We report a case of a 58-year-old man who developed erythrodermic graft-versus-host disease (GVHD) after autologous peripheral blood stem cell transplantation (PBSCT) employed for the treatment of malignant lymphoma of the sacral bone. Eighty days after PBSCT, he developed a generalized erythematous rash and diarrhea. Histopathological examination of the rash confirmed the diagnosis of GVHD. Because 25mg/day predonisolone had been prescribed for the treatment of eosinophilic pneumonia, he was followed-up without further treatment. His eruption worsened into erythroderma, and liver dysfunction developed, which together required an increase in the dosage of the corticosteroid and the addition of an immunosuppressive agent. It is important to remember that GVHD may develop after autologous PBSCT and that the skin lesion can be severe, requiring high dose corticosteroid therapy.
We describe a 60-year-old man with squamous cell carcinoma. The histology of the tumor included varied patterns, which were mainly classified into three types. Furthermore, we also confirmed the differentiation of each type using immunochemical studies of cytokeratine. Such immunochemical studies are very useful for determining the origins of cells and supporting the diagnosis. Tumor cells show varied immunochemical patterns depending on their differentiation. Thorough immunochemical studies are useful for disclosing and diagnosing the origin of the tumor, This report suggests that such a diagnosis requires consideration of the entire tumor.
A 23-year-old female had presented with a one year history of four episodes of urticaria and angioedema, which had been getting more severe. During the last episode, she suffered generalized urticaria, perioral and perioribital angioedema, and dyspnea requiring emergency treatment after the ingestion of several foods and drinks including Campari-Orange. After the treatment, she visited our clinic to determine the cause of her symptoms. We found no correlation between any the common foods or drugs and her episodes. Challenge tests with several food additives, food colorings, and aspirin were negative. Challenge tests after taking aspirin with individual or complex ingestion of several foods and drinks that she had taken during her episodes gave positive results for strawberry milk (dairy drinks including fruit juice) made by A company, fish sausage made by B company, and Campari (liqueur) imported from Italy. A challenge test after taking aspirin also gave positive results for cochineal extract which is commonly included in these foods and drinks, but a high dose of cochineal extract was required for the results. Western blotting analysis revealed the presence of cochineal-extract-specific IgE antibodies in patient’s serum that react to four bands at about 40kDa. Physicians should be aware of the possibility of rare but important adverse effects to cochineal extract, which is sometimes listed as carmic acid.
An epidemiologic survey of cutaneous tuberculosis was carried out for the cases that were treated between 1947 and 2006 in the Department of Dermatology of Nippon Medical School Hospital. The total number of cutaneous tuberculosis patients decreased markedly after the early 1960s, increased slightly after 1967, and maintained a plateau from 1987 to 2006. The number of true cutaneous tuberculosis patients decreased after the early 1960s and then plateaued from 1967 to 1996. It slightly decreased from 1997 to 2006; however, scrofuloderma was also observed once every 1 or 2 years during the last 20 years. The number of tuberculid patients also decreased after the early 1960s but increased after 1967. The number of patients with erythema induratum Bazin continued to increase gradually after 1967. The main reasons for the increase in the total number of cutaneous tuberculosis patients in the last 20 years are the continuous occurrence of scrofuloderma and the increase in the number of patients with erythema induratum Bazin, both of which reflect the present conditions for the spread of tuberculosis in Japan.