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Volume 66 (2004)
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Volume 66, Issue 2
Displaying 1-19 of 19 articles from this issue
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Clinical Case Reports
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Takashi MIYAKURA, Nanako YAMADA, Akiko YAMAMOTO, Masahiko ISHIHARA, Mo ...2004 Volume 66 Issue 2 Pages 113-116
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 71-year-old man with anaphylactoid purpura was reported. The lesions occurred on the lower legs and forearms, and they showed palpable purpura. The biopsy specimen obtained from the right lower leg showed necrotizing angitis of the blood vessels in the almost whole dermis. In immunofluorescence, slight deposit of IgA was detected in the blood vessel wall in the lower dermis. Thereafter nephrotic syndrome and renal cell carcinoma were found as complications. Thus anaphylactoid purpura in the aged may be referred to as one of the dermadromes for internal malignancy.View full abstractDownload PDF (3958K) -
Masayo NOMURA, Yoichiro HAMASAKI, Hirotsugu YAMANOUCHI, Ichiro KATAYAM ...2004 Volume 66 Issue 2 Pages 117-120
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe report two cases of systemic sclerosis with sarcoidosis. First case is a 65-year-old Japanese female with the limited type of systemic sclerosis, and lupus pernio-type cutaneous sarcoidosis. The other patient is a 55-year-old Japanese female with the limited type of systemic sclerosis and erythema nodosum type-cutaneous sarcoidosis. Both cases had positive anti-HTLV-1 antibody without leukemic changes and sarcoid lesions other than cutaneous sarcoidosis. These cases are of interest because sarcoidosis is seldom accompanied by an autoimmune disease or triggered by a virus infection. HTLV-1 integration might play some role in induction of sarcoidosis and systemic sclerosis.View full abstractDownload PDF (2671K) -
Shinya YAMANAKA, Makiko ODA, Mariko SEISHIMA2004 Volume 66 Issue 2 Pages 121-123
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 57-year-old woman developed general fatigue in December 1998 and was diagnosed with autoimmune hepatitis based on increased serum levels of transaminases, positive antinuclear antibody and anti-smooth muscle antibody. Treatment with prednisolone resulted in the improvement of symptoms and restoration of serum transaminase levels to the normal ranges. Prednisolone was gradually reduced and discontinued in December 2002. Thereafter, thirst, arthralgia, facial erythema and dry eyes appeared. Sjögren syndrome was diagnosed based on abnormal findings on Saxon test, Schirmer's test and positive anti-SS-A antibody. Symptoms improved after readministration of prednisolone. It is suggested that early diagnosis and initial treatment are critical for a Sjögren syndrome patient with liver dysfunction since prednisolone is effective for autoimmune hepatitis.View full abstractDownload PDF (3888K) -
Saori MIYAWAKI, Iwao ISOMURA, Akimichi MORITA, Shigeru SAKAKIBARA2004 Volume 66 Issue 2 Pages 124-127
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 21-year-old woman noticed ocular and oral dryness in 1992. She presented with small red papules on her trunk and extremities in March 1993. Based on a positive Schirmer's test, decreased salivary secretion and lymphocytic infiltrates in the salivary glands, she was diagnosed as having Sjögren's syndrome. Skin biopsy specimen of a red papule revealed dense nodular infiltration of lymphocytes in the dermis and subcutis with lymphoid follicle formation. Atypical lymphocytes were not observed. Immunohistochemical findings showed that L26 positive B cells were located in the follicular center which was surrounded by UCHL-1 positive T cells. We made a further diagnosis of pseudolymphoma associated with Sjögren's syndrome. Sjögren's syndrome is often associated with various B cell proliferations. Pseudolymphoma in this case might be a transient state form polyclonal to monoclonal B cell activation that might develop into malignant lymphoma.View full abstractDownload PDF (4147K) -
Rie HAMADA, Masato IWAGAKI, Kimiko NAKAJIMA, Mitsunori IKEDA, Hajime K ...2004 Volume 66 Issue 2 Pages 128-131
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSSixteen months after administration of D-penicillamine, pemphigus foliaceus-like skin lesions with histopathological characteristics of pemphigus vulgaris appeared on a 53-year-old female. Immunoblotting studies revealed positive anti-desmoglein (Dsg)-1 antibody and negative anti-Dsg-3 antibody, while ELISA showed positive anti-Dsg-1 and anti-Dsg-3 antibodies. Even after stopping the administration of D-penicillamine, vesicle formation continued. The skin lesions were well controlled by systemic corticosteroid administration, but recurred after tapering the dose of corticosteroid. At the time of recurrence, anti-Dsg-1 was positive but anti-Dsg-3 antibody was negative, indicating that the ligand for the anti-Dsg-3 antibody was drug-modified Dsg-3 and that the anti-Dsg-1 antibody was continuously synthesized. The patient had positive anti-nuclear antibody (diffuse type) and anti-cytoplasmic antibody, suggesting that she was prone to produce autoantibodies. The acantholytic cells were characteristically degenerated, but the process of their apoptosis was obscure.View full abstractDownload PDF (2476K) -
Kyoko MIZOGUCHI, Youichiro HAMASAKI, Hiroyuki MUROTA, Yasuhiro HORIUCH ...2004 Volume 66 Issue 2 Pages 132-134
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 69-year-old woman presented at our outpatient clinic with burning pain, swelling and local heat on her left ankle. Our initial diagnosis was phlegmon on the basis of surgical aspiration with suspected bacterial infection. However, clinical manifestations were not consistent with this diagnosis. Her body temperature remained normal and laboratory tests did not reveal any infectious sign. We administered oral antibiotics and undertook further intensive laboratory examinations. Subsequently, cryoglobulinemia was demonstrated through polyclonal IgG and IgM that were revealed by immunoblotting analysis. Our final diagnosis was type III cryoglobulinemia masquerading as phlegmon. We speculate that this patient had repeatedly cooled her ankle with a cold epithem, resulting in phlegmon-like lesion. We would like to propose care in excluding a diagnosis of cryoglobulinemia in an HCV career.View full abstractDownload PDF (3042K) -
Tomotaka MABUCHI, Emiko AKASAKA, Yoshinori UMEZAWA, Yukinori OHTA, Mar ...2004 Volume 66 Issue 2 Pages 135-137
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe report a case of 42-year-old male with eruptive xanthoma. He noticed skin eruption on his right forearm at first. The skin eruption spread over his whole body within 5 days. The skin eruption consisted of numerous yellowish and reddish papules on his trunk and extremities, especially on his elbows and knees. He had been treated for schizophrenia from the age of 25. The laboratory findings showed glycosuria (+++) and an increased level of triglyceride 12080 mg/dl, total cholesterol 1080 mg/dl, chylomicron (++), LDL 1900 mg/dl, VLDL 3500 mg/dl, glucose 420 mg/dl and HbA1C 16.5%. The histopathological examination revealed a mass of foam cells and perivascular infiltration of inflammatory cells in the dermis. The patient had a diagnosis of eruptive xanthoma with severe type V hyperlipidemia and diabetes mellitus. We treated this patient with diet therapy, antilipemic and antidiabetic drugs. Seven months later, the papules almost disappeared. Abnormal dietary habit due to schizophrenia and pharmacological action of antipsychotic drug caused hyperlipidemia with eruptive xanthoma.View full abstractDownload PDF (3312K) -
Rie HAMADA, Fuminori IKENO, Maki YOKOGAWA, Mitsunori IKEDA, Hajime KOD ...2004 Volume 66 Issue 2 Pages 138-140
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 33-year-old man had an 18 × 18 mm, dome-shaped tumor covered with intense telangiectasia on the temporal region. Findings of biopsy specimen were compatible with malignant fibrous histiocytoma (MFH), with prominent proliferation of highly atypical fibroblast-like and histiocyte-like cells from the dermis to the fascia. Pleomorphic and bizarre multinucleated giant cells and atypical mitotic figures were also observed. Three courses of chemotherapy comprising intravenous administration of caffeine, cisplatin and adriamycin were administered after tumor resection. As of 15 months after surgical resection, no recurrence has been detected. Effects of this combination chemotherapy for MFH should be studied in a large number of patients in the future.View full abstractDownload PDF (3417K) -
Tomoko MORI, Osamu YAMAMOTO, Yoshiki TOKURA, Yoshinori SUENAGA2004 Volume 66 Issue 2 Pages 141-146
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 68-year-old man presented with more than 30 brownish papules up to 2 mm in diameter on the penis. Histologically, there were marked hyperkeratosis and acanthosis with prominent granular degeneration. The eruption was diagnosed as localized multiple epidermolytic acanthoma. We immunohistochemically studied the expression of various antigens in the specimen along with epidermal nevus with granular degeneration, exhibiting bullous congenital icthyosiform erythroderma, and normal skin. Cytokeratin (CK) 10 and CK1 were not homogeneously distributed in the disordered granular layer, in comparison with the normal granular layer. CK17 was partly stained in the granular layer of the localized multiple epidermolytic acanthoma, but not in the other two diseases, carcinoembryonic antigen was expressed not only in the disordered granular layer but also in the adjacent normal-appearing granular layer. Therefore, we considered that the epidermis surrounding the papules had the same abnormality as the lesional skin.View full abstractDownload PDF (8391K) -
Takamitsu MAKINO, Shunji HIRAI2004 Volume 66 Issue 2 Pages 147-152
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSThis is a report of three cases of severe soft tisssue infection due to group A or group C streptococci. Case 1 was a 60-year-old male who had a high fever and bulla on his right arm and swelling on his left lower leg. Case 2 was a 73-year-old female who developed painful swelling and bulla on her left foot. Case 3 was a 32-year-old female who had a high fever and severe pain in her left knee and redness of her right knee. All cases presented cellulitis with redness, bulla, and edema. Skin swabs, drainage or content of bulla yielded Gram-positive cocci in chains by Gram's stain before antibioctic therapy. A culture of a skin lesion from cases 1 and 3 yielded group A streptococci and from case 2 yielded group C streptococci. Antibiotic therapy with high dose of ABPC-8g daily, and intravenous gamma globlin were effective. Surgical treatment was not needed. An early diagnosis of streptococcal infection by Gram's stain and culture and appropriate antibiotic therapy are extremely important for treatment of streptococcal infections.View full abstractDownload PDF (4403K) -
Taro SHINOGI, Noriyuki MISAGO, Yutaka NARISAWA, Yasuyuki SUZUKI, Takuy ...2004 Volume 66 Issue 2 Pages 153-156
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSTwo dairy farmer's children were brought to Sasebo Kyousai Hospital due to alopecia. A KOH examination of their hair revealed ectothrix parasitism. The colony was very slow growing. We identified the fungus to be Trichophyton verrucosum based on its morphology and nutritional requirements. Ribosomal DNA restriction fragment length polymorphism patterns were compatible with T. verrucosum. After diagnosing tinea capitis, we treated the patients with terbinafine hydrochloride cream. However, this caused a worsening of the lesions. After oral administration of terbinafin of 2 mg/kg/day, their cutaneous lesions improved.View full abstractDownload PDF (4778K) -
Kenjiro NAMIKAWA, Toru OGAWA, Takehiko TSUDA, Sigeruko IIJIMA, Toshio ...2004 Volume 66 Issue 2 Pages 157-164
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe herein report a rare case of 58-year-old female with localized cutaneous cryptococcosis, who had received chemotherapy and prednisolone for lung cancer with multiple metastases of bones and brain. The patient had been injured due to a trauma at the frontal aspect of her right lower leg one month before her first visit to our clinic. The wound progressively worsened and had developed into a deep ulcer, even though it had been treated with washing, debridement and various kinds of ointments. The histopathology of the ulcer revealed numerous oval-shaped bodies in the whole dermis and subcutaneous tissue. The bodies showed uneven and weaker staining with eosin than red blood cells. These bodies varied in size, but they were either the same size or smaller than red blood cells. The tissue culture yielded creamy white colonies, consisting of cells with their characteristic capsules as observed by direct microscopy using an Indian ink mount. The serological type of the yeast isolated from the tissue was A and the serological soluble antigen was positive. No other lesions were detected and we therefore diagnosed the patient as localized cutaneous cryptococcosis. The skin lesion was successfully treated with aggressive debridement and the administration of oral itraconazole at a dose of 200 mg a day for one month.View full abstractDownload PDF (3105K) -
Takashi MASU, Takahiko TSUNODA, Manabu SAKURAI, Toshiyuki TAKAHASHI2004 Volume 66 Issue 2 Pages 165-168
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 40-year-old woman developed itchy infiltrative erythema on her trunk and extremities after two months of taking a low dose contraceptive for irregular menstruation. Clinically her eruption was diagnosed erythema multiforme by medical examination. Histopathological examination showed abundant eosinophilic infiltration in the upper dermis. The eruption subsided rapidly after cessation of the pill, but slight pigmentation remained. The contraceptive she took was composed of ethinylestradiol and levonorgestrel. Patch testing revealed a much stronger reaction to levonorgestrel than to ethinylestradiol. Control patch test showed no positive reactions to these components. Immediate or delayed hypersensitivity to progesterone was not found. Therefore, we supposed that levonorgestrel was responsible for her drug-induced eruption. This is second report of drug eruption due to a low dose contraceptive.View full abstractDownload PDF (3824K) -
Miwa ASHIDA, Youichirou HAMASAKI, Kazuhiro SHIMIZU, Ichiro KATAYAMA, R ...2004 Volume 66 Issue 2 Pages 169-174
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 73-year-old woman presented with a 6-month history of the atrophic erythema on the trunk and extremities. Histological findings led to the diagnosis of parapsoriasis en plaque and/or drug eruption in response to amlodipine. Three months later, she was found to have an opportunistic infection of the lung and treatment with antibiotics was started. After recovery from drug allergy to Sennoside, the patient developed widespread maculopapular erythematous plaques which became ulceronecrotic lesions with high fever. No beneficial clinical effect was achieved through initial treatment with minocycline hydrochloride and high dose-steroid pulse therapy. Treatment with sulfamethoxazoletrimethoprin was started due to a flare-up of pulmonary nocardiosis, which brought about progression to new flares of the ulceration, resulting in a fatal outcome. We diagnosed this case as febrile ulceronecrotic Mucha-Habermann's disease presenting with hypersensitivity to many drugs.View full abstractDownload PDF (4933K) -
Yukiko MORITA, Teruyuki MITSUMA, Miho IWAI2004 Volume 66 Issue 2 Pages 175-177
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 65-year old woman had been admitted to the internal medicine department of our hospital for treatment of fever of unknown origin. She was referred to us for painful erythematous nodules of her fingers. Pathological examination revealed superficial vasculitis; thus, we diagnosed the condition as Olser's nodes. Endocardiography showed evidence of infectious endocarditis (IE). Most of the nodules disappeared after treatment with antibiotics. Because the opportunity for a dermatologist to see a case of Osler's nodes is rare, it is important for dermatologists to be aware of the skin symptoms of IE.View full abstractDownload PDF (3531K)
Clinical and Investingative Report
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Hidezumi KIKUCHI, Shinichirou TSUMORI, Motoki KUROKAWA, Mitsuru SETOYA ...2004 Volume 66 Issue 2 Pages 178-182
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSCutaneous angiosarcoma without edema of the scalp and face mostly occurs in elderly patients. It has a poor prognosis because of metastasis even at an early stage. We studied the clinical aspects, including treatment, of 9 cases of angiosarcoma diagnosed at our university hospital between April 1991 and March 2003. The male to female ratio was 8 : 1 at the time of diagnosis, the patients ranged in age from 60 to 77 years (mean 68.7). The tumors were mostly located on the scalp. At the first visit, all patients had reddish-violet macules and 8 had maculonodules. All were treated with interleukin-2 and wide electron beam irradiation; only 2 cases underwent surgery. At the time of this report, 3 patients were still alive. Of the 18 cases who have been treated at our university hospital since 1980, the average survival time of 17 cases was 23.6 months (range 1 to 120 months). One patient was excluded from analysis because treatment was only recently initiated. The cumulative 5-year survival rate was 14.1%. The cumulative 5-year survival rate of the 8 patients since 1980 who were treated with interleukin-2 injections and wide electron beam irradiation without surgery was 18.8%. This is similar to reports of those treated with surgery at other institutions. Accordingly, we conclude that surgical treatment for this type of angiosarcoma is not needed.View full abstractDownload PDF (381K)
Statistics
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Shinako KANAMORI, Tomoko NAGATA, Hiroshi UEZATO, Shigeo NONAKA2004 Volume 66 Issue 2 Pages 183-187
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSBullous pemphigoid (BP) is an autoimmune bullous skin disease of the elderly and is associated with a considerable case-fatality rate. The authors investigated the treatment and prognosis of patients with this disorder who visited the Dermatology Clinic, Ryukyus University Hospital, Okinawa, between 1988-2003. Fifty-seven percent of 26 patients were female. The mean age at the first visit was 72.6 years and mean follow-up was 39 months. Of the 26 patients, 16 cases (62%) were treated with systemic glucocorticosteroids alone, 2(8%) with diaphenylsulfone and glucocorticosteroids, 4(15%) with cyclosporin and glucocorticosteroids, 2(8%) with minocycline and nicotinamide, and 2(8%) with topical glucocorticosteroids, minocycline and nicotinamide. The fatality rate was 42%. Of the 24 patients, 5(21%) died in the first year after diagnosis. The main cause of death was pneumonia.View full abstractDownload PDF (623K)
Therapy
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Yoshiki Tokura, Tomoko Mori, Kunio Izu, Masahiro Takigawa2004 Volume 66 Issue 2 Pages 188-191
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESS
Collection
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9999 Volume 66 Issue 2 Pages 210
Published: 9999
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSDownload PDF (76K)
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