Language：English   Publisher：Journal of Infection and Chemotherapy  

A 71-year-old female with post-treatment follicular lymphoma developed COVID-19 with persistent viremia. Despite the initiation of remdesivir on day 23, she remained SARS-CoV-2 PCR-positive and ultimately succumbed to respiratory failure on day 79. Whole-genome analysis of RNA extracted from a post-mortem nasopharyngeal swab identified multiple mutations, including P323L/G671S, which enhances viral replication, and V792I, associated with remdesivir resistance. This case highlights the challenges of managing persistent SARS-CoV-2 infection in immunocompromised patients and underscores the impact of delayed treatment and antiviral resistance.

DOI： 10.1016/j.jiac.2025.102737

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Language：English   Publisher：Atherosclerosis Plus  

Background and aims: The prevalence of metabolic dysfunction associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has become a significant public health concern with an increased atherosclerotic cardiovascular disease risk. This study investigates the impact of NAFLD-related single nucleotide polymorphisms (SNPs) on carotid atherosclerosis development in a Japanese population without diabetes, dyslipidemia, and hypertension. Methods: The prospective observational study, part of the Kyushu and Okinawa Population Study (KOPS), included 945 participants (median age 55 [47, 63]) without carotid atherosclerosis, increased alcohol intake, diabetes, dyslipidemia, hypertension, or chronic hepatitis at baseline. NAFLD-related SNPs (GCKR, NCAN, and PNPLA3) were genotyped, and carotid intima-media thickness (cIMT) was measured using ultrasonography. Univariate and multivariate regression analyses were performed to assess the association of NAFLD-related SNPs on newly developed carotid atherosclerosis over five years. Results: After five years, 125 (13.2 %) participants developed carotid atherosclerosis. The NCAN (rs2228603) T allele was associated with a lower incidence rate of carotid atherosclerosis (4.7 % in NCAN CT/TT genotype vs. 13.9 % in CC genotype; p = 0.04), and NCAN T allele carriers exhibited a favorable lipid profile. These associations were not altered by either recruiting area or obese. The GCKR T allele and PNPLA3 C allele were associated with low carotid atherosclerosis development rates but were not significant. Conclusions: Our results suggested that some NAFLD-related SNPs may influence atherosclerosis through lipid metabolism among Japanese individuals without metabolic syndrome.

DOI： 10.1016/j.athplu.2024.12.003

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Language：English   Publisher：Journal of Infection and Chemotherapy  

An 81-year-old man was admitted to our hospital because of fever and malaise that had persisted for 3 months. The patient had undergone two aortic valve replacements, 10 and 5 years previously, because of aortic valve regurgitation and infectious endocarditis. He also had had asymptomatic Mycobacterium abscessus complex (MABC) pulmonary disease for the two previous years. Contrast-enhanced computed tomography showed a mediastinal abscess and an ascending aortic aneurysm. Mycobacterium abscessus subsp. massiliense was cultured from his blood, suggesting the aortic aneurysm was secondary to infection of an implanted device. After enlargement over only a few days, a leakage of contrast medium to the mediastinal abscess was found on computed tomography. The patient was diagnosed with rupture of an infectious aortic aneurysm, and emergency aortic replacement and drainage of the mediastinal abscess were successful. The patient was treated with several antibiotics, including meropenem, amikacin, and clarithromycin, and his general condition improved. Cultures from both the mediastinal abscess and a pericardial patch that was placed at the time of surgery 5 years previously revealed MABC. In our case, the infected aortic aneurysm most likely resulted from MABC pulmonary disease rather than from previous intraoperative contamination. This route of infection is rare. Physicians should be aware of the possibility of dissemination and subsequent infection of implants related to MABC pulmonary disease.

DOI： 10.1016/j.jiac.2022.09.017

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Language：English   Publisher：エルゼビア・ジャパン(株)  

症例は81歳男性で、発熱と倦怠感を主訴に当院紹介となった。患者は10年前に大動脈弁逆流症による大動脈弁置換術、5年前に感染性心内膜炎による2回目の大動脈弁置換術を受け、同時に胃癌と診断され幽門側胃切除術を受けていた。2年前に肺NTM症と診断されていた。入院時の全身の外観はわずかに不良で肩と膝の関節痛を訴えていた。表在リンパ節は触診できなかった。血清アルブミン値の減少とCRP値の軽度上昇がみられた。9ヵ月前の胃癌フォローアップ造影CT検査で大動脈弁近傍の液体貯留が示されたが、無症状のため精密検査は実施されなかった。入院5日後に実施された造影CTで前縦隔内のリング状増強低密度領域、低密度領域近くの上行大動脈の偽動脈瘤、両側胸膜液が示された。右側胸膜液の穿刺により漏出性胸水が認められたが培養でNTMは検出されなかった。感染性大動脈瘤と縦隔膿瘍が示唆されたためバンコマイシンとメロペネムを投与した。血液培養で分離された抗酸菌は迅速発育菌であったためメロペネム/アミカシン/クラリスロマイシンに切り替えた。感染性動脈瘤破裂が認められ、緊急の大動脈置換術と縦隔膿瘍ドレナージを実施した。縦隔膿瘍と心膜パッチからMycobacterium abscessus subsp. massilienseが分離された。3剤治療により術後CRP値は低下し血液培養は陰性となり、2ヵ月後リハビリ病院へ転院した。

Language：English   Publisher：Journal of Infection and Chemotherapy  

A 53-year-old male Japanese patient with COVID-19 was admitted to our hospital after his respiratory condition worsened on day 9 of the disease. With the diagnosis of severe COVID-19, treatment with remdesivir, dexamethasone, and unfractionated heparin was started for the prevention of thrombosis. Although the patient's respiratory status data improved after treatment, severe respiratory failure persisted. Thrombocytopenia and D-dimer elevation were observed on day 8 after heparin therapy initiation. Heparin-induced thrombocytopenia (HIT) antibody measured by immunological assay was positive, and contrast computed tomography showed pulmonary artery thrombus. The patient was diagnosed with HIT because the pre-test probability score (4Ts score) for HIT was 7 points. Heparin was changed to apixaban, a direct oral anticoagulant, which resulted in a reduction of the pulmonary thrombus and improvement of the respiratory failure. In patients with COVID-19, anticoagulant therapy with heparin requires careful monitoring of thrombocytopenia and elevated D-dimer as possible complications related to HIT. (151/250 words).

DOI： 10.1016/j.jiac.2022.05.001

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