We report a 34-year-old man who developed tumor-induced osteomalacia (TIO). He had noticed a subcutaneous nodule on his abdomen 4 years previously. The pain of the bones in his back and extremities started 2 years later. He suffered from the pain for 2 years before he consulted our hospital. The laboratory data revealed severe hypophostemia. We suspected the case to be TIO; therefore, we removed the abdominal mass to confirm the diagnosis. Pathologic examination demonstrated a solid tumor with numerous cystic and ductal lesions. The tumor was composed mainly of hemangiopericyte-like cells. Cartilaginous tissue, bone, and calcifications were scattered throughout the tumor. After resecting the tumor, the hypophostemia improved rapidly, and the bone pain disappeared. TIO is a relatively rare disease caused by the secretions from a specific type of soft tissue tumor. The total resection of the tumor can dramatically improve the symptoms. Therefore, if we encounter a patient with osteomalacia, we should search for the existence of any subcutaneous tumors. When we find any such tumors in patients, we must resect/biopsy them to make the proper diagnosis and treat the TIO.
Although involvement of hair follicles in lichenoid tissue reaction (LTR) is well known, little attention has been paid to sweat gland involvement. Recently, we reported two cases of lichen planus (LP) and parapsoriasis in which skin dryness due to a sweating distubance was suggested as the triggering factor. In this study, we asked whether sweat glands and ducts were histologically involved in LTR. Biopsies from 20 patients diagnosed as LP were investigated. Biopsies of discoid lupus erythematosus (DLE), Schamberg disease, and Bowen’s disease served as controls. The most characteristic histologic findings of LP included dilation of sweat glands and ducts associated with retention of sweat. In contrast, such findings were not evident in DLE or Bowen’s disease: however, morphological abnormalities of sweat glands were associated with lymphocytic infiltrates in DLE. These results indicate that sweating disturbance in LP could result from the functional impairment of the excretion sweat, but not from damage to the sweat glands and ducts by lymphocytic infiltrates. Because such sweating disturbances resulting in dry skin could be more common in lichenoid dermatoses, particularly in LP, than previously thought, moisturizers may be an alternative treatment for otherwise refractory LP.
We report a statistical analysis of HIV (human immunodeficiency virus) screening tests conducted with the use of ELISA (Enzyme-Linked Immunosorbent Assay) at the Department of Dermatology, Tokyo Medical University Hospital, between May of 2004 and March of 2009. Among the 3,764 tests reviewed, 3,415 were performed as screening tests for surgery, biopsy, or hospitalization, and 349 were performed to test for cooccurrence of HIV infection with skin diseases. Out of 29 positive results obtained by ELISA, HIV infection was confirmed in 23 cases using Western blot (positive rate 0.61%). Four cases were false positives, and two cases could not be confirmed because the patients failed to report for further testing. Among the 23 cases of confirmed HIV infection, 3 cases were detected by screening, and the 20 others were detected while testing for the co-occurrence of HIV infection with other diseases. The rate of positive results from HIV screening tests in the Tokyo metropolitan area was unexpectedly high. The HIV test is vital not only as a means of detecting HIV infection in HIV-related skin diseases, but also as an addition to screening for various other infectious diseases in the context of surgery and hospitalization.
A 28-year-old woman woke up with sudden severe pain. At our first examination, she had severe pain and sweat on her right forearm and left leg. She also had faint erythema on her painful right forearm, but we couldn’t make a diagnosis. That night, she found the carcass of red back spider on her bed, and we diagnosed her as a case of red back spider envenomation. It is important to know that symptoms other than those at the bite site are important for the diagnosis of this disease.