This case highlighted that disseminated NTM infection may follow a similar clinical course as that of TAFRO syndrome

Recurrence of Hypoglycemic Coma in a Patient with Anorexia Nervosa

Anorexia nervosa (AN) is occasionally complicated with hypoglycemic coma, which may cause sudden death by unknown mechanisms. We present the case of a 36-year-old woman with recurrent comas and a nineteen-year history of AN. She was found in a coma with remarkable hypoglycemia (28 mg/dL). Her BMI was 11.1 kg/m2. Endocrine workup revealed extremely low serum levels of glucagon, IGF-I and insulin. Asymptomatic hypoglycemia occurred with liver injury in the refeeding process. An aberrant glucose metabolism due to liver damage might have been involved in her susceptibility to hypoglycemia. This case suggests a possible mechanism of hypoglycemic coma in AN

住民による高齢者サロン運営の課題と対策

一般高齢者の介護予防推進事業である高齢者サロン運営の課題と対策を検討する目的で島根県出雲市C地区の高齢者サロンに参加して実態把握をするとともに、サロンの世話役・福祉委員・参加者等に実施したインタビュー結果をサロン活動の継続の困難さに視点を当て分析した。課題は①独居高齢者等の不参加②参加意欲維持の困難さ③働き盛り男性福祉委員の活動の困難性④世話役の高齢化と人材不足による活動の困難性⑤企画内容の工夫の困難性⑥活動記録等の保存と活用の不徹底⑦社会資源等の情報伝達と周知不足⑧予算確保の困難性・助成金の使途制限による使用の困難性⑨実施場所と回数の不足⑩実施場所の環境整備不足であった。対策として社会福祉協議会、自治協会・保健師などがサロン運営の課題を共有する機会を持ち、サロンを運営する世話役や福祉委員への情報提供や必要な支援することが重要である。また、高齢者が主体的に参加できるよう協力を求めながら実施していく必要がある