[in Japanese]

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An 80-year-old woman was referred to our clinic with the complaint of a two month history of bullous and erosive lesions on her trunk and extremities and of a one month history of erosive lesions on her oral mucosa. Western blotting using her serum revealed autoantibodies against the γ2 and α3 chains of laminin 5. She was diagnosed with mucous membrane pemphigoid and treated with prednisolone combined with minocycline, colchicine, diaminodiphenylsulfone (DDS), and azathioprine, but her mucosal lesions did not respond to these therapies. She died of septic shock eight months after initiation of the treatment. A total of 9 cases of mucous membrane pemphigoid with autoantibodies against γ2 chain of laminin 5, including the present case, were found in our search of the literature; all of them suffered from skin lesions as well as mucous membrane le sions.

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We report a case of a 76-year-old Japanese woman with a two-month history of recurrent, swelling erythema on both ears. Histological examination revealed dense mononuclear cell infiltrations surrounding the cartilaginous tissue and infiltration of mononuclear cells into the cartilage. Laboratory examination disclosed the presence of anti-type II collagen, anti-thyroglobulin and anti-microsomal antibodies. Computed tomography (CT) showed a diffuse swelling of the thyroid gland. A diagnosis of relapsing polychondritis (RP) complicated by Hashimotoʼs thyroiditis was established. In Japan, 124 cases of RP have been reported within the last 10 years. We reviewed the complications and treatments and compared the clinical difference between anti-type II collagen antibody-positive and negative patients. Anti-type II collagen antibody was positive in 45.8% of RP patients (22 cases out of 48 cases). Corticosteroid pulse therapy was required for 27.3% of anti-type II collagen antibody-positive patients, but for only 11.5% of anti-type II collagen antibody-negative patients. Surgical interventions for respiratory complications were indicated in 22.7% of anti-type II collagen antibody positive patients, but in only 3.8% of anti-type II collagen antibody negative patients. These results suggest that anti-type II collagen antibody-positive patients are likely to suffer from more severe chondritis of the respiratory tract.

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Between August 2003 and September 2008, 20 patients with cutaneous malignant melanoma (9 males and 11 females, average age 54.8) underwent sentinel node (SN) biopsy using a combination of the blue dye method and lymphscintigraphy with a gamma probe. We identified SN in 19 of the 20 patients (95.0%), but we did not identify SN in one case after the tumor had been already been removed surgically in another clinic. The average SN number was 2.3. SN metastases were detected in 7 patients (36.8%), and all the SN positive patients underwent regional lymph node (LN) dissection. In 6 patients (31.6%), we detected SN in multiple fields. The average tumor thickness for SN negative patients was 3.6 mm, and the average tumor thickness for SN positive patients was 6.0 mm. The SN metastasis rates due to T classification were 0% in T1, 25.0% in T2, and 55.6% in T3 and T4. Multi-center clinical trials of SN biopsy with the use of blue dye and radiocolloid are warranted.

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We herein describe three cases of Japanese viper bite successfully treated with local and/or systemic corticosteroids as a supportive regimen in parallel with the standard medication triad for viper envenomation, an antibacterial agent, tetanus toxoid, and cepharanthine, as well as local surgery (ie. incision of the affected skin sites and antivenin). Case 1, a 60-year-old female, had a viper bite on the left thigh; within by 4-hours, the resultant erythematous-purpuric swelling was exacerbated and spread to the leg after evading the skin sites of the preceding local corticosteroid injection. After antivenom and intravenous corticosteroid half-pulse therapy (500 mg/day), the relevant symptoms regressed immediately, and the oral predonisolone was tapered. Case 2, a 57-year-old male, was bitten on the right wrist; 48 hours later, the edematous swelling and hardening with tense blisters in the affected skin had spread extensively over his right upper torso. Because labored breathing and diplopia gradually worsened, he underwent corticosteroid pulse therapy (1,000 mg/day), and both his clinical symptoms and abnormal laboratory findings rapidly improved. Case 3, an 11-year-old boy, was bitten on the right forefinger; the edematous swelling extended to the dorsal hand. Oral predonisolone (0.6 mg/kg/day) dramatically decreased the clinical symptoms, but they flared with the cessation of the steroid therapy alone. Our case series now emphasizes the potential need to evaluate the propriety of corticosteroid supportive treatment for its apparent potent inhibitory effects in preventing further tissue damage and subsequent inflammatory reactions in patients with viper envenomation.

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