Akiva Trattner

The appearance of kaposi sarcoma during corticosteroid therapy

Background. Four epidemiologic types of Kaposi sarcoma (KS) are known: classic KS, endemic African KS, epidemic or acquired immunodeficiency syndrome–related KS, and KS associated with immunosuppressive therapy. In most of the latter patients, KS was reported to have developed after organ transplantation, particularly renal transplantation. Thirty‐nine patients who have not had a transplant have been reported to have KS associated with corticosteroid therapy.

Esophageal involvement in pemphigus vulgaris: A clinical, histologic, and immunopathologic study

Eleven newly diagnosed patients and one patient with pemphigus vulgaris who relapsed underwent endoscopy of the upper gastrointestinal tract. Three patients had blisters or erosions and two had longitudinal lines of erythema in the esophageal mucosa. In four patients histopathologic examination showed findings of pemphigus vulgaris but direct immunofluorescence was positive in all patients. This study demonstrates that the immunopathologic disturbance in pemphigus vulgaris involves the entire length of the esophagus, although only some patients have clinical or histologic involvement. To the best of our knowledge this is the first histopathologic and direct immunofluorescence study of esophageal involvement in patients with untreated pemphigus vulgaris.

Circumscribed scleroderma induced by postlumpectomy radiation therapy

A 57‐year‐old woman who had undergone a lumpectomy for infiltrating duct cell carcinoma of the right breast was found to have morphea after receiving radiation therapy. The morphea occurred at the site of the irradiated field. It is suggested that the irradiation served as a provoking factor and that the morphea might be an isomorphic response to the trauma of the irradiation. Cancer 68:2131–2133.

Familial congenital anterior cervical hypertrichosis associated with peripheral sensory and motor neuropathy--a new syndrome?

We present three patients with familial congenital hypertrichosis localized to the anterior cervical region, associated with peripheral sensory and motor neuropathy. This association may represent a new neurocutaneous syndrome. The association of anterior midline cutaneous lesions with an underlying malformation is discussed.

The theràpeutic effect of intralesional interferon in classical Kaposi's sarcoma

Interferon alpha‐2a, which has antineoplastic, antiviral, immunomodulatory, and antiangiogenic effects, was evaluated in a prospective study, treating 10 lesions of patients with classical Kaposis sarcoma. Ten patients received injections of interferon alpha‐2a intralesionally in a dose of 3 million units three times weekly for 4 weeks, and in a variable dose for 4 more weeks. Two of the patients had a complete response, and in one of these, distant lesions also responded. Seven had a partial response, and one did not respond. The treatment was generally well tolerated.

Kaposi's sarcoma with visceral involvement after intraarticular and epidural injections of corticosteroids

Kaposis sarcoma has been reported in patients receiving immunosuppressive therapy, most of whom are organ transplant recipients. The development of Kaposis sarcoma after treatment with corticosteroids has been reported in only 38 patients who have not had acquired immunodeficiency syndrome or undergone organ transplantation. Cutaneous Kaposis sarcoma developed 2 months after intraarticular steroid injections in a man with ulnar nerve entrapment. The lesions regressed spontaneously after 3 months but reappeared with visceral involvement 18 months later, shortly after initiation of a course of epidural steroid injections for treatment of low back pain. The cutaneous lesions and some visceral lesions rapidly regressed after cessation of treatment.

Esophageal Involvement in Pemphigus vulgaris: Report of Two Cases and Review of the Literature

Two patients with esophageal involvement of pemphigus vulgaris are presented, who were diagnosed histopathologically and by direct immunofluorescence. In most dermatological textbooks the possibility of esophageal involvement is not mentioned. In the English medical literature 11 cases have been reported. It seems that if upper gastrointestinal endoscopy had been done on a routine basis it might have shown that esophageal involvement is more widespread than present findings indicate.

MULTIPLE DERMAL CYLINDROMA UNDERGOING A MALIGNANT TRANSFORMATION

An 81-year-old woman presented to a dermatologist to find out whether there has been any medical progress during the last 40 years. To the doctors amazement, she took off her wig and revealed a sizable mass of multiple skin tumors overlying her entire scalp. The tumors ranged from 1 to 15 cm in diameter, red-crimson, devoid of hair, and of rubbery consistency. Those on top were ulcerated, discharging a foul smelling hemorrhagic-necrotic material (Fig. 1). Similar but smaller sized nodules could be seen over the ear lobes, sides of the face, and nape of the neck. Over tbe nasolabial folds, she had multiple flesh-colored skin nodules of 0.5 to 1.0 cm in diameter. Other than those skin lesions she was in excellent physical and mental condition and had no remarkable medical history. She rejected the suggestion of surgical removal made 40 years ago and avoided doctors thereafter. She recalled both kinds of skin lesions first appearing during her early twenties, with the scalp tumors expanding in size ever since, and tbe facial nodules remaining static. She reported that eight family members had facial skin-colored nodules similar to hers: her mother, sister, two brothers, the mothers sister and two brothers, and her mothers mother. As far as she knew, none had any scalp tumors.

Hypersensitivity to an oestrogen-progesterone preparation and possible relationship to autoimmune progesterone dermatitis and corticosteroid hypersensitivity

The cause of autoimmune progesterone dermatitis (AIPD) is unknown. It has been postulated that it may present a unique type of corticosteroid hypersensitivity. We report the case of a 68-year-old woman who had suffered for years from AIPD and corticosteroid sensitivity. For late menopausal syndrome she took an eostrogenprogesterone preparation (Pre-maril Plus, Dexxon) and a few days later she again developed AIPD. In our opinion this case clearly demonstrates the relationship between AIPD and corticosteroid hypersensitivity.

Esophageal manifestations in autoimmune bullous diseases.

Diseases of the skin and gastrointestinal tract occur together more often than would be expected by chance, and probably more often tban diseases of the skin together with any other system. In regard to the autoimmune blistering diseases, it is reasonable to assume that the immunologic process affecting the skin and mouth will also affect the esophagus, as the esophagus is lined with squamous cell epithelium, which is very similar to that of the oral mucous membranes. There are, however, very few reports of esophageal involvement in autoimmune bullous diseases, and in most dermatologic and gastroenterologic text books,^ the possibility of esophageal involvement in these diseases is hardly mentioned.