Hideto Takahama

Radiation-induced temporary hair loss as a radiation damage only occurring in patients who had the combination of MDCT and DSA

As imaging technologies become increasingly advanced, it is possible to obtain detailed morphological information as well as functional imaging data. In some imaging technologies, the radiation dose increases with the ability to obtain better images or more detailed information. We encountered three cases of temporary bandage-shaped hair loss, which was caused by perfusion studies of the head by multi-detector row computed tomography (MDCT) for evaluation of cerebral blood flow in patients with vascular disorders. In all three patients with temporary hair loss, two angiographies of the head had been performed in the period of serial CT examinations. This suggested the possibility that radiation exposure from angiography performed in serial examinations, combined with the perfusion studies of the head with MDCT, played an important role in this temporary, bandage-shaped hair loss. Radiologists should be aware that a cumulative or multiplier effect of radiation exposure from multiple diagnostic techniques may result in hair loss and other types of radiation complications.

Moisturizing effects of topical nicotinamide on atopic dry skin

Background  Certain moisturizers can improve skin barrier function in atopic dermatitis. The effect of topical nicotinamide on atopic dry skin is unknown. We examined the effect of topical nicotinamide on atopic dry skin and compared the results with the effect of white petrolatum in a left–right comparison study.

Food-induced anaphylaxis caused by ingestion of royal jelly.

We report a case of food‐induced anaphylaxis caused by ingestion of royal jelly. After taking royal jelly and several other medicinal products, a 33‐year‐old Japanese male developed severe facial pruritus and erythema, followed by vertigo, numbness in his fingers, generalized pruritus, wheals, dyspnea, wheezing and impaired consciousness. He was treated with corticosteroid and fluid therapy, and his symptoms subsided. Upon allergy testing, his only positive reaction was to royal jelly. Given the clinical symptoms and the positive prick test to royal jelly, a diagnosis of anaphylaxis due to the ingestion of royal jelly was made. In this paper, we describe this case and review the relevant published work.

A successfully treated case of mycetoma due to Nocardia veterana

We report a successfully treated case of mycetoma from which an unusual Nocardia species was isolated. The isolate was identified as N. veterana by biochemical characterization and 16S ribosomal RNA gene sequencing, and it has not been previously reported as a causative agent of human mycetomas. Treatment with various antibiotics over 6 years and surgical resection failed to cure the disease. However, the combination of intravenous imipenem/cilastatin and amikacin along with oral clarithromycin and minocycline proved very effective in this case. This is the first case report of mycetoma due to N. veterana in a clinical setting.

Detection of Human Papillomavirus Type 57 in the Tissue of a Plantar Epidermoid Cyst

Plantar epidermoid cysts with human papillomavirus (HPV) infection are not rare in Japan. Most of them show the cytopathic effect of HPV type 60 – homogeneous intracytoplasmic inclusion bodies. Our case presented a plantar epidermoid cyst with vacuolation around the granular cell layer without any features of HPV type 60. In situ hybridization and polymerase chain reaction followed by DNA sequencing analysis revealed an association with HPV type 57.

A case of anaphylaxis due to ibuprofen.

A forty‐four‐year‐old Japanese female, who had persistant rhinorrhea, was administered Benza block tabletsR orally along with two other medicines. Immediately after ingestion, the patient displayed itching of the right upper eyelid, followed by coughing, sneezing, nasal discharge, nasal obstruction, nausea, vomiting, swelling of the face, and dyspnea. She had edema, a wheal extending from the face to the neck, and swelling of the eyelids and lips. Her symptoms subsided after treatment. Her reaction to ibuprofen, which was contained in the Benza Block tabletsR was confirmed by a positive reaction to prick testing. From the results of these examinations, our patient was diagnosed as having anaphylaxis due to the ibuprofen in the Benza Block tabletsR. A review of the literature revealed no previous reports of anaphylaxis due to ibuprofen, although a few cases of ibuprofen urticaria have been reported.

Clonotypic Analysis of T Cells Infiltrating the Skin of Patients with Atopic Dermatitis: Evidence for Antigen-Driven Accumulation of T Cells

Atopic dermatitis (AD) is a chronic inflammation of the skin characterized by marked infiltration of lymphocytes, suggesting an important role for cellular immune responses in the pathogenesis of AD. It is still unclear, however, whether accumulation of lymphocytes results from antigen-driven mechanisms or by nonspecific inflammatory processes. We applied a novel method of T cell clonotypic analysis, using a combination of reverse transcriptase-PCR with multiple T cell receptor (TCR) primers and subsequent single-strand conformation polymorphism (SSCP). Using this method, we were able to detect oligoclonal accumulation of T cells in inflamed skin areas of patients with AD, but not in normal skin. Identical T cell clones with the same antigen specificities were present in samples obtained from separate skin regions. Our results indicate that antigen(s) that exist in large areas of the skin stimulate and expand a relatively restricted number of antigen-specific T cells, leading to oligoclonal accumulation of T cells. We suggest that a marked antigen-driven infiltration of T cells is present in AD.

A case of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber's disease) with dystrophic calcinosis cutis and retinal lesions.

A 65‐year‐old Japanese female developed a nodule on the distal interphalangeal joint of her right thumb. She also had multiple telangiectasias on her face, oral mucosa, tongue, nasal mucosa and upper extremities. A lip biopsy showed irregularly dilated capillaries and venules lined by flat endothelial cells. The nodule in the right thumb was resected. Histopathology revealed calcium deposits in the dermis. This case was diagnosed as dystrophic calcinosis cutis within hereditary hemorrhagic telangiectasia. Ophthalmologic examination showed bilateral retinal vascular lesions with dilated and tortuous retinal venules.

T-cell clonotypes specific for Dermatophagoides pteronyssinus in the skin lesions of patients with atopic dermatitis

T-cell mediated immune response, toward the house dust mite (HDM) antigens in particular, has been reported to be involved in the pathogenesis of atopic dermatitis (AD). On the other hand, studies on the infiltrating lymphocytes in the skin lesion of AD revealed oligoclonal T-cell accumulation. However, it is not clear exactly what antigen(s) the accumulating T cells are exactly recognize in situ. Therefore, this study attempted to determine whether or not the clonally expanded T-cell clones in the diseased skin recognize HDM. Specifically, peripheral blood mononuclear cells (PBMC) obtained from six patients with AD, who revealed high titers of anti-HDM IgE, were stimulated with HDM antigens purified from Dermatophagoides pteronyssinus (Dp). T-cell clonotypes expanded by the stimulation were then identified by the analysis of their T-cell receptor (TCR) B-gene sequences using a combination of the reverse transcription-polymerase chain reaction and subsequent single strand conformation polymorphism separation. The Dp-responding T-cell clonotypes were compared with those that accumulated in the AD skin lesion in vivo. Nucleotide sequences of the TCR were also determined. As a result, the Dp stimulation induced oligoclonal T-cell expansion from the originally heterogeneous peripheral T-cell population of AD patients. However, only a small part of the Dp-reacting T-cell clonotypes detected in PBMC was identical to those accumulated in the AD skin lesion in vivo, and vice versa. This indicates that the frequency of the clonal expansion of Dp-specific T-cell clonotypes in the skin lesion of AD would be rather limited.

Correspondence: Neutrophilic dermatosis of the dorsal hands: a case showing HLA B54, the marker of Sweet’s syndrome

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