Cameron Kennedy

Hyperpigmentation associated with oral minocycline.

Two patients receiving minocycline developed blue‐black pigmentation on the legs. Biopsies from the pigmented areas demonstrated granules containing iron, a pigment with staining properties similar to melanin, and a third pigment which may be a degradation product of minocycline. Electron microscopy showed that some, but not all the granules were membranebound and they were situated mainly within macrophages. Analytical electron microscopy showed that the granules contained iron, sulphur, chlorine and, in one case, calcium.

The spectrum of inflammatory skin disease following jejuno-ileal bypass for morbid obesity

From a scries of 105 patients who had undergone jejuno‐ileal bypass for morbid obesity, seven developed an episodic illness featuring inflammatory skin lesions, usually associated with a non destructive polyarthritis. Tenosynovitis, myalgia and fever had also occurred. The illness abated spontaneously in four patients.

Sarcoidosis presenting in tattoos

Histological examination showed numerous well defined epithelioid cell granulomata throughout the dermis, not noticeably in relation to the pigment granules (Fig. 2). Langhans and foreign body types of giant cells were seen, and several of the granulomata had necrobiotic centres. There was a sparse lymphocytic infiltrate between granulomata. The epidermis was unremarkable. No acid and alcohol fast bacilli (AAFB) were seen, and polarized microscopy was negative. The Mantoux test was weakly positive at i: 100, but negative at higher dilutions. The Kveim test (biopsied 6 weeks after intradermal injection, without a tattoo marker) was positive. The only other evidence of systemic sarcoidosis was from the chest X-ray (Fig. 3), which showed gross enlargement of both hilar, and right paratracheal lymph nodes. The following investigations were normal or negative: Full blood count and ESR, albumen, globulin and

Mepacrine pigmentation in systemic lupus erythematosus.: NEW DATA FROM AN ULTRASTRUCTURAL, BIOCHEMICAL AND ANALYTICAL ELECTRON MICROSCOPIC INVESTIGATION

A case of mepacrine pigmentation occurring in a patient with systemic lupus erythematosus has been investigated by fluorescent light microscopy, gas‐liquid chromatography and analytical electron microscopy. There is strong evidence for the presence of mepacrine itself within the typical granules, which have been shown by electron microscopy to be membrane bound and intracellular. Analytical electron microscopy also showed that the granules contain large quantities of iron and smaller quantities of sulphur.

Mercury pigmentation from industrial exposure. An ultrastructural and analytical electron microscopic study.

A study has been made of facial pigmentation resulting from industrial inorganic mercury exposure. Electron microscopy has shown electron‐dense 400–900 nm aggregates of 12 nm particles in dermal macrophages and free in the dermis. Use of the analytical electron microscope has enabled direct confirmation of the presence of mercury in these aggregates. The unexpected finding of coexistent selenium is discussed.

Systemic sclerosis with subcutaneous nodules

A case of systemic sclerosis with subcutaneous nodules is described. The nodules consited of fibrinoid degeneration with surrounding fibrosis, but lacked the typical histiocytic palisade of the rheumatoid nodule. The patient had neither coexistent rheumatoid arthritis nor circulating rheumatoid factor.

Skin changes caused by D-penicillamine treatment of arthritis. Report of three cases with immunological findings.

The clinical, histological and immunopathological details of three cases with a d‐penicillamine‐induced eruption are presented. The skin changes included (1) pemphigus erythematosus, (2) pemphigus foliaceus, (3) a bizarre localized pruritic papular eruption, the immunopathology of which was characteristic of lupus erythematosus and (4) fragility due to loss of dermal collagen. Circulating IgA was abnormally low in two cases and circulating immune complexes were demonstrated in the third case.

Eosinophilic fasciitis with erosive arthritis

A 64‐year‐old man developed a symmetrical erosive polyarthritis affecting the hands and feet in association with a progressive woody induration of the limbs and flexion contractures, Investigations showed peripheral eosinophilia and an inflammatory fibrosis maximally involving the deep fascia. The relationship of eosinophilic fasciitis to morphoea and progressive systemic sclerosis is discussed.

RENAL FUNCTION IN METHOTREXATE TREATED PSORIATICS

SiRj Methotrexate (MTX) has an accepted place in the therapy of certain severe forms of psoriasis. Most of the complications seen with the higher dosages (upwards of 0-5 mg/kg/week) used to treat neoplastic diseases are rarely encountered with the schedules used for psoriasis (0-2-0-5 mg/kg/week). However, structural hepatic damage, occasionally progressing to cirrhosis, has been reported (Coe & Bull, 1968; Epstein & Croft, 1969 j Weinstein et al., 1970j Almeyda et al., 1972), the earliest changes only being detectable by liver biopsy. Liver damage is seen much less when MTX is given orally once weekly (Dahl, Gregory & Scheuer, 1972; Warin et al., 1975). MTX is largely excreted by the kidneys (Henderson, Adamson & Olivero, 1965), but there are no comparable published studies of its effect on renal structure and fimction during MTX therapy of psoriasis. Zachariae, Grunnet & S0gaard (1976) have presented renal biopsy data indicating that there are no structural changes in the renal parenchyma during MTX therapy. A prospective survey at The London Hospital suggests that there are no significant changes in renal fvinction. This report concerns twelve patients, all taking MTX orally once weekly. The age range for males is 25-67 years J for females 28-79 years. Serum creatinine, creatinine clearance and urinary albumin were measured before MTX therapy and at intervals thereafter. The results are summarized in Table i. Although there have been isolated reports of nephrotoxicity of MTX in psoriatics (Ryan & Vickers, 1966; McKenzie & Aitken, 1967; Ryan & Baker, 1969) renal damage attributable to the drug seems to be rare in psoriatics. In contrast, in a group of patients with advanced cancer and previously normal renal function, high doses of MTX (0-5-3-0 mg/kg) were reported to cause damage. The changes included a decrease in renal clearance of inulin and PAH, elevation of blood urea, and, in three cases who

32) Painful bruising syndrome with vasculitis treated by plasmapheresis

V,M., female, aged 38 years. Housewife, Hospital case no. G.73001. History. Since 1964 she has had recurrent episodes of tender lumps in the skin, often associated with acute dyspnoea. Less frequently she has had haemoptysis, dysphagia and abdominal pain with melaena. The skin lesions have usually started as tender erythematous oedema, becoming purpuric and sometimes ulcerating. Individual lesions last upwards of several days. They vary in size from 2 to 20 cm across, occurring particularly on the legs, trunk and arms but no part ofthe skin surface has been spared (Fig. i). Similar lesions have been seen by indirect laryngoscopy in the pharynx and larynx.