Keiji Ohta

Cutaneous tuberculosis and pyoderma gangrenosum

A 59‐year‐old woman with multiple myeloma at stage IA exhibited recurrent pyoderma gangrenosum of 13 years’ duration. She also had a history of mitral regurgitation and cerebral infarction, but no significant family history was present. In September 1994, she noted a painful erythematous papule on her left foot, which was treated with a topical injection of triamcinolone. It responded well to this treatment at the time, but a similar eruption developed in the same place in February 1995, and enlarged to form an irregularly shaped, punched‐out ulcer with surrounding infiltrative erythema despite topical treatment ( Fig. 1 ). Further, since November 1994, she had noted pain in the right dorsal foot.

Bilateral Inguinal Scrofuloderma during Steroid Therapy in a Patient with Bullous Pemphigoid

This report described a case of scrofuloderma that developed in the bilateral inguinal regions during treatment of bullous pemphigoid with systemic corticosteroid. Analysis of the literature on scrofuloderma between 1978–1993 disclosed that the number of cases with extracervical involvement are increasing. Immunosuppression could disseminate tuberculous focuses, resulting in extracervical involvement of SD connected with the underlying extrapulmonary tuberculous lesions.

Mosaic expression of uncein and 180-kDa bullous pemphigoid antigen in generalized atrophic benign epidermolysis bullosa

Immunofluorescence microscopy of epidermodermal junction components in serial cryosections from the perilesional skin of a patient with generalized atrophic benign epidermolysis bullosa (GABEB) showed broken line‐like staining of both BPAG2 (180‐kDa bullous pemphigoid antigen) and uncein (antigen of 19‐DEJ‐l monoclonal antibody), whereas integrin α6 and laminin 5 were continuously expressed along the basement membrane zone. Immunoelectron microscopy revealed a mosaic distribution of the BPAG2/uncein positive and negative cells. BPAG2, a candidate protein of GABEB, probably has a close connection with uncein, an anchoring filament component.

Werner's syndrome – chromosome analyses of cultured fibroblasts and mitogen-stimulated lymphocytes

Two cases of Werners syndrome are reported. Fibroblasts derived from both patients revealedreduced population doubling numbers. Chromosomal analyses for fibroblasts from both patients and lymphocytes from one patient revealed that chromosomal aberrations occur frequently and randomly. Although some of the chromosomal aberrations involved sites where tumour suppressor genes have been mapped, neither of our patients demonstrated malignancy. Chromosomal aberration at one critical site may not be sufficient to induce cancer or additional factors may be necessary.

Foot Ulcer Due to Arteriovenous Malformation: Report of a Case

A 41‐year‐old woman had erosive eruptions surrounded by irregularly shaped pigmentation on the lateral aspect of her right foot, where she had noted gradually increasing warmth and pain for 10 years. The eruptions waxed and waned without complete healing, and an ulcer which had formed one year previously did not respond to topical treatments. Arteriography performed on the right lower extremity disclosed multiple diffuse arteriovenous malformations in the right lower leg and foot. The ulcer was treated by bed rest, surgical debridement, and topical application of bucladesine sodium ointment. After three months, the ulcer healed, leaving a shallow scar and pigmentation.

An Autopsy Case of Angioimmunoblastic T‐cell Lymphoma with a High Content of Epithelioid Cells in the Lymph Node: Immunohistochemical and Genomic Analyses

A 79‐year‐old female developed red papulonodular eruptions on her extremities, facial erythema, generalized lymphadenopathy and high fever. Histopathology of an affected lymph node showed the features of angioimmunoblastic T‐cell lymphoma with a high content of epithelioid cells. She died about two years after the onset despite therapy. Genomic Southern blotting and immunostaining of the lymph nodes were performed twice. In August of 1993, Southern blotting did not show any rearrangement of the immunoglobulin or the T‐cell receptor (TCR) gene. Small or medium‐sized lymphoid cells were positive for CD4 or CD8 (CD4:CD8=2:1). However, in September of 1994 (at autopsy), rearrangements of TCR Cβ1, Jβ2 and Jγ genes were observed. Small or medium‐sized lymphoid cells were positive for CD4, but negative for CD8. Several large cells were positive for Latent Membrane Protein 1 (LMP1) of the Epstein‐Barr virus (EBV). Our results proved that selective oligoclonal proliferation of tumor cells (probably CD4+) accompanied the disease progress.

EVALUATION OF SIALYL LEWISX ANTIGEN IN THE SKIN AND THE SERA OF PATIENTS WITH PSORIASIS VULGARIS

The roles of sialyl‐Lewisx antigen were evaluated in the pathogenesis of psoriasis. Sialyl‐Lewisxexpression was investigated immunohistochemically in the epidermis of normal human skin and erythematous lesional skin of psoriasis vulgaris by avidin‐biotin‐peroxidase complex procedures. A few sialyl‐Lewisx positive dendritic cells were detected in the epidermis of normal human skin. In 7 out of 9 cases of psoriasis vulgaris, the number of sialyl‐Lewisx‐positive epidermal dendritic cells increased in the erythematous lesion over the adjacent normal skin; there were no marked changes in the numbers of CD1a‐positive cells in the epidermis between the two skin types. In the double immunofluorescence studies, more than half of the sialyl‐Lewisx‐positive epidermal cells in psoriatic erythema were stained with a monoclonal Lag antibody that specifically reacts with Birbeck granules and related structures of human Langerhans cells. Furthermore, we determined the changes in serum levels of sialyl‐Lewisx antigens in patients with psoriasis. Although levels in the sera were not significantly elevated over those of controls, the increases correlated with the degree of disease activity. These findings suggest that sialyl‐Lewisx antigen is possibly involved in the development of psoriasis.

Case of balanitis circumscripta plasmacellularis

Dear Editor, In 1952, Zoon described eight cases of chronic balanitis, clinically resembled erythroplasia of Queyrat, characterized by a distinctive inflammatory infiltrate of plasma cells with no signs of malignancy in the surface epithelium. He named the condition “balanoposthitis chronica circumscripta benigna plasmacellularis”. Thereafter, it has been referred to as plasma cell balanitis or Zoon’s balanitis. A 74-year-old Japanese male presented in June 2005 with a 6-month history of an asymptomatic eruption on the genitalia. His medical history was not remarkable, except for a left nephrectomy 50 years previously and he was otherwise in good health. He had not received any medications prior to the onset of the eruption. There was no history of exposure to a contact allergen or local medication use. On examination, the lesion was seen on the dorsal aspect of the glans penis (inner surface of the prepuce) as a nail-sized, erythematous patch with a smooth surface and distinct border (Fig. 1). A skin biopsy specimen showed a thinned epidermis with intercellular edema, an absence of horny layer but