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Kazuharu SHIBUYA, Akira KURAMOCHI, Tetsuya TSUCHIDA, Shigeru KURAMOCHI
2000 Volume 62 Issue 2 Pages
153-158
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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A case of polyarteritis nodosa is reported. The patient was a 61-year-old woman who presented with a deep ulcer on her right leg, and two subcutaneous nodules on her bilateral legs. The pathologic findings of the subcutaneous nodules on her right leg showed necrotizing vasculitis with fibrinoid thrombus in the fatty tissue. In addition, digital subtraction angiography demonstrated multiple microaneurysms in the liver and kidneys. The patient was diagnosed to have polyarteritis nodosa and she was thus treated with the oral administration of prednisolone. She was also affected with Hashimoto’s disease (which is rare in such cases) and showed a bony deformity resembling mallet toe.
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Takashi MIZUNO, Makoto YOSHINAKA, Hiroko KOBAYASHI, Tetsuo SASAKI, Sat ...
2000 Volume 62 Issue 2 Pages
159-162
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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A 22-year-old woman with a 5-year history of asymptomatic, linear eruptions on her left chest and arm visited our hospital. Physical examination on the left chest revealed two linear lesions, which were slightly atrophic and depressed, extending from the epigastrium to the left hypochondrium and to the left axilla, respectively, which followed Blaschko’s line. Laboratory investigations revealed positive antinuclear antibodies (×640 nucleolar). A histopathologic study revealed a slightly atrophic epidermis with basal hyperpigmentation, perivascular inflammatory cell infiltration in the superficial and mid-dermis and a thickening of collagen bundles in the deep dermis. As a result, linear forms of atrophoderma of Pasini and Pierini and linear atrophoderma of Moulin were ruled out in our case, and a diagnosis of linear scleroderma was made. Thereafter the patient became pregnant and delivered a child, and her eruptions have slightly improved at the age of 24 as of April 1999.
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Sakae KANEKO, Motoko EGI, Takahiko YANO, Yoshiro TACHIYAMA, Yuzo HAYAS ...
2000 Volume 62 Issue 2 Pages
163-166
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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We report a patient with pemphigus foliaceus whose disease was refractory to conventional treatments. A 34-year-old woman was referred to our department in May 1996 for an evaluation of erythematous lesions with blisters spreading over her trunk. No oral or ocular involvement was observed. A histological examination of a skin biopsy specimen from an early erythematous lesion showed bulla without acantholysis in the granular cell layer. Systemic betamethasone 4 mg a day and diaminodiphenylsulfone 50 mg a day showed a partial effect, but the eruptions relapsed while the administration of systemic corticosteroids were tapered. A histological examination of the skin lesions in April 1998 showed bulla with acantholysis in the spinous cell layer. Direct immunofluorescence demonstrated IgG and C
3 deposition on the keratinocyte surfaces throughout the epidermis, but such deposition was more intense in the spinous cell layer, thus suggesting a shift to pemphigus vulgaris. However, ELISA using recombinant desmoglein (Dsg) 1 and 3 showed a positive reactivity against Dsg 1, but a weak reactivity against Dsg 3 throughout the clinical course, thus supporting the diagnosis of pemphigus foliaceus. Her pemphigus foliaceus resolved after the combination treatment of systemic corticosteroids, plasmapheresis, and immunosuppressive agents. The serum levels of anti-Dsg 1 correlated well with the clinical activity of the disease, thus indicating the usefulness of ELISA using recombinant Dsg 1 and 3 for not only the diagnosis but also for evaluating the clinical activity of the disease.
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Takashi ANAN, Yutaka HATANO, Tomoko ISE, Sakuhei FUJIWARA, Susumu TAKA ...
2000 Volume 62 Issue 2 Pages
167-171
Published: April 01, 2000
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A 36-year-old woman first developed generalized pruritic bullous eruptions and painful lingual ulcers five years previously. The initial diagnosis was pemphigus and she was treated with prednisolone at a maximum dose of 40 mg/day. Three years later, steroid administration was discontinued since all the lesions disappeared except for oral lesions. Five years later, in the second trimester of her pregnancy, pruritic bullous eruptions appeared again. Physical examination revealed the presence of dermatitis herpetiformis-like eruptions on her trunk and extremities. A histologic examination showed suprabasal bullae and eosinophilic spongiosis. A direct immunofluorescence study revealed the intercellular deposition of IgG and C
3. Using immunoblot procedures, the patient’s sera reacted with 130kDa and lower molecular weight epidermal antigens. The patient’s serum also reacted with desmoglein 3 by ELISA. From these findings, the diagnosis of herpetiform pemphigus was made. The condition was well controlled by the administration of oral prednisolone 40 mg/day. At the 36th gestational week, she delivered a healthy girl with no blistering lesions. No postpartum worsening of her disease was noted.
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Keiko KOBAYASHI, Akimichi MORITA, Noriyuki SAKAKIBARA, Takuo TSUJI
2000 Volume 62 Issue 2 Pages
172-174
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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A seven month-old baby developed an ulcerated nodule on his head. Yellowish and red papules on the head and back had also been noticed since he was four months old. A histological analysis of the red papule revealed a dense infiltration of histiocytes and giant cells in the dermis. In addition, an immunohistological study showed positive staining for HAM 56 (macrophage marker) and negative staining for CD1a (Langerhans cell marker). These findings were also confirmed by electronmicroscopy. Laboratory studies revealed normal lipidemia. Based on these findings, a diagnosis of juvenile xanthogranuloma was made.
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Shunji HIRAI, Takao MIYATA, Michinori KURISAKI
2000 Volume 62 Issue 2 Pages
175-178
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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We herein report 3 cases of decubitus that were treated with a prostacyclin analogue (beraprost sodium). Beraprost sodium appeared to effectively promote wound healing and prevent recurrence. In conclusion, the administration of a prostacyclin analogue might be another useful approach for the cure and prevention of chronic wounds such as diabetic ulcers or decubitus.
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Yasuhiro FUJISAWA, Yoshiyuki ISHII, Tomohiro BANNO, Takeshi TATEISHI, ...
2000 Volume 62 Issue 2 Pages
179-181
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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Two cases of adult lichen nitidus are reported. A 48-year-old man with a 5-year history of small, slightly reddish papules on his forearm and trunk. The other patient was a 42-year-old woman with a 10∼15 year history of small, slightly reddish papules on her forearm and abdomen. The histological features indicated lichen nitidus in both cases. Although 159 cases of lichen nitidus have been reported from 1968 to 1996 in Japan, generalized lichen nitidus with the clinical features of small slightly reddish papules have only been very rarely reported in adult patients.
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Yuko HOSOKAWA, Akimichi MORITA, Keiko KOBAYASHI, Takuo TSUJI
2000 Volume 62 Issue 2 Pages
182-185
Published: April 01, 2000
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We treated two refractory cases of psoriasis vulgaris with bath-PUVA therapy. Both patients had a large involved area showing scaly red plaques on trunks and limbs. The lesions almost completely disappeared after 21 exposures (27.4 J/cm
2) in case 1 and after 7 exposures (4.1 J/cm
2) in case 2. The total number of exposures was less than that for the topical PUVA therapy which they had been previously administered. These results suggest that bath-PUVA therapy thus appears to be another effective therapy for refractory psoriasis.
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Zuiei OYAMA, Tomoko IZUMI, Mariko SEISHIMA
2000 Volume 62 Issue 2 Pages
186-188
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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A case of macular amyloidosis with diabetic scleredema is reported. A 48-year-old man who had been suffering from non-insulin dependent diabetes mellitus for 10 years first noticed a sclerotic skin lesion on his posterior neck several years previously. The sclerotic skin lesion with ripple-pattern-pigmentation was observed on his posterior neck to upper back region. The histopathological findings showed thick and swollen collagen bundles in the thickened dermis. The deposits in the dermal papillae were positively stained with both Dylon and Congo-red staining. The co-existence of macular amyloidosis and diabetic scleredema appears to be a rare medical condition.
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Yasuyuki KITAJIMA, Miho ITO, Yasuko MAKITSUBO
2000 Volume 62 Issue 2 Pages
189-191
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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We report the case of a 59-year-old female who presented with Laugier-Hunziker-Baran syndrome. She demonstrated brownish, oval or round macules with a well-defined border on the mucous membrane of the palate, as well as the cheeks and the lips. She had widespread brown pigmented spots on her tongue. In addition, the tip of her finger had brown-black macules. In addition, no intestinal polyposis or adrenal dysfunction, which would have suggested the presence of Peutz-Jeghers syndrome or Addison’s disease, was observed. A biopsy of a pigmented macule from the lip revealed hyperpigmentation in the basal layer with a normal number of melanocytes.
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Hiroko KOMI, Tetsuo SASAKI, Tetsuo NAGATANI, Hiroshi NAKAJIMA
2000 Volume 62 Issue 2 Pages
192-195
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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A 24-year-old man with Recklinghausen’s disease (NF 1) had a history of a grayish blue, hairy macule on his right cheek and lateral head since the age of 8. The histopathology showed dermal melanocytosis and diffuse neurofibroma with some melanin granules invading into the subcutis. We diagnosed it to be hairy pigmented neurofibroma in NF 1. This case seems to be a valuable example that neurofibromas in NF 1 may show various pigmentary changes.
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Toshiki FUJII, Tomoko KINEBUCHI, Shinya ABE, Yutaka MATSUI, Makoto YAN ...
2000 Volume 62 Issue 2 Pages
196-198
Published: April 01, 2000
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A 57-year-old Japanese female visited our hospital because of a tumor on the dorsum of her right foot, which was first noticed as a small nodule 2 years previously. The tumor was well-demarcated, elastic soft, brownish-red and measured 22×17 mm. The histopathology showed the epidermis of the lesion to contain many well-defined nests of tumor cells. These nests were made up of basaloid cells with round nuclei and clear cytoplasm. In some sections, duct-like structures were seen within the nests of basaloid cells. A diagnosis of hidroacanthoma simplex was made. Many thin anastomosing epithelial strands were seen connected to the undersurface of the epidermis with intraepidermal nests extending into the dermis. These strands comprised smaller basophilic cells of two layers. Immunohistochemically, these strands were positively stained with anti-epithelial membrane antigen and 34
βE 12 antibodies. This proliferation may be the result of a reactive process due to acute inflammation and fibrosis in the dermis.
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Mari YOMODA, Norito ISHII, Shoji NISHIOKA, Takekuni NAKAMA, Osamu MORI ...
2000 Volume 62 Issue 2 Pages
199-203
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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The first case was an 83-year-old Japanese woman with a tumor on the top of her head, and the second case was a 90-year-old Japanese woman with a tumor on her back. A microscopic examination of the skin lesions revealed multiple lobules consisting of Sudan black stain positive foamy cells and undifferentiated basophilic cells. An electron microscopic examination showed the foamy cells to contain various amounts of lipid droplets, while the undifferentiated cells were rich in cytoplasmic organelles. A diagnosis of extra-ocular sebaceous carcinoma was made. We performed histochemical and immunohistochemical analyses on these 2 cases as well as on 27 basal cell carcinomas, and 16 squamous cell carcinomas for comparative purposes. The tumor cells of sebaceous carcinoma showed a positive reaction for epithelial membrane antigen, human milk fat globules subclass 1 (HMFG 1), and HMFG 2. All the basal cell carcinomas showed a negative reaction for HMFG 1/2. It is often difficult to distinguish sebaceous carcinoma from basal cell carcinoma with sebaceous differentiation, because both tumors have lobules consisting of Sudan black stain positive foamy cells. Our findings indicate that immunohistochemical studies for HMFG 1/2 are very useful for distinguishing these two diseases.
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Zuiei OYAMA, Tomoko IZUMI, Mariko SEISHIMA
2000 Volume 62 Issue 2 Pages
204-206
Published: April 01, 2000
Released on J-STAGE: September 02, 2010
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We report the case of a 57-year-old man who first developed several purplish blue nodules with tenderness on his right arm when he was 12 years old. The nodules were excised but thereafter recurred several times. The histopathological findings showed tumor nests in the dermis with dilated vascular spaces lined by a single layer of endothelial cells. Tumor cells with oval nuclei and eosinophilic cytoplasm were observed in the periphery of the endothelial cells, forming one to several layers. Immunohistochemical studies showed the tumor cells to be positively stained with antibodies to
α-smooth muscle actin and vimentin but not with the antibody to desmin, myosin, or S-100 protein. The endothelial cells were positively stained with antibody to factor VIII-related antigens. These results therefore support the concept that glomus tumors originate from vascular smooth muscle cells.
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Takahiko TSUNODA, Norihisa HORIUCHI, Tatsuo KASAI, Yasuo KATABIRA
2000 Volume 62 Issue 2 Pages
207-209
Published: April 01, 2000
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Tsunoda et al. first reported that an eruption of herpes zoster sometimes crosses over the midline of the trunk in 1986. We herein report two patients whose eruptions of herpes zoster skipped over the midline of the back along the cutaneous nerves of the other side. Our two cases may have been caused by the anastomosis or crossing of the cutaneous nerves at the midline of the back as described anatomically by Tsunoda in 1982.
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Yoshiko MASHINO, Aki WATANABE, Ayako MATSUMURA, Yumiko KUBOTA, Tetsuya ...
2000 Volume 62 Issue 2 Pages
210-213
Published: April 01, 2000
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A case of malignant syphilis in a 40-year-old male is herein described. He exhibited papular lesions all over his body for two weeks. The eruptions progressed with the formation of pustules and crusted ulcers. He also demonstrated symptoms of fever, general fatigue, and weight loss. His CD4(+) T cell count in the peripheral blood decreased to 65/
μl, and serological tests for both HIV and syphilis infections were positive. Spirochaetas were demonstrated in the exudate from the lesions based on the findings of Parker Q ink staining. Malignant syphilis is predicted to become more common due to the increasing incidence of HIV infection. As a result, malignant syphilis should therefore be considered as one of the cutaneous markers of HIV infection.
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Kiho KIYOI, Yoshihiro MAEKAWA, Yuko KUNITAKE, Keiko TANAKA
2000 Volume 62 Issue 2 Pages
214-217
Published: April 01, 2000
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A 28-year-old Chinese woman, who liked to eat raw fish, visited our hospital because of a painful subcutaneous nodule in the left hypogastric region. Diethylcarbamazine citrate was not effective in treating the nodule, and chest effusion and a fever developed. This case is considered to be a possible double infection of
Paragonimus and
Gnathostoma based on the clinical findings, clinical course, and the serodiagnosis. She was treated with praziquantel in addition to diethylcarbamazine citrate. As a result, she showed a marked improvement in both her clinical condition and laboratory findings.
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