Myiasis is an uncommon condition in a clean hygienic environment, such as Japan. We report a 95-year-old female patient with myiasis associated with basal cell carcinoma of the forehead. After manual removal of the maggots, a 50×45 mm ulcerative mass lesion of the forehead was resected above the periosteum, and the defect was repaired using an advancement flap. The diagnosis of basal cell carcinoma was confirmed histopathologically. We reviewed the recent Japanese literature and determined that the reports of aural myiasis have decreased and those of the wound myiasis, especially those associated with malignant wounds, have increased.
In February of 2013, 30 Aichi Medical University hospital staff members participated in a ski tour. After the tour, four participants developed hand, foot and mouth disease. Significant elevations of Coxsackie Virus A (CA) 10 NT antibody titer were observed in all four in paired sera, but additional rises of CA6, 16, and enterovirus 71 antibody titer in paired serum were also observed in some individuals, suggesting the possibility of mixed infection. In our institution, the infection control team decided to limit the attendance and work of the staff to three days after development of symptoms, and the possible spread of the infection was suppressed.
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal lymphoma in which the lymphoma cells proliferate exclusively in the lumina of small vessels of central nervous system, skin, bone marrow, lung, kidney and adrenal gland. Because specific symptoms or tumorous lesions rarely appear, early diagnosis of IVLBCL is difficult. Recently, random skin biopsy from patients who were suspected of having IVLBCL has been reported to be useful for early diagnosis. In this study, we collected 33 patients (36 cases, 108 biopsies) who underwent random skin biopsies within the past five years in our institute and investigated their clinical characteristics, their random skin biopsy positivity, and the biopsy methods. The most common clinical feature causing physicians to suspect IVLBCL was unidentified fever. Laboratory abnormalities such as high serum lactate dehydrogenase or pancytopenia and neurological symptoms such as numbness were also frequently observed. Patients were most frequently referred from neurologists (49%), followed by rheumatologists and hematologists. Among the 33 patients, six (14%) were finally diagnosed with IVLBCL, and four patients were diagnosed by random skin biopsies. Tumor cells were detected mainly within vessels of the deep dermis or subcutaneous fat tissues. From the viewpoint of subcutaneous sample volumes, the recommended method of skin biopsy should be a spindle biopsy. However, our cases did not detect any differences in the positivity of tumor cells between spindle biopsies and 5-mm punch biopsies (p=0.410). Therefore, the less invasive 5-mm punch biopsies should also be considered as appropriate, especially when patients do not tolerate multiple biopsies well.