We evaluated the clinical characteristics of eruptions in 19 patients with dengue fever treated at our hospital between September 1998 and September 2005 and present 2 representative cases. The mean age at the initial examination was 31.9 years. All the patients developed dengue fever soon after returning to Japan from areas with dengue epidemics. The major clinical symptoms were fever, pain (headache, orbital pain, muscle pain, joint pain)，diarrhea,leucopenia, thrombocytopenia, liver dysfunction, and eruptions. Eruptions appeared from the previous day to the day of the fall in fever and were characterized by diffuse or sunburn-like erythematous macules, mainly on the trunk, limbs, palms, and soles, the macules were accompanied by petechiae and red papules in some parts. At present, with people often traveling abroad, dermatologists should become awere of dengue fever as a imported infection characterized by eruptions.
Vascular remodeling in host tissues surrounding growing tumors is implicated in the successful development of tumor neovasculature The vascular endothelial growth factor VEGF-A is a prime regulator of endothelial cell proliferation, angiogenesis, vasculogenesis, and vascular permeability. VEGF-C and -D induce both tumor angiogenesis and lymphangiogenesis, and promote the lymphatic spread of tumors. Angiopoietin-1 (Ang-1) plus VEGF-A cause an increased number of new blood vessels with evidence of a mature vascular system, while angiopoietin-2 (Ang-2) plus VEGF-A promote a rapid increase in capillary diameter, remodeling of the basal lamina, proliferation and migration of endothelial cells, and stimulated sprouting of new blood vessels in vivo. In this study, we have demonstrated that human angiosarcoma cells express VEGF-A, -C, and -D, VEGF receptors (Flt-1, KDR, and Flt-4), Ang-2, and Ang-1 and -2 receptor (Tie-2). These results suggest that the VEGF family and Ang-2 signaling pathway may play a role in the cell proliferation and growth of angio-sarcoma cells. We also found, that serum VEGF-D and Ang-2 protein levels increased as the tumor stage advanced in the angiosarcoma patients. VEGF-D and Ang-2 play important roles in tumor growth and metastatic tumor spread in angiosarcoma.
We observed the infiltration of neoplastic cells into adnexal epithelium in 1,466 cases of solar keratosis diagnosed at the Sapporo Institute for Dermatopathology between May, 2001 and August, 2005. These cases were female dominant (male : female=1 : 1.7). Most of them occurred on face (87.7%). The mean age at resection was 76.8±10.9 years, and that of females (78.4±10.8 years) was significantly higher than that of males (74.1±10.5 years). We divided these cases with solar keratosis into three categories: Bowenoid type, early evolving type, and ordinary type. Bowenoid type was observed in 22.2% of the cases ; early evolving type, in 7.6% ; and ordinary type in 70.2%.In females, cases of the Bowenoid and early evolving types showed higher incidences than in males. The mean age at resection in the Bowenoid type (82.1±8.9 years) was significantly higher than that in ordinary type (76.1±10.4 years) and early evolving type (68.1±13.0 years). In 1,044 out of 1,466 cases (71.2%), neoplastic cells of solar keratosis were noticed in the epithelia of hair follicles or eccrine ducts. The mean age at resection of the cases with infiltration of neoplastic cells into adnexal epithelium (77.5±10.4 years) was significantly higher than that without infiltration (75.1±11.9 years). In cases arising on the face, neoplastic cell infiltrations into adnexal epithelium were observed in 924 out of 1,285 cases (71.9%). The incidence of adnexal epithelial infiltration of neoplastic cells was 83.1% in the cases of Bowenoid type, 72.5% in ordinary type, and 25.0% in early evolving type. In the histopathological diagnosis and treatment of solar keratosis, it is important for us to recognize that neoplasic cells of solar keratosis frequently infiltrate into the adnexal epithelium.
A 58-year-old Japanese male was referred to our clinic for the investigation of multiple skin abscesses on his trunk and extremities. He had noticed his lesions two months previously. Surgical debridement of his right thigh revealed subcutaneous and intramuscular abscess formation. Bacterial culture and PCR analysis of the surgical tissue samples demonstrated Nocardia brasiliensis (N. brasiliensis). Chest computed tomography showed the signs of pulmonary inflammation, suggesting a diagnosis of secondary cutaneous nocardiosis disseminated from the pulmonary nocardiosis. The patient was treated with trimethoprim-sulfamethoxazole and minocycline hydrochloride, resulting in improvement of both his cutaneous abscesses and pulmonary lesions. Nocardia species are common natural inhabitants of the soil ; they frequently cause opportunistic infections in immunocompromised patients. However, only nine cases of muscular nocardiosis have been reported in Japan, including two caused by N. brasiliensis. Disseminated nocardiosis has a poor prognosis because it often develops in immunocompromised patients, and the isolation rate of the Nocardia is low. Only four cases of secondary cutaneous nocardiosis, including the current case, caused by N. brasiliensis have been reported in Japan. Among them, the three other cases were all fatal. In our case, the aggressive debridement of the abscesses resulted in a rapid diagnosis and improvement of the prognosis.