A 68-year-old woman was referred to our hospital because of swollen eyelids about a month before, and her face began to show redness and swelling. We observed diffuse erythema on her face and scaling erythema on her hands. As she often pulled weeds, we suspected contact dermatitis and prescribed a topical steroid and oral antihistamines. When she visited our clinic a week after， her swollen face had worsened and she had neck-vein distension. We suspected superior vena cava syndrome and performed contrast-enhanced computed tomography (CT), which revealed a 5-cm tumor mass in the mediastinum, invading the superior vena cava， which resulted in the narrowing of the caliber of the vein. In addition, multiple pulmonary nodules that suggested a metastasis were found. We made a diagnosis of superior vena cava syndrome caused by the mediastinal tumor. She was hospitalized immediately and treated with radiotherapy， so her swollen face improved. As biopsy of the mediastinal tumor was anatomically difficult， she was treated with chemotherapy with carboplatin and paclitaxel， and the tumor shrank. Thereafter, we removed the mediastinal tumor, and histopathological examination confirmed metastasis from breast cancer. The patient had a recurrence of the mediastinal tumor and died 7 months after her first visit. When patients present with a swollen face and distention of the superficial vein， superior vena cava syndrome should be suspected and emergency contrast-enhanced CT must be performed to make a definite diagnosis. Superior vena cava syndrome caused by a mediastinal tumor may result in sudden death. Thus, it must be managed rapidly. Dermatologists rarely have chance to encounter superior vena cava syndrome in their clinical practice. It is almost impossible to diagnose it unless they don’t know the skin symptoms of it. Therefore, dermatologists should keep the disease in mind.

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Purpose: Akita National Hospital is long-term care hospital with a total of 340 patients. Of the patients, 160 have severe motor and intellectual disabilities, 80 have muscular dystrophy, 94 have intractable neurological diseases, and six have tuberculosis. We aggregated data on onychomycoses among inpatients for the purpose of foot and nail care in the wards. Methods: We checked the nails of all inpatients. A fungal examination was performed with microscopy in cases in which onychomycosis was suspected. We diagnosed patients with onychomycosis upon detection of hyphae, spores, or pseudohyphae. Results and Conclusion: We diagnosed a total of 98 patients with onychomycosis: in the toe nails in 94 patients (28.5%) and in the finger nails in 33 patients (10%). Total dystrophic onychomycosis was the predominant type. In patients with onychomycosis in the finger nails, many toe-nail lesions were present (87.8%). In cases suspicious of onychomycosis in the finger nails, we should also pay attention to toe nails.

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To identify a possible relationship between postherpetic neuralgia (PHN) and the medicines used for the treatment of patients with herpes zoster, 495 cases from Sato Dermatology Clinic, in which patients received oral antiviral medicines over the past 3 years, were analyzed; 19 cases of patients with herpes zoster treated orally with Baltrex® granules were excluded from the total 514 cases. In the Baltrex® 3000 mg/day group, which was the control drug group, PHN occurrence was approximately 6.3%, whereas it was approximately 4.9% in the Famvir® 1500 mg/day group and approximately 5.2% in the Amenalief® 400 mg/day group. The same effect in the Baltrex® treatment group was confirmed in the treatment groups orally administered Famvir® and Amenalief®. For these reasons, Amenalief®, which offers the advantages of a single dose per day and does not require consideration of the patient’s renal function, is confirmed to be useful for the treatment for herpes zoster.

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　A 68-year-old man presented to our hospital with a generalized non-pruritic red rash. He was taking 4 different oral medications, including antibiotics prescribed by his local physician for sore throat from 2 weeks before. Medical examination revealed red papules on his entire body, including his palms, redness and swelling of the pharynx, soft palate enanthema, and enlarged cervical lymph nodes. No rash was found on the external genitalia or anus. A drug eruption was most suspected. Blood test revealed biliary enzyme-dominant liver dysfunction. Of the hepatitis viral markers, only hepatitis B had an already-infected pattern, while other hepatitis viral markers and antinuclear and antimitochondrial antibodies were absent. Abdominal CT revealed no organic hepatobiliary disease. Syphilis serum reaction was strongly positive, and detailed questioning revealed a history of sexual intercourse with an unspecified number of partners. He was diagnosed as having secondary syphilis. The generalized rash was diagnosed as syphilis papulosa, while the soft palate enanthema was thought to be syphilitic angina. Pathohistology of the abdominal papules revealed perivascular inflammatory cell infiltration in the upper dermis, consistent with syphilis. The skin rash started to disappear, and the syphilis serological antibody values immediately declined after initiating oral amoxycillin administration. The liver dysfunction also started to improve, however, the hepatobiliary enzyme levels plateaued, so the amoxycillin dose was increased and liver supporting therapy was added to the treatment regimen. Immediately the liver function normalized. This clinical course suspected that not only syphilitic hepatitis was together developed, but drug-induced liver injury was associated with the secondary phase of syphilis.With the current rapid increase in the incidence of syphilis in Japan, it must be considered when patients present with symptoms such as sore throat, rash, swollen lymph nodes, and liver dysfunction.

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