Kohei Kato

Time of ovulation and prolonged pregnancy

Abstract In a prospective study of 110 women who were delivered of live infants following the spontaneous onset of labor, the time was calculated between delivery and (1) the first day of the last menstrual period, and (2) the day on which ovulation had probably taken place. The results of basal body temperature recordings were used to estimate the day of ovulation. Statistical analysis showed that delay of ovulation was the major contributing cause of apparent prolongation of pregnancy over 295 days.

Psoriasiform drug eruption due to abatacept.

A 59-year-old woman presented with a 4-month history of erythematous plaques on her palms and extremities. The patient had a long-term history of using methotrexate (8 mg/week) and oral prednisolone (10 mg/day) as therapy for RA, which had been diagnosed at the age of 37. Laboratory findings were as follows: white blood cell count 10,300 /μl; C-reactive protein 1.27 mg/ dl (normal < 0.3 mg/dl); anti-nuclear antibody × 40; rheumatoid factor 68 IU/ml (normal < 20 IU/ml); rheumatoid arthritis particle agglutination × 320 (normal < × 40); autoantibody to galactose-deficient IgG 74.9 AU/ml (normal < 6 AU/ml); and matrix metalloproteinase-3 195 ng/ml (normal 17.3–59.1 ng/ ml). Three years previously, the patient had enrolled in a clinical trial to study the effects of abatacept (750 mg/day, once every 4 weeks). The patient’s clinical symptoms of RA were well-controlled with abatacept, and thus oral prednisolone was ceased approximately 4 months before her admission to our department. Physical examination revealed that erythematous plaques of various sizes with scales were present on the patient’s extremities, palms and soles (Fig. 1). Microscopically, there was a parakeratotic hyperkeratosis with irregular acanthosis and a localized thinning of the granular layer (Fig. 2A). Cellular infiltrate comprising mononuclear cells and a few neutrophils was found around perivascular areas in the upper dermis. Inflammatory cells infiltrated into the epidermis and an accumulation of neutrophils in the cornified layer was found (Fig. 2B). The patient had no medical or family history of psoriasis. The eruptions were initially resistant to topical corticosteroids, but gradually improved within a few weeks. Skin patch-testing with abatacept (10% and 20%) was negative. After the remission of skin symptoms, abatacept was re-administered, resulting in the recurrence of skin symptoms within a few days. The patient is being controlled with reduced doses of abatacept (less than 500 mg/day) together with occasional use of topical corticosteroids.

Site of Ovulation and Ectopic Pregnancy

Abstract. In a study of 130 tubal pregnancies the relationships as to location of the corpus luteum, the implantation site, and the gross findings of the non‐pregnant fallopian tube were analyzed. A contralateral corpus luteum was found in 20% of the cases. Hydrosalpinx, peritubal adhesions and/or thickening of the tubal wall were observed in 33% of the non‐pregnant tubes. Grouping by implantation site—ipsilateral or contralateral corpus luteum—showed no statistical differences. The incidence of chronic pelvic inflammatory diseases was no greater in the subjects above 30 years of age and those having had more than 2 pregnancies. The results suggest that “tube locking” of the ovum, sometimes a result of previous tubal inflammatory disease, sometimes a result of supposed insufficiency of tubal peristalsis. was the major cause of tubal gestation. External migration of the ovum alone may not be an important factor in the genesis of tubal pregnancy.

IgG4-positive cells in skin lesions of cutaneous and systemic plasmacytosis

ejd.2013.1962 Auteur(s) : Kohei Kato1, Takahiro Satoh2 tasaderm@ndmc.ac.j, Tomoko Tanaka-Fujimoto1, Nobuhiko Ueda1, Hiroo Yokozeki1 1 Department of Dermatology, Tokyo Medical and Dental University, Tokyo, Japan, 2 Department of Dermatology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Saitama, Japan. Cutaneous plasmacytosis is a rare lymphoplasmacytic disorder characterized by multiple red-brown nodules, mainly affecting the trunk. Histopathologically, it is characterized by [...]

Histiocytoid Sweet syndrome: a novel association with relapsing polychondritis

1 Akiyama M. ABCA12 mutations and autosomal recessive congenital ichthyosis: a review of genotype/phenotype correlations and of pathogenetic concepts. Hum Mutat 2010; 31:1090–6. 2 Shibata A, Ogawa Y, Sugiura K et al. High survival rate of harlequin ichthyosis in Japan. J Am Acad Dermatol 2014; 70:387–8. 3 Thomas AC, Cullup T, Norgett EE et al. ABCA12 is the major harlequin ichthyosis gene. J Invest Dermatol 2006; 126:2408–13. 4 Rajpopat S, Moss C, Mellerio J et al. Harlequin ichthyosis: a review of clinical and molecular findings in 45 cases. Arch Dermatol 2011; 147:681–6. 5 G€ urkan H, Fischer J, Ulusal S et al. A novel mutation in the ABCA12 gene in a Turkish case of harlequin ichthyosis. Clin Dysmorphol 2015; 24:115–17. 6 Koochek A, Choate KA, Milstone LM. Harlequin ichthyosis: neonatal management and identification of a new ABCA12 mutation. Pediatr Dermatol 2014; 31:e63–4.

A case of mucous membrane pemphigoid involving the trachea and bronchus with autoantibodies to β3 subunit of laminin-332.

Mucous membrane pemphigoid (MMP) is an autoimmune bullous disease of the mucous membranes, including the eye, nose, oral cavity, pharynx, larynx and oesophagus, with occasional skin lesions (1). We report here a case of a patient with MMP who demonstrated concomitant tracheal and bronchial lesions, in addition to oral, ocular and cutaneous lesions, in whom autoantibodies to β3 subunit of laminin-332 were detected by immunoblot analysis.

Systemic Nickel Allergy Presenting as Papuloerythroderma-like Eruptions

An 82-year-old woman had had pruritic papules on her entire body for 4 years. Her medical history included hypertension controlled with cilnidipine. On examination, there were numer ous red-brown lichenoid papules on her trunk and extremities. The papules tended to aggregate or coalesce to form diffuse erythematous plaques with sparing flexors, mimicking papuloerythroderma (Fig. 1). Laboratory data revealed elevated levels of blood eosinophils (1204/μl) and lactate dehydrogenase (354 U/l), but no other abnormal findings. Histologically, lichenoid papules showed irregular acanthosis with hyperkeratosis. There was a cellular infiltrate comprising lymphocytes and eosinophils in the upper dermis (Fig. 2). Extensive examinations, including serum tumour markers, computed tomography and fiberscope examination of the gastrointestinal tract, did not reveal any evidence of internal malignancy. The condition had been resistant to topical corticosteroids prior to admission, but the skin lesions improved after external application of petrolatum and without cessation of cilnidipine. Lymphocyte stimulation test and patch-testing for cilnidipine (10% and 20% in petrolatum) were negative. She did not have a history of allergic reactions to metals. However, patch-testing for metals revealed positive reactions for NiSO4 (5% aq) and K2Cr2O7 (0.5% aq) at 48 h, 72 h and 7 days. Oral challenge test with 12 mg NiSO4·6H2O (2 mg Ni) (1, 2) induced diffuse erythema with pruritus on her trunk and extremities, but similar effects were not seen with 7.5 mg K2CrO4 (2.5 mg Cr) or placebo control (NaCl 10 mg) (Fig. 3); the reaction peaked at 2 days after challenge. Examination revealed that her dental materials contained nickel, as deter mined by X-ray fluorescence spectroscope. In addition, the patient had been consuming boiled Japanese barnyard millet as part of her diet. She was advised to avoid this food and to commence a low-nickel diet (3) together with sodium chromoglycate.

Bullous eosinophilic annular erythema

Dear Editor, Eosinophilic annular erythema (EAE) is a rare dermatosis characterized by annular erythematous plaques with a dense tissue eosinophilia. EAE is usually devoid of bullae, hypereosinophilia and flame figures histopathologically in addition to annular erythematous plaques. The disease entity of EAE and Wells syndrome (WS) is still debatable. However, no case of EAE with bullous lesions has been reported to date. Here, we present a case of EAE with bullous lesions. A 69-year-old woman presented with multiple annular erythematous plaques on her trunk and limbs. The patient had a past history of asthma, hypertension, uterine fibroids and

Extraocular sebaceous carcinoma in association with a clonal seborrheic keratosis: Dermoscopic features

Dear Editor, The clinical diagnosis of extraocular sebaceous carcinoma is challenging due to the lack of specific clinical manifestations of this neoplasm. However, previous reports of extraocular sebaceous carcinomas using dermoscopy have been limited. Here, we present a case of an extraocular sebaceous carcinoma in association with a clonal seborrheic keratosis and we describe its dermoscopic features. A 75-year-old woman presented with a tumor in a black plaque on her abdomen. The patient had a history of burn injury on her abdomen 30 years prior. Her burn scar had gradually become black and then developed a tumor with bleeding 3 months earlier. Physical examination revealed a 20 mm 9 12 mm black keratotic plaque with an elevated tumor in the center of her abdomen infraumbilically (Fig. 1a). Dermoscopic examination revealed that this lesion had two components: polymorphous vessels with homogenous yellow backgrounds in the center and blue-gray globules at the periphery (Fig. 1b). The polymorphous vessels were composed of linear irregular vessels, glomerular vessels and hairpin-like vessels (Fig. 1c). At the periphery, similar findings with bluegray structures of various size and shape were observed.

Histiocytoid Sweet syndrome with ophthalmologic involvements: A novel association with uveitis

Dear Editor, Histiocytoid Sweet syndrome (HSS) is histologically characterized by a predominant inflammatory infiltrate of mononuclear histiocytoid cells, and M2-like macrophages have been speculated to participate in the pathogenesis of HSS. Here, we present a novel case of HSS associated with uveitis. A 70-year-old man presented with multiple erythematous plaques on his trunk and upper limbs. The patient had initially developed erythematous plaques 10 years prior. He was diagnosed with uveitis and serous retinal detachment 1 year before, and methylprednisolone pulse therapy had been performed. He also had slight anemia and was diagnosed with myelodysplastic syndromes from a bone marrow biopsy. Physical examination revealed multiple erythematous plaques on his trunk and limbs (Fig. 1a), some of which were annular and indurated (Fig. 1b,c). Ophthalmologic examinations in addition to magnetic resonance imaging revealed conjunctivitis, uveitis and serous retinal detachment in his right eye (Fig. 1d). Histopathological examination showed a moderate perivascular and periadnexal inflammatory infiltrate in the dermis (Fig. 1e). The interface change was slight (Fig. 1f). Nuclear debris was intermingled with an inflammatory infiltrate of histiocytoid mononuclear cells and neutrophils (Fig. 1g). Immunohistochemical examination showed positive reactions for phosphoglucomutase-1 (PG-M1), lysozyme, kinesin-like protein 1 (KP-1) and (a) (b)