Cardiac metastasis of thyroid carcinoma is extremely rare. We treated a case of anaplastic thyroid carcinoma with prominent cardiac metastasis. The 61-year-old male was admitted because of high fever. Investigations revealed a cardiac mass and anaplastic thyroid carcinoma. Resection of the cardiac mass revealed that it was metastasis from the thyroid carcinoma. After 4 months, he died in spite of intensive therapy. Marked leukocytosis was observed during the clinical course, and a concomitant increase of granulocyte macrophage-colony stimulating factor (GM-CSF) level was demonstrated in the sera. It was suggested that the high GM-CSF level in serum contributed to leukocytosis. (Internal Medicine 31: 1107-1111, 1992 Key words: high fever, cytokine Case Report A 61-year-old male with high fever was admitted to our hospital. From 2 months prior to admission, he had had a fever of above 38.0°C. He first consulted another doctor and received antibiotic therapy because of an elevated peripheral white blood cell (WBC) count. However, there was no response, and he was referred to our hospital for investigation of fever of unknown origin. At the age of about 30 years, he was noted to have a nodular goiter, but since he was asymptomatic, no treat ment was sought. He had no noteworthy family history. On admission, his temperature was 36.0°C, which later increased. His pulse was 90/min, and blood pressure was 104/58mmHg. In the left lobe of the thyroid gland, there was an elastic hard tumor of about 50mm in diam eter, which was mobile and non-tender. No superficial lymph nodes were palpable. On examination, there were no specific findings in the heart, lungs, and abdomen. Laboratory investigations revealed the following values: hemoglobin, ll.0g/dl; red blood cell count, 3,970,000/mm3; platelet count, 153,000/mm3; WBC count, 35,300/mm3 (segmented neutrophil, 65% ; band neutrophil, 23%; lymphocyte, 8%; monocyte, 3%; metamyelocyte, 1%); total protein, 5.0g/dl; albumin, 2.5 g/dl; glutamate oxaloacetate transaminase, 12IU/1 (normal, 7-27); glutamate pyruvate transaminase, 59 IU/1 (normal, 0-24); lactate dehydrogenase, 526 IU/1 (normal, 213-397); alkaline phosphatase (ALP), 331 IU/1 (normal, 39-118); leucine aminopeptidase, 113 IU/1 (normal, 31-54); gamma-glutamyl transpeptidase (y-GTP), 190IU/1 (normal, 5-42); serum calcium, 4.0 milliequivalent/1. Serum creatinine, blood urea nitrogen, and other electrolytes were within the normal range. The prothrombin time and activated partial thromboplastin time were also within the normal range. The erythrocyte sedimentation rate was 74mm/h and C-reactive protein was 13.6mg/dl (normal, less than 0.3). Serum thyroid stimulating hormone, free thy roxine, and free triiodothyronine level were respectively 0.67^IU/1 (normal, 0.35-3.78), 0.90pg/ml (normal, 0.93-1.73), and 0.61ng/ml (normal, 2.7-5.0). Serum carcinoembryonic antigen, calcitonin, and thyroglobulin were respectively 0.6ng/ml (normal, 0-4.0), HOpg/ml (normal, less than 100), and 3,000ng/ml (normal, less than 30). Urinary examination ...

Objectives This study evaluated the prognostic factors for acute exacerbation (AE), including sequential changes in Krebs von den Lungen-6 (KL-6) levels, in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) patients. Methods This was a retrospective observational study. We reviewed 125 patients diagnosed with RA-ILD between 2010 and 2019. We defined ΔKL-6 as the annual variation rate of KL-6 one visit before AE onset (or the last visit). The Cox regression analysis was used for evaluating significant variables associated with AE. We analysed the overall survival and respiratory-related death-free survival. Results Thirty-three patients (26.4%) developed AE during the observation period. The univariate analysis revealed that KL-6 levels at RA-ILD diagnosis [hazard ratio (HR), 1.11; 95% confidence interval (CI), 1.05–1.15; p < .01) and ΔKL-6 (HR: 3.69; 95% CI: −1.36 to 7.96; p = .01] were significantly associated with AE. ΔKL-6 was an independent prognostic factor for AE in the multivariate analysis (HR: 3.37; 95% CI: −1.16 to 8.87; p = .03). Patients with AE had a significantly higher overall mortality rate (p = .02) and respiratory-related mortality rate (p < .01) than those without AE. Conclusion ΔKL-6 can be a prognostic marker for detecting AE in RA-ILD patients.

Recent large observational studies of antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) show that severe infection is a major cause of death and that the majority of infections occur during the early phase of initiating remission-induction therapy. Many risk factors for severe infection have been suggested, but these have been inconsistent. Nevertheless, infectious risk factors in elderly patients with AAV have not been adequately investigated in previous studies. In this retrospective observational study, we examined potential predictors of severe infection within 90 days (early severe infections) after remission-induction therapy in patients with AAV aged 65 years or older. We included 167 consecutive elderly patients with AAV admitted to our hospital. Data from medical history and remission-induction therapy were analyzed for predictive risk factors associated with early severe infections. The relationship between initial doses of corticosteroids and cumulative incidence of severe infections was also analyzed. A multivariate analysis of risk factors for early severe infections was performed using logistic regression analysis. The Kaplan–Meier method was used to estimate the overall survival, and the log-rank test was used to evaluate the differences between patients with and without early severe infections. Gray method was used to compare the cumulative incidence of severe infections in patients who did and did not receive initial high-dose corticosteroids. Logistic regression analysis showed that initial high-dose corticosteroid administration (prednisolone ≥0.8 mg/kg/d) (odds ratio [OR] 3.86, P = .030) and serum creatinine levels at diagnosis ≥1.5 mg/dL (OR 5.13, P  = .003) were independent predictors of early severe infection although administration of cyclophosphamide or rituximab was not. The cumulative incidence of severe infections was also significantly higher in patients who received initial high-dose corticosteroids (P = .042), and patients with early severe infections exhibited a high mortality rate within 6 months (P < .001). Our findings suggest that initial high-dose corticosteroids and renal impairment at diagnosis are associated with a higher risk of early severe infections and early death in elderly patients with AAV.

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