Finding the ideal balance between efficacy and safety of immunosuppression is challenging, particularly in cases of severe TAFRO syndrome. We herein report a 60-year-old man diagnosed with grade 5 TAFRO syndrome mimicking hepatorenal syndrome that was successfully treated by glucocorticoid, tocilizumab, and cyclosporin despite virus infection. Furthermore, by examining 14 peer-reviewed remission cases, we revealed that the recovery periods among inflammation, renal dysfunction, and thrombocytopenia were quite different, with recovery from thrombocytopenia notably slow. All patients requiring dialysis were successfully withdrawn from dialysis, and the reversibility from kidney injury was good. This clinical information will help clinicians plan treatments and tailor the intensity of immunosuppression.

The number of patients with syphilis has been rapidly increasing. Without treatment, syphilis can damage various organs and become life-threatening. We herein report a 29-year-old woman diagnosed with neurosyphilis, acute hydrocephalus, syphilitic uveitis combined with hypertensive retinopathy, and malignant hypertensive nephropathy. To our knowledge, this is the first report of syphilis complicated with malignant hypertensive nephropathy proven by a renal biopsy. Neurosyphilis was successfully treated with intravenous penicillin G, and severe hypertension subsequently resolved. However, delayed medical examinations and complications of syphilitic uveitis and hypertensive retinopathy resulted in irreversible visual loss. To prevent irreversible organ damage, early treatment is essential.

Duplex stainless steels (DSSs), which consist of ferrite and austenite phases, are widely used owing to their high strength and good corrosion resistance. However, the oxidation behavior of DSSs is extremely complicated because they have dual phases. In this study, changes in the scale and the metal substrate during oxidation were investigated. UNS S32101 (Fe-21.5%Cr–5%Mn–1.5%Ni–0.3%Mo–0.22%N), which is a typical type of DSS, was annealed at 1473 K for up to 36 ks in air. The microstructure of UNS S32101 consisted of austenite/ferrite phases, the ratio of which was 50:50 at room temperature. After oxidation, Cr, Mn-oxide formed predominantly. The metal substrate beneath the scale changed mostly to ferrite. In the same region, depletion of Mn and N concentrations resulted. The decrease in Mn was due to the formation of Cr, Mn-oxide. In addition, it was revealed that N content of the metal substrate decreased due to the formation of N2 gas along with the depletion of Mn. It was assumed that the decrease in Mn and N, which are austenite-stabilized elements, led to an increase in ferrite in the depletion area of Mn and N. From this result, it was expected that the compositional changes in the Mn/N depletion area were caused by the oxidation of steel.