山下 武志

Pyogenic spondylodiscitis is a rare infection, with cervical spine involvement occurring in only 3%–10% of the cases. Streptococcus gallolyticus subsp. pasteurianus , a normal gut flora component, is a rare causative agent of spinal infections. Here, we report the case of an 88‐year‐old man with cervical pyogenic spondylodiscitis caused by this organism, complicated by a clinical relapse following a standard antibiotic course. The patient presented with fever and neck pain. Blood cultures revealed Streptococcus gallolyticus subsp. pasteurianus , and cervical magnetic resonance imaging (MRI) revealed spondylodiscitis at the C4–C6 levels. The patient was treated with a 90‐day course of antibiotics (46 days intravenous and 44 days oral), leading to initial clinical and biochemical resolution. However, clinical relapse occurred on day 174, characterized by recurrent neck pain and elevated C‐reactive protein levels despite no clear signs of active inflammation on repeat MRI. Extended oral antibiotic therapy was resumed and continued for 9 months, resulting in sustained remission without surgical intervention. To our knowledge, only isolated case reports of spinal infections caused by this subspecies have been published, and no prior case has described clinical recurrence. This case suggests that standard antibiotic durations may be insufficient in selected complex or relapsing spinal infections caused by Streptococcus gallolyticus subsp. pasteurianus and highlights the importance of individualized treatment duration and long‐term surveillance.

Background and aim Cytotoxic lesions of the corpus callosum (CLOCCs) are transient lesions characterized by restricted diffusion on MRI and are associated with various infectious and noninfectious conditions. However, the clinical spectrum of infection-related CLOCCs, particularly those associated with bacterial infections, remains incompletely defined. This study aimed to describe the clinical, etiological, and neuroimaging characteristics of CLOCCs diagnosed at a single center, encompassing both infectious and noninfectious etiologies, with particular attention to infection-related cases. Methods We retrospectively reviewed patients diagnosed with CLOCCs at Jichi Medical University Saitama Medical Center between January 2016 and May 2025. Patients were identified by searching institutional radiology reports and electronic medical records for callosal lesions, followed by review of the corresponding records. Clinical characteristics, underlying etiologies, laboratory findings, MRI features, treatment, follow-up imaging, and clinical outcomes were extracted from medical records. Results Eight patients were identified (median age, 47.5 years; range, 12-70; five male and three female). Five patients had infection-related CLOCCs, including bacteremia, meningoencephalitis, and COVID-19-associated myocarditis. One patient had Fusobacterium nucleatum bacteremia, which, to the best of our knowledge, has not been well documented in association with CLOCCs. In all eight patients, the lesion was confined to the splenium of the corpus callosum. All patients showed hyperintensity on diffusion-weighted imaging, and six showed corresponding hypointensity on apparent diffusion coefficient maps. Follow-up MRI was available in seven patients (performed at a median of 17 days; range, 14-50 days); six showed complete resolution, whereas one showed near-complete resolution with faint residual fluid-attenuated inversion recovery hyperintensity. Seven patients improved clinically; one patient died during hospitalization from infection-related complications unrelated to the corpus callosum lesion, which had already resolved on follow-up MRI. Conclusions In this single-center case series, infection-related etiologies accounted for most of the cases. The association with F. nucleatum bacteremia, based on a single case, represents a possible rather than established addition to the bacterial infections reported in CLOCCs and should be regarded as hypothesis-generating. Early recognition of the characteristic MRI findings, evaluation for underlying infectious causes, and treatment directed at the underlying condition may support favorable clinical and radiological outcomes.

We report a rare case of a right-to-left shunt through a patent foramen ovale (PFO) triggered by constrictive pericarditis secondary to an organized pericardial hematoma. A 72-year-old woman presented with thoracic back pain and subsequently developed persistent hypoxemia following idiopathic pericarditis. Despite appropriate anti-inflammatory and antimicrobial therapy, she experienced a cerebral embolism involving the right middle cerebral artery territory on hospital day 50. Imaging studies revealed a pericardial effusion compressing the right heart. Intraoperative transesophageal echocardiography confirmed a right-to-left shunt through a PFO. Surgical evacuation of the organized pericardial hematoma relieved right heart compression, normalized intracardiac pressures, and resolved the shunt. The pericardium was markedly thickened and adherent to the right ventricle with a fibrotic hematoma, and histopathology revealed fibrotic thickening with inflammatory infiltration and hemosiderin deposition. The patient's respiratory status gradually improved, and she was discharged home without the recurrence of paradoxical cerebral embolism. This case highlights a rare pathophysiological mechanism in which constrictive pericarditis elevates right atrial pressure, unmasking a previously silent PFO and resulting in paradoxical embolism and refractory hypoxemia. Constrictive pericarditis should be considered a potential trigger for right-to-left shunting in patients with unexplained hypoxemia or cryptogenic stroke.

Anorexia nervosa (AN) is often accompanied by numerous medical complications and mental disorders. There are few specialized AN facilities in Japan, resulting in the unmet medical needs of patients with AN. A 37-year-old Japanese woman was admitted to the hospital after experiencing a disturbance of consciousness. Her body mass index was 10.2 kg/m2. She developed the following serious medical concomitants associated with extremely severe AN: hypothermia, shock liver, refractory hypoglycemia, acute gastric mucosal bleeding, gelatinous marrow transformation, catheter-related bloodstream infection and infective endocarditis due to β-lactamase-negative Staphylococcus aureus, aspiration pneumonia, intracranial hemorrhage, candidemia, and osmotic demyelination syndrome in the pons, which led to a fatal condition that quickly worsened after we started treatment. The patient was able to overcome several serious concomitants and be discharged from the hospital after multidisciplinary treatment team care. AN is associated with increased rates of all-cause mortality. It is important to take an interdisciplinary approach with emergency physicians, intensivists, hematologists, gastroenterologists, psychiatrists, clinical psychologists, a nutrition support team with a nationally registered nutritionist and hospitalists, and hospitalization as required based on appropriate medical evaluation with good patient and family rapport. Furthermore, social and educational efforts aimed at preventing the development of AN are necessary.

A 37year old Japanese man experienced severe sore throat. He was infected by the Omicron variant of SARSCoV2. The posterior pharyngeal wall in the left showed closely aggregated multiple milletsized white spots with surrounding redness.