A 25-year-old female first developed fever and purpura in 1994. In October of 1998, hyper-γ-globulinemia, dry mouth, and lymphocyte infiltration in the labial salivary gland were observed, and the patient was diagnosed with Sjögren syndrome. In May of 1999, a subcutaneous induration formed in the right thigh during the course of observation. A biopsy revealed infiltration of atypical lymphocytes in the subcutaneous tissue and fascia, and reconstruction of T cell receptors was also confirmed. The involvement of EB virus was detected by in situ hibridization, and the patient was diagnosed with EB virus-associated subcutaneous T cell lymphoma. Radiotherapy and combination chemotherapy were performed, but the disease did not resolve, and the patient died of immunodeficiency-induced Aspergillus pneumonia two years after the diagnosis.
The patient was a 64-year-old woman with edematous erythema over the bilateral palpebra and the buccal region. Although we at first suspected a collagen disease, sarcoidosis, contact dermatitis, angioedema, erysipelas, or superior vena cava syndrome, the diagnosis of Basedow’s disease was finally made on the basis of the laboratory results of biochemical profiles and thyroid functional tests as well as the histopathologic findings. We concluded that her dermatosis was due to Basedow’s disease because it disappeared soon after treatment with thiamazole. Hyperthyroidism is known to rarely induce skin lesions such as those observed in our case, so we should check whether or not a patient has hyperthyroidism when we observed skin lesions such as edema in the eyelids with unknown reasons.
A 4-month-old girl was afflicted with a dome-shaped subcutaneous tumor of about 2 cm in diameter protruding below the left eyelid. The tumor first appeared at about 2.5 months after birth. At initial presentation, a reddish-brown infiltration containing numerous nodules was observed on the patient’s chest and abdomen. The skin biopsy revealed uniform dense infiltration of atypical mononuclear cells in the dermis and subcutaneous tissue. A bone marrow puncture esfablished a diagnosis of acute monoblastic leukemia (M5a by FAB classification). Although the skin symptoms disappeared about one week after the introduction of chemotherapy, the disease was complicated by infection and DIC, and the patient died two months after the initial diagnosis. We review other case reports of leukemia cutis in infants in Japan.
A statistical survey was made of 36 patients with sporotrichosis seen at the Dermatological Clinic of Tokai University Hospital during the years from 1975 to 2001. Females were more often affected. Patients under 10 were more often affected on the face and those from 50 to 80 were more offen affected on the upper extremities. Of the patients, 83.3% were brought to our clinic within a year after the first eruption. Thirty-two patients (88.9%) were treated with oral administration of potassium iodide. The adult average total potassium iodide dose and period for therapy were 100.4±88.0 g and 84.1±49.9 days, respectively. Those of children were 1.78±0.85 g/kg, and 68.5±23.0 days respectivery. We compared our results with those of other reports.
Highly Active Antiviral Therapy (HAART), involving the concurrent administration or three or more antiviral agents, is among the methods currently used to treat HIV-positive patients. In the present report, we examine the incidence of skin conditions seen in some 205 patients who underwent HAART between the years of 1996 and 2002 at Tokyo Medical University Hospital. The individual components of HAART were varied because of the emergence of drug resistant strains of virus. An average of 2.2 doses was administered per patient for a total of 451 sessions. Of the 205 patients, 76 (37.1%) developed skin conditions thought to have been the result of HAART. The total number of occurrences was 109, consisting of maculopapular eruptions (43/451 instances, or 9.5%), eczema (18/451 instances, or 4.0%), acneiform (14/451 instances, or 3.1%), Stevens-Johnson Syndrome (4/451 instances, or 0.9%), ingrown nail (18/451 instances, or 4.0%), and other (12/451 instances, or 2.7%). Although it was clearly established that numerous skin conditions occurred as sideeffects of HAART, we were unable to establish whether all of the conditions identified were the direct results of the drug therapy, owing to the fact that the gravity of the primary illness prohibited experimental manipulation of the drugs or dosages.