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A 57-year-old male visited the hospital's internal medicine department with a chief complaint of cognitive impairment for the past month. His Mini-Mental State Examination (MMSE) score was 23 points, exhibiting mild cognitive impairment. Brain magnetic resonance imaging (MRI) revealed no abnormalities; however, positive anti-SSA and anti-SSB antibodies were detected via bloodwork. To assess the patient for Sjögren's syndrome (SS), the internal medicine department referred the patient to our department. Lip biopsy detected infiltrates of more than 50 lymphocytes surrounding the duct of the minor salivary gland. Furthermore, the patient's brain single-photon emission computed tomography (SPECT) revealed a mild blood flow reduction within the frontal lobe, parietal lobe, and posterior cingulate gyrus on the right side. Findings from the patient's bloodwork and histopathological examination led to a diagnosis of SS. Other autoimmune diseases did not complicated the diagnosis, and the diagnosis was primary Sjögren's syndrome (pSS) accompanied by autoimmune encephalitis. After hospitalization by internal medicine physicians, pulse steroid therapy was initiated, and the patient displayed cognitive improvement, with an improvement in the MMSE score to 27 points. [ABSTRACT FROM AUTHOR]

Lusutrombopag is an oral platelet production promoter for thrombocytopenia in patients with chronic liver disease (CLD) that is usually administered before an invasive procedure. However, not all patients showed adequate platelet elevation. To the best of our knowledge, there is only one case report published so far on patients treated with lusutrombopag before tooth extraction. Here, we reported three cases of CLD complicated by thrombocytopenia treated with lusutrombopag before tooth extraction, whose platelet count (PLC) increased appropriately in two cases but did not rise in the third case, necessitating platelet transfusion. Case 1 was that of a 72-year-old male with cirrhosis, hepatocellular carcinoma, hypertension, chronic renal failure, and low PLC (4.7 × 104/μL). Case 2 was that of a 67-year-old female with cirrhosis, diabetes, and chronic renal failure, low PLC (3.6 × 104/μL). Both the PLCs of cases 1 and 2 increased appropriately after the administration of lusutrombopag, and we were able to perform extraction without platelet transfusion. Case 3 was that of a 56-year-old female with idiopathic portal hypertension, giant spleen, portal vein embolism, and systemic lupus erythematosus, whose PLC was reduced at 2.9 × 104/μL. Abdominal ultrasonography revealed an abnormal enlargement of the spleen. The PLC did not increase after lusutrombopag administration, and platelet transfusion was required during surgery in this case. Furthermore, PLC did not increase on the day after platelet transfusion. Therefore, this suggested that PLC did not increase by lusutrombopag or platelet transfusion because of splenomegaly caused by idiopathic portal hypertension. [ABSTRACT FROM AUTHOR]

A 67-year-old female presented at our hospital with an indolent tumor in the buccal mucosa region. A spherical and movable, elastic soft tumor of approximately 10 mm was found under the right buccal mucosa. Contrast-enhanced magnetic resonance imaging revealed a 14 × 13-mm mass with smooth edges and a non-uniform contrast effect. She was diagnosed with a benign tumor of the buccal mucosa region, and a tumorectomy was performed. Histopathological examination revealed a cyst-like enlargement with visible vasculature. Because the tumor was isolated, she was finally diagnosed with a venous aneurysm (VA). [ABSTRACT FROM AUTHOR]