Tumor necrosis factor receptor-associated factor 3 (TRAF3) is an anti-inflammatory molecule that negatively regulates the non-canonical nuclear factor-κB pathway. Although TRAF3 haploinsufficiency (TRAF3 HI) can influence innate and adaptive immune cells, its effect on inflammatory bowel disease (IBD) development remains unclear. Here, we report the first case of severe early-onset IBD with a novel TRAF3 variant leading to HI, successfully treated with ustekinumab. A 6-year-old girl with a recurrent parotitis, otitis media, tonsilitis, and atopic dermatitis developed IBD involving the stomach, small intestine, and colon. At diagnosis, the immunoglobulin (Ig)G and IgA levels were relatively high, and lymphocyte subsets showed increased counts of plasmablasts, class-switch recombination B cells, and circulating T-follicular helper cells. Treatment with azathioprine and infliximab failed to maintain remission marked by several relapses accompanied by erythema nodosum and arthritis; however, ustekinumab, an anti-interleukin (IL)-12/23p40 antibody, led to long-term clinical remission, normalizing the Ig level and reducing abnormal lymphocyte counts. Whole-exome sequencing revealed a novel heterozygous mutation in TRAF3 [p.(Pro487Leufs*8)], resulting in TRAF3 under-expression. Our case may highlight the contribution of TRAF3 HI to the development of IBD and provide insights into IBD pathophysiology, suggesting the involvement of the IL-12/23-T-follicular helper cell pathway affected by genetic mutations.

Objective: Cardiac arrest (CA) has been observed in some patients with Takotsubo syndrome (TTS), most of whom had CA at the initial presentation of TTS. The objective of this report was to discuss the factors underlying the onset of this syndrome.Case presentation: A 72-year-old woman with refractory antineutrophil cytoplasmic autoantibody-associated lung disease was referred to our hospital. Twenty minutes after bronchoscopic examination, cardiopulmonary arrest suddenly occurred. Resuscitation immediately resumed her heartbeat and spontaneous breathing. Subsequent 12-lead electrocardiography, echocardiography, and left ventricular angiography revealed TTS.Conclusion: This case indicates that bronchoscopy can cause severe TTS, especially in patients with systemic inflammation.

Visceral fat accumulation is a notable risk factor in the incidence of lifestyle-related diseases such as metabolic and circulatory disorders. In this study, we measured visceral fat area (VFA) and subcutaneous fat area (SFA) in rugby football players by using dual bioelectrical impedance analysis, as well as other metabolic and circulatory parameters. A total of 28 male players (15 forwards, 13 backs; mean age±SD: 23±4 years) participated in this study. VFA and SFA were significantly correlated with body weight. Thus, heavier players had higher VFA and SFA as well as higher body weight. In addition, VFA was significantly correlated with various blood parameters such as alanine aminotransferase, gamma-glutamyl transpeptidase, and triglyceride. Six of the 28 players met the criteria for visceral obesity, defined as both body mass index ≥25 kg/m² and VFA ≥100 cm². In some of these players, blood parameters such as high-density lipoprotein cholesterol <40 mg/dL, triglyceride ≥150 mg/dL, or systolic blood pressure ≥130 mmHg indicated elevated risk for metabolic syndrome. These findings suggest that in athletes like heavier rugby football players, abdominal visceral fat accumulation may indicate risk of lifestyle-related diseases.