The Epstein-Barr (EB) virus induces various malignancies, including natural killer (NK) cell and T cell lymphoproliferative disorders (LPD), and eventually hemophagocytic syndrome. Chronic active EB virus infection is the background on which NK-LPD and T-LPD develop. As lethal outcomes, hemophagocytic syndrome and NK or T cell lymphoma occur at the age of about 20 years in approximately 50% of patients with chronic active EB virus infections. In this process, patients may have severe hypersensitivities to mosquito bites or hydroa vacciniforme (or hydroa vacciniforme-like eruptions). Therefore, these two conditions are important signs of chronic EB virus infections. Extranodal NK/T cell lymphoma (nasal and nasal type) is another type of NK cell lymphoproliferative disease that is associated with EB virus infection. The skin is one of the predilection sites for the nasal type.
Dramatic progress in therapeutic strategies for malignant tumors and autoimmune diseases has been made recently through the development of monoclonal antibodies targeting various molecules of the immune system. These targets include cytokines, receptors, and other cell surface molecules. Furthermore, there are various candidate diseases in the dermatological field that may be suitable for treatment by immunotherapy. Several immunotherapies are currently in clinical trials in patients with psoriasis vulgaris or autoimmune diseases.
Ultrasonography carried out in place of X-ray fistulography was able to clarify the location and shape of hip fistulas in a 23-year-old maleʼs chronic perianal pyoderma and a 24-year old maleʼs pilonidal sinus. Because the ultrasound examination technique is completely safe and is not invasive compared to the radiographic examination, the technique is recommended for searchs for fistulas as well as for subcutaneous tumors.
A 37-year-old man with lumbago had been taking diclofenac (Blesin®), quercus salicina extract (Urocalun®) and rebamipide (Mucosta®) from January 14, 2004, and allopurinol (Zyloric®), colestimide (Cholebine®) and bezafibrate (Bezalip®) for hyperlipidemia from January 19, 2004. On February 1st, he developed a high fever, general fatigue, toothache, edema of the lips, and erythema on the genital areas, palms, and soles. On February 4th, he developed gait disturbance because of swelling of his hands and feet and dyspnea. Using methylpredonisolone pulse therapy and oral predonisolone (PSL), his fever was reduced to normal after a week, the vesicles and bullae of the genital areas, hands, and feet diminished after three weeks, and the erythema and oral erosion improved after a month. A biopsy of the erythema of the left foot showed a large number of necrotic keratinocytes in the epidermis and subepidermal bulla formation. The result of a closed patch test (PT) with Zyloric® on the lesional area was positive. A drug-induced lymphocyte stimulation test (DLST) with some of the suspected drugs was serially measured. High positive reactions to the DLST for Zyloric®, Cholebine®, Bezalip® and diclofenac continued for half a year. There was an elevation of the antibody titers of mycoplasma in his serum. We diagnosed our case as Stevens-Johnson syndrome due to Zyloric® because of the positive results of both the PT and the DLST.
A 55-year-old woman presented to her primary physician with the chief complaint of multiple lymphadenopathy in the right axilla. Axillary lymphadenectomy was performed ; however, extensive adhesion to surrounding structures precluded complete excision of the involved nodes. Examination of the excised nodes showed findings consistent with metastasis of malignant melanoma. A thorough preoperative examination detected no primary lesions, and she was referred to our hospital. A total excisional biopsy of a dark brown macula on the inside of the right elbow, which had previously exhibited a blackish brown color, revealed findings consistent with spontaneous regression of malignant melanoma. The finding led to the diagnosis of lymph node metastasis of malignant melanoma originating on the inside of the right elbow. Treatment with dacarbazine, nimustine, cisplatin, and tamoxifen (DAC-Tam) was initiated. After six courses of therapy, radiographic complete remission was achieved, and the minimal residual nodes were excised. Histopathological examination revealed necrotic tumors and scars without viable tumor cells. As of this writing, no recurrence or new metastasis has been noted for 18 months after the start of treatment.