Although the research trends in studying Behçet’s disease (BD) were reviewed in this Journal in 2002, I would again like to introduce the articles from the point of view of the latest research results for BD pathogenesis, the newly revised diagnostic criteria, and the current treatments. The number of BD patients registered with the Japanese Ministry of Health, Labour and Welfare reached nearly 20,000. The sequence based tying of the HLA gene revealed that HLA-B51 and its HLA-B*510101 allele were significantly associated with BD immunopathogenesis as the intrinsic factor, suggesting that BD might be distributed from the Mediterranean countries to the Far East. Streptococcus (S.) sanguinis (old classification: S. sanguis), which is freguently isolated from the oral cavity of BD patients, is suspected to be one of the external factors triggering the BD symptoms in the pathogenesis, because BD patients have intense hypersensitive reactions to S. sanguinis related materials. The heat shock protein (HSP)-65 derived from S. sanguinis is found to cause human HSP-60 in the sera of patients who have some peptides homologous to HSP-65. Although it has been thought that these homologous regions may enhance the inflammation of BD lesions, it is suggested that some regions can reduce the production of inflammatory cytokines, such as IL-12, IL-6, IL-8, TNF-α, etc., from peripheral blood mononuclear cells (PBMC) of BD patients. It is found that these homologous regions were also homologous to the epitope of T cells of BD patients. Lehner and his research group, UK, have recently demonstrated that the clinical tolarization could be induced to the advanced uveitis of BD patients for treatment by use of the homologous peptides (p336–351) combined with choleratoxin B. Regarding to the immunological condition of BD patients, it has been cleared that cytotoxic T cells, CD3+, CD8+T cells and γδT cells including CD69+ cells, are accelerated in active disease stage of the patients and that they are stable in the remission. The newly revised diagnostic criteria (2003) which may be able to investigate the quality of life (QOL) and the prognosis of BD patients and the treatments for BD patients with various clinical types including biological treatments using anti-TNF-α and anti-IL-6 antibodies are introduced here.
The differences between Stevens-Johnson Syndrome (SJS) in pediatric and adult patients were studied by investigating cases of SJS (123 cases of children, 208 cases of adults) reported from 1981 to February of 2004 in Japan. Drugs were reported as the cause of SJS in 48.8% of the pediatric patients and in 76.9% of the adult patients. Mycoplasma infection was considered as the cause of SJS in 27.6% of the pediatric patients, but in only 5.3% of the adult patients. Mycoplasma infection did not progress to toxic epidermal necrolysis in any of the patients. No significant differences were recognized between the two groups in the frequencies of internal lesions (liver dysfunction, respiratory dysfunction and others) or sequelae. Mortality was 0.8% in pediatric patients and 8.2% in adult patients.
We reported five cases of tinea corporis and two cases of tinea capitis caused by Trichophyton tonsurans (T. tonsurans) in judo and sumo wrestlers. Skin and/or hair samples from all the patients were examined by microscopic examination with 10% KOH and cultured in Sabouraud’s dextrose (2%) agar. Furthermore, PCR-RFLP analysis was performed to identify the fungal strains. All of these isolates were determined to be T. tonsurans. All seven patients noticed that their teammates or competitors also had similar skin eruptions, indicating that T. tonsurans spread through judo and sumo practice matches. This is the first report of a T. tonsurans epidemic in sumo teams. We should take prompt measures to prevent the spread of the T. tonsurans epidemic, particularly in body contact sports.
A 34-year-old male with pharyngitis, rhinorrhea and mild fever developed generalized purpura, particularly on the palms and soles, 30 minutes after the second intravenous injection of clindamycin 600 mg/day. Histological examination of the involved skin on the extensor surface of the right thigh revealed endothelial cell swelling and a dense infiltrate composed of neutrophils showing fragmentation of nuclei in the upper dermis, permitting a pathologic diagnosis of leukocytoclastic vasculitis. The eruption subsided following withdrawal of the drug and rest. A patch test, intradermal test and drug-induced lymphocyte stimulation test (DLST) with clindamycin were negative. An oral challenge test with 150 mg of clindamycin provoked a flare-up of the eruptions on the soles. This is the first report of clindamycin-induced cutaneous vasculitis in Japan.
We report three cases of basal cell carcinoma (BCC) successfully treated with radiotherapy. Case 1 was an 85-year-old female with a partly-pigmented tumor located at the right internal eye angle. Case 2 was a 65-year-old male who had a tumor attached to the left side of the anus. It was 6 cm in diameter, with a non-pigmented ulcer. Case 3 was a 79-year-old female with a non-pigmented tumor at the right nasolabial groove. After the radiotherapy, the size of the tumor in Case 1 showed a remarkably reduced and could then be easily excised. In Cases 2 and 3, the tumor completely disappeared after the radiation, as confirmed by histological examination. Most BCCs that occur in Japanese patients are pigmented and are surgically treated, because radiotherapy is ineffective against tumors with melanin pigment. Based on our experiences of successful treatment, radiotherapy for non-pigmented BCC should be more often used with patients requiring a better cosmetic and functional outcome after treatment.