Aya Tanaka

Critical renal adverse event induced by nivolumab therapy in a stage IV melanoma patient

good prognosis and heal after a short duration, as in the present case; however, the stings of social bees, such as Vespinae and Polistinae, are toxic and may be lethal. As the number of stings increases, the severity of the reaction also increases and sometimes results in severe allergic reactions to wasps and honeybees. Although it is not clearly known whether the allergen of large carpenter bees has the same effects, a case of a fatal sting by a large carpenter bee, Xylocopa tranquebarica, has been reported recently. Therefore, although our patient may have little or no chance of receiving another sting from the peaceful Japanese carpenter bee, she should be careful not to stimulate the bee to avoid additional stings.

Severe gangrene accompanied by varicella zoster virus-related vasculitis mimicking rheumatoid vasculitis.

Herpes zoster infection occurs more frequently and severely in immunosuppressed populations. However, the condition sometimes presents with atypical clinical manifestations of the skin, which makes it difficult to reach a correct diagnosis. We experienced a case of acral gangrene caused by varicella zoster virus (VZV)-related vasculitis in a rheumatoid arthritis (RA) patient. Histologically, necrotic vasculitis was observed; however, there were initially no findings in the epidermis suggestive of a viral infection. We thought that the skin ulcer was related to rheumatoid vasculitis. However, an immunohistochemical analysis for VZV confirmed VZV infection in the vascular endothelium of the dermis, leading to effective treatment with intravenous acyclovir. Since various pathogenic skin phenotypes are observed in RA patients, modified according to the status of immunosuppression, clinicians must recognize the variation in typical and atypical manifestations in order to manage these patients.

Development of necrotising fasciitis in a patient treated for rheumatoid arthritis with tocilizumab.

Necrotising fasciitis (NF) is a potentially lethal infection affecting subcutaneous tissue and superficial fascia that may progress to multiple organ failure, and the prognosis is often worse when the host is immunocompromised. The prognosis is influenced by early diagnosis and early surgical debridement (1). Biologic therapies have been used in treating intractable inflammatory diseases, including collagen disorders. When using such a treatment strategy, it is critical to be aware that the treated subject may be highly susceptible to infection. Tocilizumab is a humanised monoclonal antibody directed against the interleukin-6 (IL-6) receptor and is recognised as an excellent biologic treatment in inflammatory rheumatic conditions (2). However, we wish to highlight the fact that its use may be associated with serious adverse reactions such as NF. It is known that tocilizumab may completely suppress induced C-reactive protein (CRP) via neutralisation of IL-6 effects (3). In fact, there have been a few reports of infections and other adverse events in subjects treated with tocilizumab (4). CASE REPORT

Adult case of Stevens–Johnson syndrome possibly induced by Chlamydophila pneumoniae infection with severe involvement of bronchial epithelium resulting in constructive respiratory disorder

membranes, play important roles for organ development and function, including skin, hair, skeletal muscle, nervous system, kidney, lung and vasculature. Laminins are large heterotrimeric glycoproteins composed of one a-, one band one c-chain. There are currently five a-, four band three c-chain genes that have been described in vertebrates and the chains can assemble into at least 15 different heterotrimers. The molecular specificity of anti-laminin autoantibodies generally determines the phenotype of autoimmune subepidermal blistering disease. In patients with anti-laminin-c1 pemphigoid, subepidermal blisters with neutrophil infiltration, which are predominant skin lesions, heal rapidly in response to treatment without scarring resolution. The exact laminin targeted by anti-laminin-c1 antibodies has not yet been identified. On the other hand, a chronic course and debilitating scarring of multiple mucous surfaces are considered to be the common clinical features of most patients with anti-laminin-332 mucous membrane pemphigoid. Previously, two patients with an autoimmune response to both laminin-c1 and laminin-332 were reported. In these cases, tense blisters affecting both skin and mucous membranes, which were characteristics of two distinct clinical phenotypes in anti-laminin-c1 pemphigoid and anti-laminin-332 mucous membrane pemphigoid, were observed. Our case presented with flaccid blisters on the dorsal surface of her body, while mucous membranes were not affected. This is not typical for both anti-laminin-c1 pemphigoid and anti-laminin-332 mucous membrane pemphigoid. It is possible that both antilaminin-c1 and anti-laminin-332 autoantibodies synergistically induced this unusual clinical phenotype. It is also possible that in pemphigoid patients without mucosal involvement showing anti-laminin-332 autoantibodies, unrevealed antibodies triggered the development of skin pemphigoid, which was followed by the epitope-spreading phenomenon of autoantibodies against laminin-332. Interestingly, as in our patient, although the a3and c1-subunits in laminin-6 (a3b1c1) and laminin-7 (a3b2c1) are detectable in alveolar basement membranes, no respiratory complications were reported in anti-laminin-c1 pemphigoid and anti-laminin-332 mucous membrane pemphigoid. Although in contrast to laminin-332, the pathogenicity of antilaminin-c1 autoantibodies could not been shown, we should take into consideration the possibility of dual detection of autoantibodies against laminin-c1 and laminin-332 in patients with subepidermal blistering disease. A higher number of patients with combined autoimmunity against laminin-c1 and -a3 is needed to further define the clinical phenotype in this variant.

Epithelioid angiosarcoma of the skin with spontaneous regression.

and pancreas, and cholangiocarcinoma show variable reactivity. Hepatocellular carcinomas and carcinoid tumors often show focal reactivity limited to scattered tumor cells. In contrast, CK20 is virtually absent in primary adenocarcinomas of the lungs, ovaries and endometrium. Of course, it is negative in primary EMPD. Notable exceptions among ovarian tumors are mucinous neoplasms that show variable, sometimes significant, CK20 reactivity. TCC of the bladder is usually positive, while prostatic and renal adenocarcinomas are negative. Accordingly, CK20 is a suitable adjunct marker, especially for separating primary versus secondary EMPD. On the other hand, GCDFP-15 was initially thought to be specific for apocrine glands and tumors with apocrine differentiation. Although GCDFP-15 is also found in mammary and salivary glands, it is not found in gastrointestinal mucosa, endometrium and urothelium. Accordingly, GCDFP-15 is also a useful marker to distinguish between primary and secondary EMPD. The present case corresponded to secondary EMPD from TCC because Paget’s cells were positive for CK20 and negative for GCDFP-15. In the present case, tumor cells could not be found in the urethral epithelium after urethrectomy. Furthermore, Paget’s cells were detected in the dilated lymph vessel in the deep layer of the dermis of the glans penis and the lamina propria of the urethra. Accordingly, epidermotropic metastasis to the epidermis of the glans penis occurred from retrograde lymphatic dissemination by TCC of the bladder. In general, TCC is supposed to extend continuously via the urothelium to the glans penis, where clinical and histological characteristics of EMPD occur. However, epidermotropic secondary EMPD of the vulva has been reported to be caused from retrograde lymphatic dissemination by TCC of the bladder with pelvic lymph node metastases. Accordingly, TCC of the bladder can give rise to epidermotropic secondary EMPD from retrograde lymphatic dissemination as in the present case. In conclusion, TCC of the bladder can lead to secondary EMPD of the glans penis in two patterns either via the urothelium or lymph vessel, recognition of which is important for suitable treatment.

A rare case of mucinous carcinoma of the skin with multiple organ metastases

Mucinous carcinoma of the skin (MCS), which was first reported by Lennox [1], is an adnexal neoplasm considered to originate from the secretory coil of eccrine sweat glands [2]. It is a rare skin malignancy as only approximately 200 cases have so far been reported [3]. Its most common location is the head and neck [4]. Although local recurrences are frequent, only a few cases of distant metastases have been so far reported [5, 6]. We present herein an extremely rare case of MCS metastasizing to [...]

Non-pigmenting fixed drug eruption caused by an over-the-counter non-steroidal anti-inflammatory drug: Drug-specific CD8+ T lymphocytes identified in peripheral blood

ejd.2012.1793 Auteur(s) : Takaaki Hanafusa1, Hiroaki Azukizawa1 azukizaw@derma.med.osaka-u.ac.jp, Sayaka Matsumura1, Yukako Murakami1, Aya Tanaka2, Kishiro Kurachi2, Ichiro Katayama1 1 Department of Dermatology, Osaka University Graduate School of Medicine* 2-2 Yamadaoka Suita-shi, Osaka, 565-0871, Japan 2 Department of Dermatology, Toyonaka Municipal Hospital Fixed drug eruption (FDE) is a common cutaneous adverse reaction (cADR), frequently caused by oral intake of non-steroidal anti-inflammatory [...]