A 77-year-old Japanese woman presented with peripheral oedema following COVID-19 vaccination. Three weeks before, the day after the second dose of BNT162b2 mRNA COVID-19 vaccination, she presented with low-grade fever, peripheral oedema and arthralgia of the bilateral foot joint. Fever and arthralgia were relieved spontaneously within a week. Since there was no improvement in the peripheral oedema, she was referred to our department. Her medical history revealed type 2 diabetes mellitus and dyslipidaemia, for which she had been prescribed 500 mg/day of metformin and 10 mg/day of atorvastatin. Physical examination revealed symmetrical non-pitting oedema of her legs (Figure 1a). Laboratory tests showed blood eosinophilia (3750/ll). The serum IgM level was within normal. Non-episodic angioedema with eosinophilia (NEAE) was diagnosed. Her symptoms improved quickly with prednisolone administration (20 mg/day) (Figure 1b). She has been recurrence-free after tapering off prednisolone.Angioedema with eosinophilia is of two types: episodic angioedema with eosinophilia (EAE; Gleich's syndrome) and NEAE. 1-3 EAE has been reported mainly in Europe and the USA, whereas NEAE in Korea and Japan. 4 EAE is characterized by recurrent episodes of angioedema, urticaria, fever and increased body weight, with markedly high peripheral blood eosinophil count and serum IgM levels. 1,2 NEAE is characterized by a single episode of persistent oedema of the extremities, peripheral eosinophilia, transient arthralgia, lack of increased serum IgM levels and a less severe clinical course than that of EAE. 2,3 NEAE can occur after influenza vaccination; however, NEAE after COVID-19 vaccination has not been previously reported. 5 NEAE is also characterized by the effectiveness of low-dose prednisone or spontaneous remission within 2-3 months. 2,3 In conclusion, non-pitting oedema of the extremities with eosinophilia should be considered eosinophilic angioedema, which can occur after COVID-19 vaccination.

UNSTRUCTURED ChatGPT (Open AI, San Francisco, California, USA) has gained considerable attention because of its natural and intuitive responses. One limitation of OpenAI is its failure to perform reinforcement learning based on reliable information, thereby providing inaccurate or meaningless answers. Fortunately, on March 2023 update introduced GPT-4, which, according to internal evaluations, is expected to increase the likelihood of producing factual responses by 40% compared with its predecessor, GPT-3.5. We verified the accuracy of ChatGPT based on GPT-4 (ChatGPT4) and based on GPT-3.5 (ChatGPT3.5) by solving the Japanese National Medical Examination. We excluded questions containing figures and tables unsupported by ChatGPT. Of the 400 questions, 292 were analyzed. The correct response rate for ChatGPT4 was 81.5%, which was significantly higher than 42.8%, the rate for ChatGPT3.5. Moreover, ChatGPT4 surpassed the passing standard (>72%) for the Japanese National Medical Examination, indicating its potential as a diagnostic and therapeutic decision aid for physicians. We anticipate that future updates of ChatGPT will further enhance its accuracy, making it an invaluable resource in the field of medicine.

A 55-year-old Japanese man was hospitalized with the novel coronavirus disease. On the 13th day after the start of favipiravir administration, the patient developed a fever with a temperature of 38.1. His pulse rate also became elevated to 128 bpm, so relative bradycardia was not suspected. Since he was in good overall health and no concomitant symptoms and signs were apparent, we considered it to be drug fever due to favipiravir. After the completion of favipiravir treatment, the patient's temperature normalized within 24 hours. We herein report this case of drug fever caused by favipiravir.

No abstract

No abstract