A 33-year-old male with a 10-year history of severe hidradenitis suppurativa had suffered from painful recurrent abscesses, purulent drainage, and sinus tract and fistula formation on the head, lower jaw, axillae, groin, and buttocks. He also had systemic inflammation, including high fever, weight-loss of 10 kg, night-sweats and lymphadenopathy for one year. His left groin lymph node biopsy showed numerous plasma cells in the interfollicular areas, and he was diagnosed with Castleman's disease. The systemic inflammation is markedly improved following administration of the interleukin-6-receptor inhibitor, tocilizumab. Interlrukin-6 may be critical in the development of hidradenitis surppurativa in our case.
During the 2016 Kumamoto Earthquake, our hospital, the core disaster base hospital nearest to epicenter of the earthquake, received patients for emergency care. Among the 1,455 patients who visited our hospital from April 14 to 16 in 2016, we reviewed 393 patients whose chief complaints were dermatological disorders. We also summarized 75 burn cases from April 14 to March 5 and compared the results with our burn data from the previous three years. From our experience, we found proper dermatological diagnosis and treatment are essential in the acute phase of a disaster and that dermatologist should be active in front line from the onset of a disaster.
Bowen's disease of the nail apparatus is uncommon. We report a case of a 48-year-old man with a pigmented streak on his left index fingernail. Physical examination revealed a well-demarcated, 3-mm-wide brownish streak with nail deformity on the left index fingernail. The streak didn't contact the lateral edge of the nail plate. After confirming a diagnosis of Bowen's disease by excisional biopsy, removal of the entire nail apparatus followed by full-thickness skin-grafting. HPV DNA was detected in the biopsy specimen by PCR using the L1C1/L1C2 consensus primers. The PCR product was analyzed by direct DNA sequencing, which revealed that the sequence corresponded to the L1 gene of HPV type 56. Immunohistochemical staining for HPV and HPV in situ hybridization using a high-risk HPV cocktail probe showed positive results in the epithelium. We reviewed the literature published since 1987 on Bowen's disease of the nail apparatus and summarized 156 cases, including 43 patients presenting as longitudinal melanonychia. The mean age of the patients with Bowen's disease of the nail apparatus was 51.5, years and the male/female ratio was 3.8:1. Eighty-seven percent of the patients in whom HPV examination was performed revealed positive results. HPV genotypes had been analyzed in 20 patients presenting as longitudinal melanonychia. In 13 of them (65%), HPV type 56 had been identified.
These results suggest that Bowen's disease of the nail apparatus may arise in a younger generation with male predominance, secondary to sexually transmitted HPV infection, and that HPV type 56 may have a propensity for infecting the nail matrix and bed epithelium.