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We report a case of a 73-year-old man diagnosed with pulmonary pleomorphic carcinoma who showed profound durable response after a single treatment with pembrolizumab. The patient underwent a diagnostic workup in our hospital due to a hoarseness of voice. Chest computed tomography revealed a massive pulmonary tumor in the left upper lobe and multiple nodules in the both lung fields. Histological examination of a transbronchial lung biopsy specimen revealed pulmonary pleomorphic carcinoma. First-line treatment with pembrolizumab was discontinued after a single administration due to treatment-related pneumonitis. However, durable response has been observed over 17 months to date.

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Thrombotic thrombocytopenic purpura (TTP) is rare complication resulting from adult-onset Still’s disease (AOSD). We report the case of a 69-year-old Japanese man who initially presented with fever and joint pain and was diagnosed as having concurrent AOSD with TTP 1 month later. He had extremely high ferritin levels (32 696 ng/mL). He initially responded to plasma exchange but subsequently died of septic shock. AOSD accompanied by extremely high ferritin levels might be considered a sign of concurrent TTP.

Background The BNT162b mRNA vaccine for coronavirus disease 2019, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mimics the immune response to natural infection. Few studies have predicted the adverse effects (AEs) after the second-dose vaccination. We present a predictive model for AEs and immune response after the second-dose of the BNT162b mRNA vaccine. Methods To predict AEs, 282 healthcare workers (HCWs) were enrolled in this prospective observational study. The classification and regression tree (CART) model was established, and its predictive efficacy was assessed. To predict immune response, 282 HCWs were included in the analysis. Moreover, the factors affected by anti-SARS-CoV-2 spike protein RBD antibody (s-IgG) were evaluated using serum samples collected 2 months after the second-dose vaccination. The s-IgG level was assessed using Lumipulse G1200. Multiple regression analyses were conducted to evaluate variables associated with anti-s-IgG titer levels. Results The most common AEs after the seconddose vaccination were pain (87.6%), redness (17.0%) at the injection site, fatigue (68.8%), headache (53.5%), and fever (37.5%). Based on the CART model, headache after the first-dose vaccination and age < 30 years were identified as the first and second discriminators for predicting the headache after the second-dose vaccination, respectively. In the multiple linear regression model, anti-s-IgG titer levels were associated with age, female sex, and AEs including headache and induration at the injection site after the second-dose vaccination. Conclusion Headache after the first-dose vaccination can be a predictor of headache after the seconddose vaccination, and AEs are indicators of immune response.

A 70-year-old woman was referred to our hospital after a nodular shadow was noted on chest X-ray. Chest computed tomography showed a pulmonary mass in the right upper lobe, and brain magnetic resonance imaging revealed a right-sided frontal lobe tumor. A histological examination of a transbronchial lung biopsy specimen revealed adenocarcinoma with epidermal growth factor receptor mutations involving both exon 19 deletion and exon 20 insertion. After stereotactic radiotherapy for brain metastasis, the patient was treated with afatinib, which resulted in a complete response. We observed a case in which a patient had non-small cell lung cancer with compound EGFR mutations involving both exon 19 deletion and exon 20 insertion mutations that responded well to afatinib therapy.

Patients with fibrosing interstitial lung disease (FILD) have poor health-related quality of life (HRQOL). We analyzed predictors of short-term improvement of HRQOL after starting pulmonary rehabilitation (PR) in moderate to severe FILD patients. This study involved 28 consecutive patients with FILD (20 males, median age of 77.5 years), who participated in PR program of our hospital for >6 weeks. The St. George’s Respiratory Questionnaire (SGRQ) score and the 6-min walk distance (6MWD) were evaluated before and after PR, and the predictors of efficacy of PR were analyzed. The duration from diagnosis of FILD to start of PR showed a positive correlation with the increase in the SGRQ score, and the baseline SGRQ score showed a negative correlation with increase in the 6MWD. The FILD subtype, modified Medical Research Council score, and treatment history were not associated with the endpoints. According to the receiver operating characteristic curve (ROC) analyses, starting PR within 514 days after diagnosis of FILD was a significant favorable predictor of improvement in the SGRQ total score more than a minimal clinically important difference of 4. In this study, early intervention of PR and lower SGRQ score were associated with the favorable response to PR. PR for FILD should be initiated early before the disease becomes severe.

Introduction Post‐nasal drip (PND)‐induced cough is a common cause of chronic cough. However, there is little known about the characteristic physical findings of this condition. Objectives We investigated views of the pharyngeal wall in patients with PND‐induced cough using a handy endoscopic images. Methods The subjects were 135 consecutive patients referred to our hospital with a sensation of something “dripping down the throat” as one of their symptoms. Physical findings for the oropharynx were examined using Wi‐Fi endoscope camera. The difference in probability of symptoms in patients with acute cough and those with subacute/chronic cough was assessed using a Bayesian Fisher exact test on a 2 × 2 table. Results Among the patients, 105 (78%) complained of cough, 78 (58%) of acute cough, 20 (15%) of subacute cough, and 7 (5%) of chronic cough; and 71 (53%) had coexisting asthma. Using Bayesian inference, a sore or scratchy throat and fever were more common in patients with acute cough than in those with subacute/chronic cough. In endoscopic images of the oropharynx, a reddish curtain sign on the posterior pharyngeal wall behind the palatopharyngeal arch was found in 121 patients (90%). Conclusion Patients with acute PND‐induced cough have a component of acute upper respiratory infection, because of high probability of a sore or scratchy throat and fever as symptom. A reddish curtain sign may be a useful finding for identifying PND‐induced cough in these cases.