A prospective study of hospitalized patients with cellulitis on the lower extremities was carried out in our department to elucidate the risk factors. Twenty-six patients, including 16 males and 10 females, were enrolled in the study for a period of ten months between April 2008 and January 2009. The average age was 52 years. Our study indicates that obesity (50.0% in men, 80.0% in women) and tinea pedis (80.8%) are important predisposing factors. Detailed questioning disclosed that the patients had previous histories of orthopedic injuries (57.7%) such as fractures and sprains; cellulitis (38.5%) was much more frequent in the involved lower extremity than in the uninvolved one. On average, the cellulitis occurred approximately 30 years after the orthopedic injury. This long period seems to be the reason why the link between these two conditions has been overlooked. We repeatedly examined ASO and ASK titers for the period of hospitalization and follow-up in our outpatient clinic. Unexpectedly, significant alterations in these titers suggesting streptococcal infection were found in 53.8% of the patients. When the patients were divided into two groups depending on the positivity of streptococcal infection, the positive group was found to be associated with female patients, purpura on cellulitis lesions, regional lymphadenopathy, and a previous history of cellulitis in the involved extremity.
The patient was a 69-year-old man for whom Terbinal® (generic terbinafine) was prescribed. Administration was discontinued after the appearance of systemic erythema caused suspicion of Terbinal®-induced drug rash. The prolonged rash continued even after drug withdrawal, and he was referred to us. He presented with diffuse flushing of the face and systemic disseminated erythema. At first examination on admission, his anti-HHV-6 IgG antibody titer was 1:40; this rose to 1:160 by day 21 post-admission. The patient had not been exposed to any known causative agents of drug-induced hypersensitivity syndrome (DIHS); nevertheless, the clinical course and laboratory data resembled those of DIHS. There have been several recent reports of patients following a DIHS-like course after administration of drugs other than those known to cause this syndrome. Further accumulation of relevant case studies is required.
Muir-Torre syndrome (MTS) is a dominantly inherited autosomal disorder characterized by sebaceous neoplasms or keratoacanthoma (KA) and visceral malignancies. Case 1 was a 45-year-old male with past histories of rectal cancer, colon cancer, and KA on his face. He noticed a red nodule on his head, 2 cm in diameter, which progressively enlarged in the next 2 months. This nodule was histopathologically confirmed as KA. Immunohistochemical analysis revealed no expression of MSH2 proteins in the KA or the rectal cancer. Case 2 was a 77-year-old male, the father of Case 1. His past histories were 9 colon cancers, 4 gastric cancers, a squamous cell carcinoma on his nose, and over 10 lesions of KA. His familyʼs medical history included his father (liver cancer), elder sister (colon cancer twice, rectal cancer, and gastric cancer), and his son, Case 1. On initial examination, there were two yellow nodules on both the right eyelid and left cheek (4 mm and 2 mm in diameter). Their histopathological features were diagnosed as sebaceous adenoma and sebaceoma, respectively. A survey of 50 MTS reports in our country found no immunohistochemical analysis that identified the responsible gene. This study highlights the importance of immunohistochemical analysis in diagnosing MTS.
Nine cases of adverse reactions to BCG have occurred in the last five years in our department. The infants were 8 boys and 1 girl aged 4 to 16 months at the hospital visit. BCG vaccination was given at 3 to 4 months, the standard age of vaccination that was unchanged in the revisions to the law made in April of 2005. Of the 9 patients, seven had subcutaneous tuberculous granuloma. There was also one case of non-annular-type generalized granuloma annulare and one of papular tuberculid. We conclude that treatment should be given as follows: 1. As systemically disseminating papulonecrotic tuberculid, lichen scrofulosorum and papular tuberculid resolve naturally, a wait-and-see policy was used for patients with these diseases. 2. For lupus vulgaris, scrofuloderma, and subcutaneous tuberculous granuloma, two to three months of follow-up observation was conducted. Biopsy and microbial detection were performed for patients with no tendency toward closing of the lesion, with aggravation or with self-destruction, and anti-tuberculosis drugs were considered for cases in which tuberculosis bacteria were detected during follow-up. The appropriate drug administration period was assumed to be 3 to 6 months.