A 56-year-old woman was referred to our hospital for recurrent asthma of 20 years duration. She was diagnosed as having allergic bronchopulmonary aspergillosis on the basis of clinical symptoms, peripheral blood eosinophilia, elevated total serum immunoglobulin E value, positive results of specific IgE and precipitating antibodies against Aspergillus sp., central bronchiectasis, and mucoid impaction. Systemic corticosteroids and anti-fungal therapy improved her symptoms, but the cessation of these treatments led to frequent exacerbations. Omalizumab improved her asthmatic symptoms to the point that corticosteroids could be stopped; however, radiological findings were not improved, and coexisting eosinophilic sinusitis and otitis media worsened. After her treatment was changed from omalizumab to mepolizumab, not only her asthmatic symptoms but also her sinusitis and otitis media became well controlled, and chest radiological findings improved.

A case of acute necrotic myelopathy (ANM) is reported in conjunction with a noninvasive reticular type of lymphoma. The clinical course was characterized by two rare phenomena: (1) acute torticollis occurred as an initial manifestation, probably as a result of irritation of the dorsal root or dorsal horn; (2) recurrent cardiac arrest occurred late in the course, probably as a result of hypersensitivity of the sensors of postural change. The occurrence of ANM in patients with neoplasia is reviewed and it is concluded that the nature of the association is unknown. Some evidence points to abnormal immunological reactions leading to vascular damage and cord ischemia.

This manuscript describes the first known case of a patient with multiple system atrophy whose parasympathetic dominant disturbance might have been associated with the relative constriction of the superior mesenteric artery, leading to nonocclusive mesenteric ischemia and subsequent portomesenteric venous gas with pneumatosis intestinalis on abdominal computed tomography approaching death.

No abstract

Patients who initially have Alzheimer’s disease dementia with no or mild cerebral amyloid angiopathy (CAA) might later develop CAA‐related inflammation. We described a 76‐year‐old man with possible Alzheimer’s disease dementia and steroid‐responsive probable CAA‐related inflammation. Initial diffusion‐weighted imaging demonstrated symmetrical high signal intensities in the bilateral posterior region, which might suggest ischemia and predilection of CAA pathology for posterior brain regions. Magnetic resonance images thereafter demonstrated asymmetrical cortical swelling in the left temporo‐parieto‐occipital region with leptomeningeal enhancement, which might show subtle cerebrovascular immunological response may influence the subsequent distinct differences.