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Junko HIGO, Chikako MORIYA, Hideharu ISHIHARA, Masato KIDO, Hiroshi MI ...
2000 Volume 62 Issue 5 Pages
581-584
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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We report a term infant who showed a late onset of neonatal TSS-like exanthematous disease. A 15-day-old girl was admitted to our hospital because of a high-fever. On the next day, she presented with generalized confluent papulo-erythema and a consecutive high-fever. Pustules on the erythema of the trunk and pyogenic exudate in the navel were observed. Laboratory data revealed a low platelet count, a weak positive reaction of CRP, and a large percentage of neutrophils (88.2%) in the pustules. In addition, a bacterial culture from the umbilical swab yielded TSST-1-producing MRSA. The clinical symptoms and data led us to make the above described diagnosis. Although MRSA was not sensitive to the administration of CEZ, the disease ran its course and the fever cleared on the third day after onset while the exanthema resolved on the fifth day. In addition, desquamation on the palms was noted during the recovery.
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Fumiko NAGATO, Emiko TANABE, Makoto SUEISHI, Motonobu NISHIMURA, Ryuta ...
2000 Volume 62 Issue 5 Pages
585-590
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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Adult Still’s disease (ASD) is a systemic inflammatory disorder of unknown aetiology characterized by a triad of symptoms including high fever, skin rash and arthralgia or arthritis. We herein report three cases of ASD (case 1: 29-year-old man, case 2: 37-year-old man, case 3: 33-year-old woman). They presented with a high spiking fever, rash, arthralgia and a sore throat. Antinuclear antibodies and rheumatoid factors were negative. In two of three cases investigations revealed neutrophilia and an elevated feritin level. Case 2 demonstrated pericardial and pleural effusion. All three cases presented with nonpruritic macular eruptions measuring from 3 mm to 3 cm in diameter, of a light red color, involving the chest, upper arms, forearms and legs, occurring predominantly with fever. A histologic examination of the eruption showed slight edema of the upper dermis, dilated capillaries, and perivascular and interstitial sparse lymphocytic and neutrophilic infiltrate. In all cases, steroid therapy was effective.
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Yayoi SUZUKI, Masaru NAKAJIMA, Akimichi MORITA, Takuo TSUJI
2000 Volume 62 Issue 5 Pages
591-593
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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We report a case of a 60-year-old woman with Sjögren’s syndrome who developed an ulcer on her right lower leg of about one year’s duration. The ulcer had recently increased in size. A cutaneous biopsy specimen near the ulcer demonstrated typical lipomembranous fat necrosis. Histological changes were considered to be related to hypergammaglobulinemia and stasis dermatitis.
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Shinichi IMAFUKU, Hiromaro KIRYU, Masutaka FURUE, Shinichiro YASUMOTO
2000 Volume 62 Issue 5 Pages
594-597
Published: October 01, 2000
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Multiple blue nevi are rare and have been reported in several different terms. We herein report a case of agminated blue nevi and also review the literature. A 35-year-old woman was referred to us with multiple bluish papules and macules on her right chest. A lesion appeared at birth and the number of pigmented papules thereafter gradually increased. On inspection, multiple 1 to 5 millimeter-sized bluish papules and ill-defined macules were found to have aggregated over an area measuring 48 × 22 mm in size. A histological examination revealed an aggregation of spindle shaped pigmented cells in the middermis, exclusively around hair follicles and eccrine glands, thus leading to a diagnosis of common blue nevi.
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Ayako KUSABA, Manabu HAMADA, Osamu YAMAMOTO, Yoshinori SUENAGA, Masaka ...
2000 Volume 62 Issue 5 Pages
598-601
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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We report a rare case of malignant fibrous histiocytoma (MFH) with angiosarcoma. A malignant soft tissue tumor was excised from an 81-year-old woman’s buttock in 1981. Eight years later, however, a tumor recurred in the same region and an excision had to be carried out again. We next used combination therapy consisting of intra-arterial infusion of interlaukin-2 and irradiation for angiosarcoma on her scalp in 1996. She felt a pain in her right thumb in August of 1998, which was found to be caused by a soft tissue tumor combined with a pathological bone fracture. A histopathologic examination revealed a proliferation of atypical cells which had a number of fibroblastic or histiocytic characters and formed a storiform pattern in the tumor mass. Scattered bizarre giant cells and many mitotic cells were also observed in the tumor region. The tumor cells infiltrated into the bone tissue. The above observations and results of immunohistochemical examinations suggested this tumor to be MFH which developed independently of her buttock’s tumor and the angiosarcoma on her scalp.
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Etsuko KOMIYAMA, Katsuya HISAMICHI, Rie UEKI, Masataro HIRUMA, Ryoji T ...
2000 Volume 62 Issue 5 Pages
602-605
Published: October 01, 2000
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Four cases of eccrine spiradenoma were treated at our clinic. The first case was a 53-year-old male with a subcutaneous nodule measuring about 1.5 cm in diameter on his right chest. The second case was a 59-year-old male with a subcutaneous nodule measuring about 1 cm in diameter on his left neck. The third case was a 33-year-old male with a teleangiectasic nodule measuring 1 cm in diameter, below the left nostril, and the fourth case was an 81-year-old male with a nodule measuring about 5 mm under the skin of his right cheek. Histologically, each tumor had a gland-like, papillary structure and consisted of two distinct cell types. We also reviewed 49 cases of eccrine spiradenoma reported in Japan since 1990.
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Yumiko GOTOH, Junji NAKAFUSA, Kimiaki SATOH, Yutaka NARISAWA, Hideki K ...
2000 Volume 62 Issue 5 Pages
606-609
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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We report the case of a 73-year-old woman with squamous cell carcinoma (SCC) arising on a burn scar. She showed hypercalcemia and leucocytosis. No bone metastasis was observed and the serum level of parathyroid hormone (PTH) was within the normal limits. However, the serum level of parathyroid hormone-related peptide (PTHrP) was 187.4 pmol/l (13.8∼55.8 pmol/l). After operation, the hypercalcemia and leucocytosis both rapidly improved. We consider that the serection of PTHrP from SCC caused the hypercalcemia.
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Yoshihisa MIYATA, Hiroki ONO, Ayumi ADACHI, Yasushi TOMITA, Kazuo HARA
2000 Volume 62 Issue 5 Pages
610-613
Published: October 01, 2000
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We report the rare case of a male patient (age 42) who presented with more than 11 trichilemmal cysts (TC) and a proliferating trichilemmal cyst (PTC) on his head. The PTC was a large keratinized protuberant lesion of an open cyst with a continual wall to the epidermis, and no such PTC case has yet been reported in Japan. We suppose that the PTC developed from the TC after one of the cysts had ruptured due to an injury.
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Kunio IZU, Osamu YAMAMOTO, Yoshinori SUENAGA, Masakazu ASAHI
2000 Volume 62 Issue 5 Pages
614-619
Published: October 01, 2000
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Multiple myeloma is a disease characterized by a systemic proliferation of neoplastic plasma cells in the bone marrow, and rarely shows any formation of extraskeletal tumors. In this report, we describe a case of IgG-
λ type multiple myeloma which metastasized to the skin and thus formed a giant tumor. The patient was a 57-year-old woman who had experienced the explosion of atomic bomb at Hiroshima. She received combined chemotherapy and plasma, exchange therapy, but died 8 months after the initial development of cutaneous metastasis. We collected 50 cases of the multiple myeloma associated with skin metastasis which have been reported since 1982 in Japan and reviewed them. Among the previous 50 reports of metastatic cutaneous myeloma, IgD type multiple myeloma tended to have earlier skin metastasis than other immunoglobulin types of myeloma. There was, however, no significant difference in the prognosis between the skin metastasis of each immunoglobulin type of multiple myeloma.
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Miho TAJIRI, Osamu YAMAMOTO, Yoshinori SUENAGA, Masakazu ASAHI, Kentar ...
2000 Volume 62 Issue 5 Pages
620-625
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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An 83-year-old female, who had received a right radical mastectomy followed by irradiation for breast cancer eighteen years earlier, was admitted to our hospital with a red plaque on her right upper arm which was diagnosed to be postirradiated lymphedema. The patient was treated with an intravenous and local injection of interleukin-2 (IL-2), and a local excision with a skin graft. After the operation, the tumoral lesion of angiosarcoma reccurred arround the grafted area of the right forearm. The lesion was treated with a local injection of IL-2, however the patient showed no remarkable improvement and died 11 months after the onset. Immunohistochemically, the lesion showed an increased number of CD 8-positive cells but no NK cell infiltration. The significance of these results is not clear at present, but similar observations have previously been reported. In addition, it was interesting to note that CD 20-positive cell infiltration was remarkably observed in the lesion after IL-2 treatment.
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Michiyo KURIBAYASHI, Hideo YABUNAMI, Hideharu ENDO, Hiroshi SHINKAI
2000 Volume 62 Issue 5 Pages
626-628
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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A 57-year-old male patient had multiple well-circumscribed scaly erythema on his left crus, and the lesions spread over his whole body, which had waxed and waned for 10 years. Thereafter, some of the scaly erythematous lesions became elevated and red colored tumors measuring from 1-to-2 cm in diameter. Cutaneous biopsies from the tumor showed dense infiltrates of atypical mononuclear cells in the epidermis, which displayed a so-called pagetoid appearance. The rearrangement of T cell receptor
β chain was observed by Southern blot hybridization. We diagnosed this to be a case of disseminated pagetoid reticulosis (Ketron-Goodman type).
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Wen-Ya CHEN, Eiko WAKEYAMA, Katsutaro NISHIMOTO
2000 Volume 62 Issue 5 Pages
629-631
Published: October 01, 2000
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A 2-year-old boy had been scratching his scalp for a period of 2 weeks and his family brought him to our outpatient department for a dermatological consultation. An incomplete alopecia patch was found on his occipital area, and many miliary-sized black dots were noticed in the lesion. The microscopical findings of the black dots revealed a hair shaft filled with numerous spores showing endothrix parasitism. A culture of the affected hairs yielded slowly growing grayish yellow-brown colonies with a glabrous surface, and measured 1.5 cm in diameter after four weeks on SDA. The isolated fungus was identified to be
Trichophyton glabrum. The patient was treated with the oral administration of terbinafine 30 mg/day for three weeks. Seventy-four days after the discontinuation of terbinafine therapy, the patient visited our department for a follow-up examination. Only a few scales were noticed on his scalp, and while a KOH examination revealed several round spores, a brushing sample yielded no fungal growth. There was no recurrence of the skin lesion. Terbinafine is thought to have a higher cure rate and requires a shorter treatment period than griseofulvin, which has been the drug of choice for oral antifungal treatment of tinea capitis.
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Sachiko ORIMA, Yukari MIYAMOTO, Tsutomu OHTSUKA, Noriaki HARA, Akiko B ...
2000 Volume 62 Issue 5 Pages
632-635
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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We report a 73-year-old man who had suffered from myelodysplastic syndrome since May 1993. He presented with eruptions on his left elbow and right fingers since December 1996, and was treated with oral corticosteroids. He was diagnosed to have interstitial pneumonia and was treated with steroid pulse theapy in March 1998. He thereafter developed multiple subcutaneous tumors on his back, thighs and legs. A histological examination of one of these red tumors revealed fungus in the dermis and subcutaneous fatty tissue.
Aspergillus fumigatus was detected from the same skin biopsy specimen. Although he was treated with oral itraconazole and topical injections of amphotericin B, the
β-D glucan level increased and multiple fungus granules appeared in his blood vessels, heart and lungs. He died from pulmonary insufficiency in November 1999.
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—It is Difficult to Judge the Causative Drug—
Motoko UEDA, Hijiri MORI, Tetsuo SANDA, Yuko IWASE, Takashi YASUE
2000 Volume 62 Issue 5 Pages
636-638
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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A 4-year-old girl had taken cefuzonam for 4 days, and cefixime for the following 8 days for pneumonia, which had been diagnosed by a doctor in her neighborhood. Thereafter, an eruption consisting of erythema and blistering developed over her entire body, and the mucous membranes were also involved. She was thereafter transferred to our hospital. She was diagnosed to have Stevens-Johnson Syndrome (SJS). She was treated with prednisolone and
γ-globulin. The skin reepithelialized with pigmentation 3 weeks later. The drug lymphocyte stimulation test (DLST) for cefuzonam was positive. A patch test was negative, but the histopathological findings of the skin, where the test was conducted, showed features of allergic dermatitis. Cefuzonam was suspected to be the causative drug. It is difficult to judge the causative drug of this case, because the chemical structure of cefixime is similar to cefuzonam.
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Tomoko NAGATA, Takeo AOKI, Shigeo NONAKA
2000 Volume 62 Issue 5 Pages
639-641
Published: October 01, 2000
Released on J-STAGE: September 02, 2010
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We report a case of drug eruption (erythema multiforme type) due to the oral administration of terbinafine in a 67-year-old Japanese male. He noticed a gradual onset of reddish, ring-like eruptions along with itching on his legs and trunk after continuing to take terbinafine for 14 days. The erythematous circinate eruptions were from bean to egg sized. A skin biopsy revealed perivascular lymphocytic infiltration in the upper dermis. Terbinafine was discontinued and prednisolone (20 mg/day) was orally administered for 4 consecutive days. Thereafter, the eruptions dramatically disappeared in both size and number. A patch test of terbinafine (10% pet) was negative. A prick test with 1.0%-0.01% solutions of terbinafine was negative. Intradermal testing with 0.02ml of 1.0%-0.01% solutions of terbinafine showed a positive reaction in the patient but was negative in three controls.
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Michiyo KURIBAYASHI, Hirotoshi NAGAYAMA, Hideharu ENDO, Hiroshi SHINKA ...
2000 Volume 62 Issue 5 Pages
642-643
Published: October 01, 2000
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A 30-year-old male patient developed erythema on his lips, fingers and penis shaft after taking over-the-counter analgesic. No ingredients of the medicine were positive for patch test reactions even on the erupted lesions. However, an oral challenge test with allyl-isopropyl acetylurea was positive on the erupted lesions. We diagnosed this case to be a fixed drug eruption due to allyl-isopropyl acetylurea. Two years later, he took a medicine containing allyl-isopropyl acetylurea that had been mistakenly prescribed by his family doctor. This time he presented with bullous eruptions in addition to erythema and the eruptions were even observed on his intraoral mucosa. He was treated with steroids for 2 weeks and the eruptions were successfully cured.
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Kazuyo MAEKAWA, Takeo AOKI, Masayoshi HANASHIRO, Shigeo NONAKA
2000 Volume 62 Issue 5 Pages
644-647
Published: October 01, 2000
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Anaphylaxis due to the consumption of Ensure Liquid
® (oral nutrients in liguid form) ocurred in a 2-year and 3-month old infant. She had bacterial meningitis a few hours after birth. She was on a respirator, and sometimes had pneumonia due to the bacterial meningitis. After first taking Ensure Liquid
®, she demonstrated a low blood pressure, bronchospasm and fell into a state of shock. A scratch test, prick test and IgE-RAST check revealed that casein had caused the anaphylaxis, and casein is the principal protein ingredient of Ensure Liquid
®. Several studies have previously reported that casein causes milk allergies. An infant’s gastric intestine is immature, and easily absorbs allergens. In addition, she had frequently had pneumonia and taken antibiotics before taking Ensure Liquid
®. We consider that these events had led to a higher activation of the intestinal immune cells and intestinal bacterial flora change, which thus led to the onset of anaphylaxis after consuming Ensure Liquid
®.
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