62 specimens of tick bite with tick were examined to establish histopathologic diagnostic criteria. The most common histopathologic findings are extravasation of erythrocytes in dermis 62/62 (100%), sclerosis of dermal collagen fibers 59/62 (95.2%), epidermal necrosis 54/62 (87.1%), ulcer 47/62 (75.8%), neutrophilic cell infiltration in dermis 46/62 (74.2%). We believe that these findings are useful clue for histopathological diagnosis of tick bite in the absence of tick parts.
A case of 27-year-old woman with NF1 was tried to treat her small fleckling on the trunk with either photo RF irradiation and/or topical vitamin D3 (maxacalcitol) ointment. The fleckling area of her abdomen was divided into four parts ; 1) photo RF+vitamin D3, 2) photo RF only, 3) vitamin D3 only, 4) no treatment. The most effective therapeutic modality was found to be the combination therapy. Histopathological findings of the treated pigment spot clearly showed decrease in melanin pigment on the basal layer and also decrease in melanophages in the upper dermis. L* value of the L*a*b*system of the colorimeter was increased in the treated area, which means that the treated area got lightening from darker appearance. These results indicate that this combination therapy is effective and safe in the tratment of small fleckling of NF1, and this modality can be a new option for the treatment of pigmented lesions of NF1.
A 52 year-old woman developed purple maculars and nodules on the left forearm with chronic lymphedema at the age of 38 years right after radical mastectomy of breast cancer. A skin biopsy specimen showed angiosarcoma. The tumor lesions were recurred locally in the grafted skin a few days after the local excision. Magnetic resonance imaging (MRI) showed metastatic lesions in the left upper arm. The patient was treated with systemic chemotherapy with mesna, doxorubicin, ifosfamide, and dacarbazine (MAID regimen). Partial remission of the lesion on the forearm was observed after three cycles of MAID every four weeks. The major side effect of this treatment was only bone marrow suppression, while microscopic hematuria due to ifosfamide was not observed. Our present case suggests that this combination chemotherapy is effective for advanced progressive angiosarcoma.
We reported a case of streptococcal toxic shock syndrome (STSS) due to Streptococcus mitis (S. mitis). A 55-year-old woman with SLE admitted to our hospital on April 20, 2004, complaining an acute pain in the right hip. On physical examination, her right hip and leg was enlarged and diffuse purpura was identified. Results of laboratory studies showed CRP of 21.17 mg/dl and CK of 1,006 IU/l. Though medication of antibiotics and γglobulin were started immediately, purpura spread rapidly and was accompanied by ulceration and necrosis of the skin. Next day the patient became confused and hypotensive. A diagnosis of necrotizing fasciitis was made, and emergency surgical debridement was undertaken. But 5 days later, erythema was prominent around the operative wound and spread again. Second operation was performed on April 28, but in vain. The patient died on May 2 because of multiple organ failure (MOF). Streptococcus mitis was detected from blood culture and necrosis tissue, so we finally diagnosed the patient as STSS due to S. mitis. Streptococcus mitis is one of the most common species of viridans streptococci and generally avirulent. In this country, there was no report of STSS due to S. mitis, so we thought this case is very rare.