The Nishinihon Journal of Dermatology
Online ISSN : 1880-4047
Print ISSN : 0386-9784
ISSN-L : 0386-9784
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Volume 64, Issue 4
Displaying 1-21 of 21 articles from this issue
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Clinical Case Reports
  • Hypergammaglobulinemic Purpura Occuring in a Female Delivered of an Infant Diagnosed with Neonatal Lupus Erythematosus
    Hiroshi ARAKAWA, Toyoko OCHIAI, Ayako FUJITSUKA, Takafumi MORISHIMA
    2002 Volume 64 Issue 4 Pages 412-415
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.412
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    A 31-year-old pregnant female presented with an 8-month history of purpura on both legs. This condition worsened after becoming pregnant. A history of facial annular erythema at age 22 and purpura experienced after standing for long periods from age 28 was elicited. A physical examination revealed 2-3mm multiple erythema and purpura on both legs, intermingled with plaques of pigmentation. The titers of anti SS-A and SS-B antibodies were 30.8 and 138.4 on ELISA index, respectively, and the level of γ-globulin was 2.0g/dl. Rose-Bengal and fluorescein tests elicited positive results. A histological examination revealed predominantly dermal perivascular neutrophilic cellular infiltration with nuclear dust and extravasation of erythrocytes. Purpura and pigmentation improved with rest from exertion at about 9 months into pregnancy, but the pigmentation remained. The baby was diagnosed to have neonatal lupus erythematosus following the observation of annular erythema, a ventricular septal defect and high titers of anti SS-A and SS-B antibodies. These results indicate that the mechanism of maternal purpura formation may be an obstruction of the venous return at the inferior vena cava (due to pressure from the enlarged uterus), vasculitis, increased γ-globulin and hyperviscosity, and increased plasma volume. However, the patient was also diagnosed to have Sjoögren’s syndrome according to high titers of anti SS-A and SS-B antibodies. In addition, she was also suspected to have keratoconjunctivitis sicca. She thereafter delivered an infant with neonatal lupus erythematosus. In conclusion, the present case suggests that the measurement of anti SS-A and SS-B antibody titers is important, and therefore careful consideration should be given to cardiac disease of the fetus in pregnant woman demonstrating hypergammaglobulinemic purpura.
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  • Systemic Scleroderma with Linear Scleroderma
    Mahiro YAMAMURA, Zuiei OYAMA, Mariko SEISHIMA
    2002 Volume 64 Issue 4 Pages 416-418
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.416
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    We report a 53-year-old Japanese woman who was diagnosed to have systemic scleroderma with linear scleroderma. She previously suffered from interstitial pneumonia with sclerodactylia and had been treated with oral prednisolone since 1975. Several years previously, she noticed a subcutaneous induration on her upper chest skin with an exacerbation of sclerodactylia. Several months before the first consultation, she recognized an extension of the subcutaneous induration, so she consulted our department. A slight erythematous, linear and subcutaneous induration measuring 16cm in length was seen on her upper chest. The laboratory findings showed positive antinuclear antibody(1 : 320) and an increased level of KL-6(643U/ml). A chest computer tomography test and chest X-ray test revealed interstitial pneumonia. Histological findings from the subcutaneous induration of her upper chest showed an increase of collagen fibers in the dermis and slight perivascular lymphocytic infiltration. From these observations, the diagnosis of systemic scleroderma with linear scleroderma was made. Raynaud’s phenomenon and coldness in the fingers improved gradually after treatment with oral tocopherol nicotinate 300mg/day and the regular injection of alprostadil 10/μg/day. However, the subcutaneous induration of her upper chest continued to increase and measured 22.5cm in size after 17 months.
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  • A Case with Cryoglobulin-positive Chronic Hepatitis C and Erythematosus-like Eruptions
    Toshiko IDO, Atsushi TOKURIKI, Takahiro KIYOHARA, Masanobu KUMAKIRI
    2002 Volume 64 Issue 4 Pages 419-422
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.419
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    A 72-year-old woman with chronic hepatitis C and cryoglobulinaemia developed various cutaneous manifestations. The patient exhibited erythema, mimicking a butterfly rash of erythematosus on her face, pruritic red plaques on the back of her hands and forearms, and livedo reticularis and purpura on the extremities after being exposed to the cold for one month. Laboratory examinations revealed negative antinuclear antibody, low CH50, high γ-globulin, elevated GOT and GPT levels, mixed cryoglobulinaemia, and positive hepatitis C antibodies. The cryoglobulinaemia was identified as Type III. A skin biopsy from the pruritic red plaques on the left forearm showed lichenoid tissue reactions. Her cutaneous manifestations improved after being treated for chronic hepatitis C. The present case suggests that the development of various cutaneous manifestations may thus be associated with hepatitis C virus infection.
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  • A Case of Unique Subepidermal Blistering Disease with Autoantibodies Reactive with the Dermal Side of the 1M NaCl Split Skin
    Mika YOSHIDA, Riyo BABA, Hirohiko SUEKI, Masafumi IIJIMA, Takashi HASH ...
    2002 Volume 64 Issue 4 Pages 423-426
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.423
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    A 63-year-old Japanese man developed vesicles with pruritus on the trunk and extremities 2 months previous to presentation, when he was suspected to have lung cancer. Examinations at his first visit revealed scattered thumb-head-sized erosions, crusts and pigmented macules on the trunk and extremities, but no apparent blisters, milia, or involvement of mucous membranes were observed. Later, vesicles on the periphery of erythematous plaques developed on the trunk, and a biopsy was taken under a tentative diagnosis of bullous pemphigoid. Histopathology revealed the subepidermal blisters to contain lymphocytes. Direct immunofluorescence showed a deposition of C3 but no immunoglobulins along the basement membrane zone. Indirect immunofluorescence on 1M NaCl split skin demonstrated linear IgG staining exclusively on the dermal side of the split. An immunoblot analysis identified about 200kDa protein in dermal extracts, although it was different from the 200kDa antigen found in the sera of bullous disease with psoriasis. Because the number of blisters gradually increased, oral prednisolone 20mg/day was administered and tapered. Five mg of prednisolone every other day was continued to maintain the resolution, however, the patient died of lung cancer and severe renal dysfunction 20 months after the start of treatment.
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  • A Case of Cutaneous Calcinosis Following Extravasation of Calcium Gluconate
    Yoko YAHATA, Yuji SHIRAKATA, Koji HASHIMOTO, Yoshihiro TAKAHASHI, Taka ...
    2002 Volume 64 Issue 4 Pages 427-429
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.427
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    We report a case of cutaneous calcinosis following extravasation of calcium gluconate. A 3-year-old female was treated for a decreased serum calcium level with an intravenous injection of calcium gluconate. Six days later, erythema and swelling were observed at the injection site on her right arm. After 20 days, a yellowish-white subcutaneous nodule appeared at the site. An X-ray examination showed a subcutaneous high-density region. HE staining of a biopsy specimen showed the deposition of amorphous basophilic material at the dermal site. Von Kossa staining confirmed that this deposit to be calcium. Transepidermal elimination occurred in some nodules. All the deposits disappeared without treatment within 6 months.
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  • A Case of Multiple Lichen Sclerosis et Atrophicus on the Arm
    Nobue KOIZUMI, Atsushi HATAMOCHI, Kaoru MURATA, Hiroshi SHINKAI
    2002 Volume 64 Issue 4 Pages 430-433
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.430
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    A 52-year-old woman presented with a 10-year history of multiple atrophic erythematous plaques and milky white sclerotic plaques on her left arm. Histological examinations showed hyperkeratosis with follicular plugging in the epidermis, liquefaction degeneration of the basal layer, remarkable edema in the upper layer of dermis, inflammatory cell infiltration, and an increase in the number of swollen collagen fibers in the middle and lower layers of dermis of erythematous plaques. On the other hand, atrophy and a disappearance of rete ridge was seen in the epidermis, and remarkable increase of swollen compacted collagen fibers in the middle and lower layers of dermis of sclerotic plaques. Elastica van Gieson staining showed decreased elatic fibers in the upper dermis of the erythematous plaques, and fragmented and depressed elastic fibers in the upper dermis of the sclerotic plaques. We therefore diagnosed this patient to have lichen sclerosis et atrophicus. After topical PUVA therapy showed unsatisfactory results, the lesions were reduced and softened by the localized application of corticosteroid cream and injection.
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  • A Case of Pachyonychia Congenita Type 2 Successfully Treated with Oral Etretinate
    Kenjiro TERASAKI, Shinichi YOTSUMOTO, Tamotsu KANZAKI, Mitsuru SETOYAM ...
    2002 Volume 64 Issue 4 Pages 434-438
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.434
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    Pachyonychia congenita (PC) is a rare hereditary disease showing congenital ectodermal dysplasia first described by Jadassohn-Lewandowsky in 1906. It consists of 2 major subtypes. We report a case of PC type 2 (Jackson-Lawler type) in a 19-year-old male who had onychogryposis, planter hyperkeratosis with blister formation, follicular keratosis, hair abnormalities, hyperhidrosis and steatocystoma multiplex. No neonatal tooth and elected hairs were found in this case which is different from previous reports, and might have been caused by a new gene mutation. His hyperkeratotic lesions improved after treatment with oral etretinate.
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  • Successful Mapping of Sentinel Lymph Nodes with Technetium-99m Phytate in Two Cases with Cutaneous Malignancies Arising on a Toe
    Osamu YAMASAKI, Kenji ASAGOE, Eiichi MAKINO, Keiji IWATSUKI, Shuhei SA ...
    2002 Volume 64 Issue 4 Pages 439-442
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.439
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    We herein report the successful usage of preoperative lymphoscintigraphy using technetium-99 m-phytate for two cases of cutaneous malignancies arising in a toe. Case 1 was a 67-year-old man with subungual melanoma on his right big toe. Although no sentinel nodes were detected by lymphoscintigraphy using technetium-99 m tin colloid, technetium-99 m phytate successfully demonstrated two sentinel nodes in the right inguinal region. Case 2 was a 61-year-old man with subungual squamous cell carcinoma on his right big toe. Lymphoscintigraphy using technetium-99 m phytate demonstrated three sentinel nodes in the right inguinal region. The sentinel nodes imaged by lymphoscintigraphy were further identified using intraoperative blue dye and then were successfully excised in both cases. Because phytate is smaller in size than tin colloid, technetium-99 m phytate is thus considered to be potentially useful for the detection of sentinel nodes.
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  • A Case Report on the Coexistence of Squamous Cell Carcinoma and Basal Cell Carcinoma in the Right Leg of a Patient with Type I Oculocutaneous Albinism
    Hideki HOZUMI, Reiji UCHIMIYA, Tamotsu KANZAKI, Kouichiro KIUE
    2002 Volume 64 Issue 4 Pages 443-446
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.443
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    A 67-year-old man with type I oculocutaneus albinism visited our clinic with a 3 cm ulcer on the dorsal aspect of his right foot. A skin biopsy revealed the ulcer to be squamous cell carcinoma. We also found a red nodule on his right lower leg which was revealed to be basal cell carcinoma. This was thought to be a relatively rare case with squamous cell carcinoma and basal cell carcinoma occurring in a patient with albinism.
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  • Two Cases of Adult T-cell Leukemia (ATL) Treated Successfully with IFN-γ
    — An Immunohistochemical Investigation —
    Yoshihiko KATAHIRA, Tamotsu KANZAKI, Mitsuru SETOYAMA
    2002 Volume 64 Issue 4 Pages 447-451
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.447
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    Two cases of adult T-cell leukemia/lymphoma (ATL), one classified as cutaneous type and the other as chronic type, were treated by intramuscular injections of 1,000,000 units of IFN-γ five times a week, amounting to 20 million units in 4 weeks or 40 million units in 8 weeks. The ATL skin lesions in both cases almost completely resolved, and favorable results were obtained. The lesions in both cases were immunohistochemically investigated before and after the treatment. Decreases m the number of CD4+ and CD25+ cells and relative increases in the number of CD8+ cells were noted after the treatment. This indicates that IFN-γ is mainly effective against ATL due to a mechanism involving host immunocompetence mediated by cytotoxic T lymphocytes.
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  • A Case of Cutaneous Larva Migrans Caused by Dog Hookworms was Suspected
    Teruki DAINICHI, Tetsuya KOGA, Makiko KIDO, Yoichi MOROI, Kazunori URA ...
    2002 Volume 64 Issue 4 Pages 452-455
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.452
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    A 31-year-old American man visited Thailand and walked on the resort beach in his bare feet. Nine days later, a creeping eruption developed on his right sole. A skin biopsy revealed a blister formation and many eosinophils were infiltrated in the epidermis and perivascular area of the dermis. No parasite larvae were found in serial sections. The parasite-specific antibody titer in serum sample of the patient was not elevated. This eruption was thus diagnosed to be cutaneous larva migrans due to dog hookworms, because of the characteristic clinical course and the manifestation of symptoms.
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  • A Case of Atypical Myrmecia with a Unique Appearance
    Takuya INOUE, Tatsurou TANAKA, Junji NAKAFUSA, Noriyuki MISAGO, Yutaka ...
    2002 Volume 64 Issue 4 Pages 456-460
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.456
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    A 29-year-old male complained of a reddish nodule on the dorsum of his right hand. He was administered prednisolone 40 mg/day for the treatment of IgA nephropathy. The nodule rapidly grew and reached 2 cm in diameter. Clinically, the nodule had a papillomatous appearance with an irregular hyperkeratotic surface. A diagnosis of verruca vulgaris was considered from the clinical appearance. Histologically, the tissue revealed hyperkeratosis, acanthosis, and papillomatosis. Moreover, granular intracytoplasmic inclusion bodies were present throughout the prickle-cell layer. In the nuclei of some of the affected cells, there were intranuclear basophilic inclusion bodies. In situ hybridization demonstrated human papillomavirus type-1 (HPV-1) DNA sequences in the nuclei of the epidermal cells. These histological findings were compatible with the features of Myrmecia. In this report, we emphasize the existence of atypical myrmecia with an unusual clinical appearance.
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  • A Case of Drug Eruption due to Treatment with Iomeprol (Iomeron®)
    Kenji SAITO, Akihiko KOMURA
    2002 Volume 64 Issue 4 Pages 461-463
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.461
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    A case of drug eruption due Iomeprol were reported. A 69-year-old woman developed skin eruptions on her trunk 6 days after undergoing angiography. Patch tests with Iomeprol, Iohexol were positive. Intravenous adninistration test with Iopamidol was negative and therefore the patient was thereafter treated with Iopamidol in radiological examination.
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Clinical and Investigative Report
  • Clinical Evaluation of an Enzyme-linked Immunosorbent Assay (ELISA) for Detecting Pemphigus Antibodies
    Mari KISHIBE, Hikaru SHIBAKI, Hiroshi NAKANE, Akemi ISHIDA-YAMAMOTO, H ...
    2002 Volume 64 Issue 4 Pages 464-468
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.464
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    Pemphigus is an autoimmune bullous disease that is characterized by acantholytic bullae in the skin and a mucous membrane. The sera of such patients contain antibodies against desmoglein 1 and/or desmoglein 3, that are epidermal cell adhesion molecules. Recently, an enzeme-linked immunosorbent assay (ELISA) system was established to detect and quantitate anti-desmoglein antibodies. The clinical usefulness of the ELISA system was examined at our institution. The system turned out to be highly sensitive and specific showing a good correlation with disease activity. However, when ELISA was applied to high titer antibody sera (> 120 ELISA index value), a further dilution of the sera was required to detect precise values. As a result, the ELISA system was found to be highly useful for a clinical evaluation of pemphigus cases, if the sera are properly diluted.
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Review
Statistics
  • Statistical Analysis of Herpes Zoster Observed at Sasebo City General Hospital
    Tetsuo SHUKUWA, Wen-ya CHEN, Akiko KOBAYASHI
    2002 Volume 64 Issue 4 Pages 477-482
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.477
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    A statistical survey was performed on 276 Japanese patients with herpes zoster, who visited the dermatological division of Sasebo City General Hospital from January 1999 to December 2000. These 276 cases (119 males and 157 females) accounted for 4.1% of all new outpatients. Their age distribution showed two peaks: one in the sixties and one in the twenties. The most frequently involved site was the thorax (28.3%) followed by the head and neck (27.5%) and the abdomen (25.0%). The mean duration from the onset to the first examination was 6.0 days. About seventy-seven percent of the patients had an underlying disease such as a malignant neoplasm, hypertension or diabetes mellitus. Furthermore, 55.8% of all patients, and 81.0% of cases in their twenties, experienced tiredness within three weeks before onset. The mean duration of skin eruptions was 18.4 days, and that of pain was 39.0 days. Both of these durations were significantly shorter in the patients who had begun taking acyclovir within 3 days after onset than in patients who had begun acyclovir later than that. The efficacy of pain medicines was 81.6% for prednisolone, 80.3% for amitriptyline, 76.8% for Sairei-to, and 52.6% for ethyl loflazepate. The percentage of patients responding to topical treatment for skin eruptions was 93.2% for tretinoin tocopheril and 83.3% for suprofen. Recurrent attacks occurred in 22 cases (8.0%).
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Therapy
  • A Trial of Chemoimmunotherapy Using Paclitaxel, Mitoxantrone, IFN-α and Cepharanthin for Metastatic Malignant Melanoma
    Saburo ANZAI, Yoshitomo UCHIBAYASHI, Toshihiro SATO, Hiroto TERASHI, S ...
    2002 Volume 64 Issue 4 Pages 483-486
    Published: August 01, 2002
    Released on J-STAGE: September 02, 2010
    DOIhttps://doi.org/10.2336/nishinihonhifu.64.483
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    A 50-year-old woman noticed a tumor on the left second digit, where she had suffered a burn injury in 1995. The digit was amputed and left axillary lymph node dissection was performed in February 1996. Multiple metastatic lesions appeared in both lungs in 1997 after ten cycles of combination chemotherapy of DAV-IFN (dacarbazine, nimustine hydrochloride, vincristin and interferon-β). Despite three partial pneumoectomies and four cycles of combination chemotherapy of DAC-Tam (dacarbazine, nimustine hydrochloride, cisplatin and tamoxifen) or IL-2-based chemoimmunotherapy, new metastatic lesions appeared again in both lungs in November 1999. She was then treated with the chemoimmunotherapy using cepharanthin, interferon-α, paclitaxel and mitoxantrone. All metastatic lesions had disappeared at four months after the therapy. This is the first case successfully treated with a combination of these four drugs.
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