From April through October 2008, 40 patients hospitalized at Rakuwakai Otowa Hospital were treated for scabies using oral ivermectin and external benzyl benzoate eurax. All patients were over 65 years of age.
During or after their treatment, five of these patients showed abnormal blood chemistry ; however, the blood chemistry of all five patients returned to normal without any additional medicines. Two patients died of causes relating to pre-existing critical diseases. Two patients treated with ivermectin had previous minor liver disorders but showed no abnormal effects in their blood test data. Due to Sarcoptes scabiei’s life cycle, it was believed that at least two administrations would be needed ; however, only 71% of scabies were cured after two administrations and twelve patients required more than three administrations.
Based on this experience, during an outbreak of scabies in a closed community, such as a hospital, including groups of elderly individuals, we suggest ivermectin as a safe and effective treatment.

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Case 1 : A 30-year-old man presented at our hospital complaining of high fever, headache and unconsciousness. Viral encephalitis was suspected by cerebrospinal fluid analysis and MRI examination, followed by the appearance of erythematous subcutaneous nodules on the front of his bilateral lower legs. Case 2 : A 19-year-old man with Sjögren syndrome presented at our hospital with high fever, vomiting, diarrhea and numerous erythematous nodules on his face, back and front of the bilateral lower legs. After admission, he developed a headache. He was diagnosed with aseptic meningitis by cerebrospinal fluid analysis and MRI examination. Histopathologically, panniculitis with lymphocytes infiltrating the septa of subcutaneous fatty tissues was observed in both patients. This was diagnosed as erythema nodosum associated with viral encephalitis or aseptic meningitis.

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The patient was a 70-year-old man with chronic radiodermatitis.
At the age of 28, this patient had undergone surgery and postoperative radiation therapy for a pituitary tumor. Forty-two years later, an ulcer developed in a scar on his forehead, which was suspected to be a spinocellular carcinoma. Total resection was performed and in the tissue specimens there was a deposit of calcium-like material, but no sign of malignancy was observed. The lesion extended to the periost, making reconstruction difficult.

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A 71-year-old woman was administered two antibiotics, clindamycin (CLDM) and ceftazidime hydrate (CAZ), following total excision for squamous cell carcinoma on her left face. Four days after drug administration, she developed asymptomatic erythema on her back that rapidly extended, covering her whole body over a 4-day period. Small pustules were also noted. Simultaneously, she experienced a high fever and hypouresis. We stopped the administration of CLDM and CAZ, and changed to meropenem (MEPM). Clinical symptoms and laboratory data improved remarkably ten days after changing the antibiotics. Drug lymphocyte stimulation tests (DLST) revealed both CLDM and CAZ as positive. Only CLDM was positive by patch testing. On the basis of these findings and the clinical course, we diagnosed this case as AGEP and acute kidney injury induced by CLDM and CAZ.

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We report a case of human immunodeficiency virus-associated eosinophilic folliculitis (HIV-AEF). A healthy 29-year-old man presented with diffuse erythema, papules and pustules on his face, neck, chest and back, which was diagnosed as acne or contact dermatitis and had been treated with oral antibiotics or topical steroid without success. Histology of a pustulo-erythematous lesion on the neck showed dense perifollicular and perivascular infiltrate of eosinophils. A diagnosis of eosinophilic pustular folliculitis (EPF) was made.
Further examinations revealed that he was serologically HIV positive, and he was diagnosed with AIDS with a low CD4+ cell count. His symptoms gradually improved after recovery of the CD4+ cell counts with highly active anti-retroviral therapy.

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We report a 38-year-old man with malignant clear cell hydradenoma on the right axilla. The tumor had grown rapidly for a couple of months and was 10×8cm in diameter at the first hospitalization in April 2009. The massive tumor was clinically a blue-to-purple elastic hard nodule with slight hemorrhage from the surface and tightly adhered to the lower tissues. Histological examination showed numerous lumens of irregular shape consisting of atypical clear cells and basaloid cells with tumor necrosis in the center. Based on a histopathological diagnosis of malignant clear cell hydradenoma by initial skin biopsy, we performed a wide tumor resection with axillar lymph node dissection followed by adjuvant local irradiation. Nevertheless, multiple lung metastasis appeared within six months of our surgical procedure, followed by liver metastasis. Considering the aggressive clinical course of this case, we retrospectively suspect that metastasis to distant organs might have occurred by the first hospitalization and discuss the high-grade malignancy of this tumor.

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We report a case of nasal cancer with skin involvement as the presenting sign of internal carcinoma. An 80-year-old man presented with a red nose resembling rhinophyma of one-month duration. Skin biopsy revealed squamous cell carcinoma that involved the nasal skin.
Endoscopic findings and biopsy of nasal mucosa also revealed squamous cell carcinoma. He was treated with radiotherapy and chemotherapy by an otorhinolaryngologist, but his dementia became so severe that treatment was stopped.
Primary malignancies of the nasal septum are uncommon. Early diagnosis may be difficult, so appropriate investigative tests should be done.

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