Language：Japanese   Publisher：Heliyon  

Although mycobacterial adjuvants are capable of eliciting a strong adaptive humoral and cellular immunity, they also sometimes provoke detrimental outcomes, including autoimmune/inflammatory syndromes. Here, we show that the deletion of caspase recruitment domain family member 9 (Card9), a signaling adaptor of a set of innate immune receptors, can eliminate the detrimental effects of mycobacterial adjuvants. Long-lasting tissue-destructive skin inflammation at the site of complete Freund's adjuvant (CFA) injection, lung granuloma formation induced by intratracheal Mycobacterium bovis Bacillus Calmette-Guérin infection, and the incidence and severity of experimental autoimmune encephalomyelitis and collagen-induced arthritis induced by autoantigen immunization with CFA were considerably attenuated in Card9-deficient (Card9−/−) mice compared to control wild-type mice. Card9−/− mice showed impaired development of Th17, but not Th1, in the early phase after autoimmune induction, due to the impaired development of IL-6-producing Sirpαhigh dendritic cells, which are essential for priming pathigenic Th17, in the draining lymph nodes. However, Card9 deletion did not affect overall adaptive antibody production or delayed-type hypersensitivity following immunization with CFA, indicating that humoral and type 1 immune responses remained intact. These results suggest that avoiding the activation of Card9 signaling during vaccination with mycobacteria-containing vaccines may mitigate the risk of detrimental type 3 immune responses, while preserving type 1 immune responses that are effective against intracellular pathogens and cancers.

DOI： 10.1016/j.heliyon.2024.e38139

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Language：Japanese  

Cavitary lung lesions are uncommon radiological findings in cytomegalovirus pneumonia, and tissue biopsy is rarely performed for diagnosis. A 67-year-old man presented with a wet cough. Extensive white moss in the oral cavity was found on physical examination, and chest computed tomography revealed an approximately 4 cm cavitary lesion in the upper lobe of the right lung. Blood tests showed a critically low CD4+ T lymphocyte count and positivity for human immunodeficiency virus type 1 antibodies. A transbronchial biopsy of the cavitary lung lesion was performed, and inclusion bodies in the nuclei of enlarged alveolar epithelial cells were seen in the histopathological findings. Immunohistochemistry staining for cytomegalovirus was positive, and cytomegalovirus pneumonia was diagnosed. Ganciclovir treatment was initiated, and the symptoms and imaging findings resolved. Cytomegalovirus pneumonia can present as cavitary lung lesions in patients with acquired immunodeficiency syndrome, and a transbronchial biopsy is essentially useful for a definitive diagnosis.

DOI： 10.1002/rcr2.1392

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Language：Japanese  

A 75-year-old woman presented at our hospital with bilateral visual impairment. Ophthalmological examination revealed multiple choroidal tumours. Chest computed tomography revealed a tumour shadow in the right lower lobe and multiple lymph node metastases in the mediastinum and pulmonary hilum. Following a detailed examination, the patient was diagnosed with primary lung adenocarcinoma (cT1cN3M1c Stage IVB) with choroid metastases. The tumour proportion score of programmed death ligand 1 (PD-L1) was 1% and EGFR exon 20 insertion mutations were also detected. The patient was administered combination chemotherapy with nivolumab and ipilimumab. Primary lung and metastatic tumours, including the choroid, were reduced, and visual disturbances improved completely. Herein, we describe a rare case in which a combination of chemotherapy with nivolumab and ipilimumab significantly reduced vision loss due to choroidal metastasis.

DOI： 10.1002/rcr2.1262

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Language：Japanese   Publisher：(一社)日本結核・非結核性抗酸菌症学会  

症例は25歳女性。右眼の見えにくさを主訴に当院眼科を受診し,蛍光眼底検査で結核性ぶどう膜炎を疑われた。インターフェロンガンマ遊離試験(Interferon-gamma release assay:IGRA)が陽性であり,胸部単純X線検査で右上肺野に粒状影を認め,体幹部CTで右肺上葉S2に小葉中心性の粒状影と浸潤影を,左肺上葉にもわずかに粒状影を認めた。喀痰抗酸菌検査は陰性であり,経気管支生検でラングハンス型多核巨細胞を伴う壊死性肉芽腫を認めた。画像所見,IGRA陽性およびその他の検査結果とあわせて,肺結核および結核性ぶどう膜炎と診断した。抗結核薬の標準治療(イソニアジド,リファンピシン,エタンブトール,ピラジナミド)を開始し,治療2ヵ月後のCTで両側肺野の粒状影,浸潤影は消退傾向であった。右眼の症状については,経過中に硝子体出血を合併したため,硝子体手術を施行し,症状は回復した。結核性ぶどう膜炎は診断の遅れが失明につながる可能性がある。そのため,眼科と密な連携をとり,早期診断,早期治療介入を行う必要がある。(著者抄録)

Publisher：(NPO)日本呼吸器内視鏡学会  

背景. 気管支原発粘表皮癌は、唾液腺型肺癌に分類される稀な腫瘍である。症例. 26歳男性。血痰を契機に当院に入院となり、右上幹腫瘍および右上葉無気肺を指摘された。気管支鏡検査で右上幹入口部に表面平滑な結節を認め、自家蛍光気管支内視鏡画像ではマゼンタ色を呈していた。生検で確定診断に至らなかったが、悪性疾患の可能性が高いと判断した。当院呼吸器外科にて胸腔鏡補助下右上葉スリーブ切除を施行し、低悪性度気管支原発粘表皮癌の診断に至った。結論. 若年男性に発症し、右上葉スリーブ切除を行った気管支原発粘表皮癌の症例を経験した。完全切除された気管支原発低悪性度粘表皮癌は予後良好とされているが、再発の有無について注意深い経過観察が必要である。(著者抄録)

Language：Japanese   Publisher：(一社)日本結核・非結核性抗酸菌症学会  

症例は25歳女性。右眼の見えにくさを主訴に当院眼科を受診し,蛍光眼底検査で結核性ぶどう膜炎を疑われた。インターフェロンガンマ遊離試験(Interferon-gamma release assay:IGRA)が陽性であり,胸部単純X線検査で右上肺野に粒状影を認め,体幹部CTで右肺上葉S2に小葉中心性の粒状影と浸潤影を,左肺上葉にもわずかに粒状影を認めた。喀痰抗酸菌検査は陰性であり,経気管支生検でラングハンス型多核巨細胞を伴う壊死性肉芽腫を認めた。画像所見,IGRA陽性およびその他の検査結果とあわせて,肺結核および結核性ぶどう膜炎と診断した。抗結核薬の標準治療(イソニアジド,リファンピシン,エタンブトール,ピラジナミド)を開始し,治療2ヵ月後のCTで両側肺野の粒状影,浸潤影は消退傾向であった。右眼の症状については,経過中に硝子体出血を合併したため,硝子体手術を施行し,症状は回復した。結核性ぶどう膜炎は診断の遅れが失明につながる可能性がある。そのため,眼科と密な連携をとり,早期診断,早期治療介入を行う必要がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本呼吸器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本呼吸器内視鏡学会  

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：(一社)日本呼吸器学会  

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