Renal transplant recipients are at risk from severe varicella-zoster virus (VZV) infections because they receive immunosuppressive therapy. We retrospectively evaluated 81 cases of VZV infection among 584 renal transplantation recipients in our institute. Our study revealed that VZV infection was more frequent in renal transplant recipients than in the general population, or in general dermatology clinics. Specifically, in VZV infection recipients after kidney transplantation, 11 patients developed disseminated herpes zoster, and one died of VZV encephalitis. We proposed a treatment protocol for VZV infection in renal transplant recipients.
Familial pityriasis rubra pilaris (PRP) is caused by gain-of-function mutations in CARD14. We report familial cases of a 28-year old mother and a 11-month old daughter with well-demarcated salmon-coloured plaques accompanied by scales. The mother is tolerant with emollients and moisturizers, and her daughter's symptoms improved with topical vitamin D3, steroid, and oral vitamin A. After genetic counselling, genetic analysis revealed a heterozygous missense mutation in CARD14, c.467T>C (p.Leu156Pro) in the mother and the daughter, but not in the father. We diagnosed them with familial cases of PRP type V. This variant has been reported from a Israeli group. In Japan, 4 cases of PRP identified with a CARD14 mutation have been reported, but none of them had this variant.
A 40-year-old male developed a transient fever on the day before presentation to our hospital; then which itching developed over the entire body. Clinical examination revealed dark reddish erythema and papules scattered on the trunk and extremities, but concentrated on the back. A chest X-ray showed no abnormalities. Viral infection was suspected, with drug eruption considered as a reasonable differential diagnosis. When interviewed 5 days later, the patient reported a mild cough, and mentioned that a colleague at his workplace was suspected of having COVID-19. PCR confirmed SARS-CoV-2. In patients with COVID-19, a rash occasionally precedes respiratory symptoms. Such patients may initially consult a dermatologist, who must consider the possibility of COVID-19 on encountering maculopapular lesions of unknown etiology, and perform both in-depth interview and virological examination.