We report a case of Sjögrenʼs syndrome with cryoglobulinemia and cutaneous vasculitis. A 55-year-old female was diagnosed with Sjögrenʼs syndrome because she had dry eyes and mouth, positive anti-SS-A and SS-B antibodies, keratitis, and hypofunction of the salivary glands. Indurative purpuras and ulcers had appeared on her face, ears, hands, feet, and lower legs, and they worsened with cold exposure during winter for two years before the first visit. Histopathological examination of the purpura on her lower leg showed leukocyteclastic vasculitis around the small vessels in the dermis. The immunofluorescence technique showed granular deposits of IgM and C3 around the small vessels. She was diagnosed with immunocomplex vasculitis due to type II mixed cryoglobulinemia from the detection of monoclonal IgA-κ and polyclonal IgG-κ, λ cryoglobulin by immunoelectrophoresis. Treatment with 30 mg/day prednisolone was effective, resulting in disappearance of the purpuras and ulcers. She has been gradually tapered off the prednisolone by avoiding the cold exposure.
We attempted to establish whether test disorders occur more frequency in patients with diabetes mellitus (DM) than in healthy controls and whether the presence of Candida albicans (C. albicans) on the tongue is a cause of such taste disorders. Taste disorders and their severity were assessed by filter-paper methods. DM patients demonstrated significantly higher incidences of taste disorders than healthy controls, but there was no relationship between carriers of C. albicans of the tongue and taste disorders. We also demonstrated a relationship between the taste disorders and DM controls (HbA1c). There was no correlation with HbA1c, but the taste disorders tended to occur in the DM patients who had nerve complications. The results suggested the taste disorder test using these filter-paper methods contributes to easy detection of the nerve complications in DM patients.
Narrowband UVB phototherapy for skin diseases such as psoriasis is an effective and safe treatment modality. However, the possibility of increasing the risk of skin cancer and lentigines caused by phototherapy is a serious concern. In contrast, the role of narrowband UVB therapy in skin carcinogenesis and lentigines is less clear. We investigated the incidence of skin tumors and lentigines in a total of 62 patients receiving narrowband UVB therapy between December 1999 and April 2005. The median cumulative term of the narrowband UVB treatment and the total dose were 22.3 months (range, 7–53) and 92.3 J/cm2 (14.4–552.5), respectively. The risk of skin cancer was not increased after the treatment. Lentigines were observed in 17 (27.4%) out of the 62 patients. However, we found that, of these 17 patients, 14 (82.4%) had undergone another type of phototherapy, and 9 (52.9%) had a long history of much sunbathing. Subsequently, out of the 62 patients, 30 patients received only the narrowband UVB therapy without any other phototherapies, and lentigines were observed in only 3 of those patients. To determine the true long-term risk of the narrowband UVB phototherapy, longer follow-up observations are required in a number of patients with only this exposure.
A statistical analysis was performed on 23 examples of lymph node metastasis among 95 patients with extramamary Pagetʼs disease in the Division of Dermatology, National Cancer Center Hospital, from 1962 until 2005. Although lymph node metasyasis had distinguished by the difference between one side or two sides in “the TNM classification of Paget disease (proposal)” which Ohara advocated in 1992, the five-year probability of survival with more than two lymph node metastasis was only 13.5%, but that with one lymph node metastasis was 100%. So it is necessary to improve the standard of lymph node dissection to above two lymph node metastasis, We examined whether we could judge exactly one lymph node metastasis or above two lymph node metastasis with a sentinel lymph node biopsy.