Daisuke Omoto

Nivolumab in the treatment of malignant melanoma: review of the literature

Nivolumab was developed as a monoclonal antibody against programmed death receptor-1, an immune checkpoint inhibitor which negatively regulates T-cell proliferation and activation. Intravenous administration of nivolumab was approved for the treatment of unresectable malignant melanoma in 2014 in Japan. When advanced melanoma patients were treated with nivolumab, median overall survival became longer. Overall survival rate was significantly better in nivolumab-treated melanoma patients than dacarbazine-treated melanoma patients. Nivolumab had an acceptable long-term tolerability profile, with 22% of patients experiencing grade 3 or 4 adverse events related to the drug. Therefore, nivolumab can become an alternative therapy for advanced malignant melanoma.

Increased circulating Th17 cell in a patient with tinea capitis caused by Microsporum canis

Tinea capitis is a relatively common superficial fungal infection. In the infection ofMicrosporum canis (M. canis), the lesion is around a hair shaft and eventually the hairs break off 1e3 mm above the scalp. The patients sometimes experience permanent hair loss, especially after longstanding inflammation. However, the detail mechanism of severe inflammation leading to subcutaneous pustular formation and hair loss caused by tinea capitis remains unclear. Recently, IL-17-producing Th17 cells, which are comprised in established CD4þ T helper cell subsets, exacerbate skin inflammation,

Maculopapular type drug eruption caused by silodosin

Silodosin is one of the a1-adrenergic receptor antagonists and is commonly used to treat male lower urinary tract symptoms due to benign prostatic hypertrophy.1 The incidence of silodosin-related adverse events was 69.7%,1 and themost common adverse event after silodosin treatment was abnormal ejaculation.1 However, to our knowledge, there has been no case report on cutaneous drug eruption caused by silodosin in English literature. Herein, we report the first case of silodosin-induced drug eruption. A 58-year-old male, who had suffered from benign prostatic hypertrophy for 5 years, developed his erythematous plaques andwas referred to our department for evaluation of his eruption. Physical examination revealed that papules and erythematous eruption had developed on his trunk (Fig. 1AeC) and extremities without mucosal involvement after the 3rd administration of silodosin for his benign prostatic hypertrophy. Laboratory and biochemical examinations were within normal ranges. At the first visit, a skin biopsy specimen taken from an erythematous lesion on his trunk revealed lymphocyte infiltration around vessels in dermis (Fig. 1D) with less epidermal change. We performed lymphocyte stimulation test (LST) with silodosin as described previously.2,3

Drug eruption caused by secukinumab

The Th17 cell is a pro-inflammatory T helper cell subset defined by the production of IL-17, which plays an important role in various inflammatory diseases [1]. IL-17 exacerbates inflammatory responses through activation of various immune cells, such as neutrophils and keratinocytes. Therefore, the IL-17 axis is a key therapeutic target for the regulation of inflammatory diseases, such as psoriasis and rheumatoid arthritis [2]. Secukinumab is an IL-17 neutralizing antibody, and widely used for the [...]

Acute Generalized Exanthematous Pustulosis Caused by Faropenem: A Possible Pathogenetic Role for Interleukin-23.

© 2016 The Authors. doi: 10.2340/00015555-2225 Journal Compilation

CD30-positive Cutaneous Pseudolymphoma Caused by Tocilizumab in a Patient with Rheumatoid Arthritis: Case Report and Literature Review

Tocilizumab is a biological disease-modifying anti-rheumatic drug (DMARD) that targets interleukin 6 (IL-6) receptor, blocking IL-6 signalling (1). Tocilizumab has shown efficacy in the treatment of rheumatoid arthritis (2); however, it sometimes induces cutaneous adverse reactions. We report here a case of pseudolymphoma caused by tocilizumab, manifesting as an unusual cutaneous eruption. We also review the literature concerning drug eruption caused by tocilizumab, and pseudolymphoma caused by biologics in general.

Photoallergic Drug Eruption Caused by Certolizumab Pegol.

Certolizumab pegol is a novel tumour necrosis factor (TNF) inhibitor, comprising a humanized Fab antigenbinding fragment fused to a 40-kDa polyethylene glycol (PEG) moiety (1). This unique structure avoids the potential Fc-mediated effects seen in vitro, such as complement-dependent or antibody-dependent cellmediated cytotoxicity or apoptosis (2). Certolizumab pegol is used to treat autoimmune diseases, such as Crohn’s disease and rheumatoid arthritis, and exhibits strong anti-inflammatory effects. Although diarrhoea and vomiting have been reported as adverse events of treatment with certolizumab pegol, there have been few case reports of cutaneous side-effects, such as psoriasiform drug eruption (3). We report here the first case of photoallergy caused by certolizumab pegol.

Anaphylactoid purpura triggered by cellulitis as a favorable prognosis: case report and literature review.

AbstractBackgroundAn anaphylactoid purpura affects small capillaries in the skin and other organs. Although two cases of anaphylactoid purpura exacerbated by cellulitis have been reported in Japanese literatures, its prognosis remains still unclear. Because cellulitis exacerbates various cutaneous inflammations, it has been speculated that cellulitis might also exacerbate cutaneous inflammation, such as vasculitis. FindingsIn this article, we report that 78-year-old woman exhibited anaphylactoid purpura, following cellulitis. We also reviewed the literature concerning about this subject.ConclusionsThis type of anaphylactoid purpura is thought to have a favorable prognosis dependent on the treatment for cellulitis.

Acute edema/cutaneous distension syndrome representing as eczéma craquelé-like change: A case and published work review.

protein secretion by peripheral blood mononuclear cells was influenced by different alleles of the IL-17A gene (rs2275913). However, little is known about the association of IL-17A with each of the clinical phenotypes of BD. In order to see the association of IL-17A gene SNP with clinical symptoms of BD, we examined the frequency of IL-17A gene SNP (rs2275913) in 95 BD patients and 96 healthy controls. The study was approved by the ethics committee of Saitama Medical University. Genomic DNA was analyzed by polymerase chain reaction (PCR) with specific primers. The PCR products were sequenced using an ABI Big Dye cycle sequencing termination kit (Applied Biosystems, Foster City, CA, USA). Fisher’s test was performed to examine the statistical correlations. P < 0.05 was considered to be statistically significant. There were no significant differences in the genotypic or allelic frequency of the IL-17A gene SNP in the BD patients and controls. No significant differences in the genotypic frequency of the IL-17A gene SNP were identified in the patients with and without individual clinical signs (such as skin, ocular, vascular and central nervous system involvement, arthropathies and epididymitis). However, there was a tendency of different IL-17A gene SNP frequency with intestinal involvement in patients with BD, although not significant (Table 1). The odds ratio of the GG + GA genotype compared with the AA genotype (rs2275913) was 5.9, and the risk genotype was thought to be GG + GA. Our result suggests the possibility that there may be an association between the IL-17A gene polymorphism and gastrointestinal symptoms in patients with BD, although there was not a significant difference. ACKNOWLEDGMENTS: We express our thanks to Atsuko Neuchi (Saitama Medical University) for her skillful assistance. We express our thanks to Professor Yasushi Sakamoto (Saitama Medical University Biomedical Research Center Division of Analytical Science) for his helpful support. This study was partially supported by a Health and Labor Sciences Research Grant in Japan.

Dome-shaped metastatic lesion on the scalp from a uterine smooth muscle tumor of uncertain malignant potential (STUMP)

Smooth muscle tumor of uncertain malignant potential (STUMP) is a tumor that cannot be histologically diagnosed as unequivocally benign or malignant [1]. Uterine STUMP is histologically characterized by the existence of standard smooth muscle differentiation, low mitotic index and diffuse atypia. We describe a case of cutaneous skull metastasis from uterine STUMP. To our knowledge, this is the first case report in English of cutaneous metastasis of STUMP.A 68-year-old woman was referred to our department [...]