A 66-year-old man accidentally burned himself on the right postauricular region with a curling iron about 15 years ago. He visited our department recently, and a diagnosis of basal cell carcinoma (BCC) was made by skin biopsy. It is well known that the majority of tumors that arise on a burn scar are squamous cell carcinoma, which usually takes several decades to develop after scar formation. Although rare, BCC is also reported to occur on burn scars, especially superficial ones on elderly subjects. When we surveyed published cases of BCC from burn scar in Japan, we found 25 such cases; when we sorted them by the age of injury, they fell into two characteristic groups: 1) burned at a young age and had a long term before the onset of BCC, and 2) burned later than the 4th decade of life and developing BCC soon thereafter. Most BCCs occurred on sun-exposed areas in both groups, and they arise on relatively mild burn lesions. This tendency has also been reported in a case series study overseas. The onset of BCC has been shown to be associated with loss of heterozygosity (LOH) of the mutated PTCH gene; mild burn ulcers or scars may be able to facilitate the LOH, as does ultraviolet light. We should keep in mind that mild burn ulcers or scars located in sun-exposed areas may develop into BCC.
A 61-year-old man had been diagnosed with immunotactoid glomerulopathy 5 years previously and had been on hemodialysis. He had also suffered from multiple embolisms in several organs and had continued anticoagulant therapy. He developed purpura on the left heel and right external malleolus three months before his first visit to us. The purpuric lesions had expanded and ulcerated; moreover, the left foot had developed gangrene. Histological examination of the skin around the ulcer showed homogeneous eosinophilic material in the vascular lumen, and the material was positive for the immunohistchemical stain for IgA. He also suffered a cerebral infarction as the foot gangrene progressed. The results of a skin biopsy indicated that deposition of immune reactants had induced these embolisms in the vessels of the foot and brain in a way similar to that of the glomerular lesions, so we chose immunosuppressive therapy instead of additional anticoagulant therapy. After this immunosuppressive therapy, his paralytic symptoms caused by the cerebral infarction improved and the expansion of his gangrene halted. In most cases of immunotactoid glomerulopathy, the deposition of immune reactant is almost exclusively restricted to the glomeruli. This is a rare case of immunotactoid glomerulopathy affecting multiple organs and developing foot gangrene.
A 79-year-old man was found to have epithelioid hemangiosarcoma of the bladder and multiple metastatic deposits on the skin, subcutaneous tissue, muscles, and bones localized in a limited area of the left pelvic region. He had also a metastatic nodule on the glans penis. No pulmonary or liver metastases were noted. It is suggested that the peculiar distribution of his metastatic lesions could be explained by a route via the vertebral vein system of Batson but not by orthodox hematological or lymphatic spread.
We report herein the clinical symptoms and laboratory findings of 22 rubella patients, 20 males and 2 females, seen at our hospital from December 20, 2012, to February 4, 2013. The ages of the male subjects ranged from 20 to 44 years old, while those of the female subjects ranged from 24 to 35 years old. All the patients had fevers, with 8 patients (36%) having a fever of 38 degrees or higher. An erythematous maculopapular rash was observed in all of the patients, and a fusion rash appeared in 20 patients (91%). Postauricular and submandibular lymphadenopathy was observed in 19 patients (86%), and conjunctival hyperemia in all of them. These adult cases of rubella were noted to be more severe than the pediatric cases. All of the patients were found to be positive for the rubella IgM antibody. Seven patients were negative on the first visit but were positive by the next visit. Rubella patients are unlikely to test positive for the antibody in the early stages of infection. We presumed that the rubella IgM antibody level would become elevated approximately on day 3. From detailed interviews, we determined that 14 of the patients had gone to pachinko parlor A within 2–3 weeks before the onset of rubella. We hypothesized that rubella had spread within the store, which was a closed space. Because of the history of vaccination in Japan, those who are now between the ages of 26 and 34 are likely to have low immunization coverage, as in our cases. Rubella is currently prevalent in the Tokyo metropolitan area and the Kansai region. The recent increase in the number of reported infections is a matter of grave concern.