Mamoru Kohda

An Autopsy Case of Dermatomyositis with Rapidly Progressive Diffuse Alveolar Damage

A 47‐year‐old woman visited a clinic with dyspnea which had continued for two months and was followed by general fatigue and fever. Antibiotics were not effective. Edematous erythema occurred on her face, elbows, knees and feet, and she entered our hospital. A skin biopsy revealed interface dermatitis with severe edema and mucinosis in dermis. Diffuse bilateral infiltration was observed in the chest X‐ray, and laboratory findings showed increased LDH, GPT, GOT and CPK. No antinuclear factor was detected. Her respiratory condition rapidly worsened, and she died eight days after hospitalization in spite of corticosteroid pulse therapy. The autopsy revealed that the main cause of death was diffuse alveolar damage (DAD).

Squamous Islands in eccrine neoplasms

The presence of squamous cells in eccrine neoplasms is not well recognized, but is usually considered to denote malignant transformation. The small nests composed of squamoid cells (squamous islands), however, were found in 46% of the eccrine neoplasms we studied. They were divided into three types according to their location, histological structure, and degree of cellular atypia. These types possibly represented intermingling of epidermis or hair follicle, squamous syringometaplasia, and malignant transformation. We would like to stress that squamous islands are seen not only in malignant eccrine neoplasms, but also in benign ones, and that their presence should not be interpreted as evidence of malignancy.

Studies on the retest reaction in contact sensitivity to DNCB.

DNCB-sensitized guinea pigs demonstrated an accelerated reactivity on retest of DNCB at the site of prior contact reaction, though presenting normal contact sensitivity at the virgin site. The retest reaction reached maximal at 9 h and waned at 24 h after antigenic challenge. Massive accumulation of eosinophils in either the epidermis or dermis was its distinguishing histologic feature. The reaction was induced at the site of delayed skin reaction to DNP-GPE in the animals sensitized with DNCB or DNP-GPE. A retest reaction in delayed sensitivity to DNP-GPE was also elicited at the site of contact reaction to DNCB in the animals. The significance of these findings is discussed.

Pemphigus vulgaris Associated with Silicosis

Pemphigus vulgaris has never before been associated with silicosis, although there are many reports of silicosis accompanied by several autoimmune diseases such as progressive systemic sclerosis, systemic lupus erythematosus, dermatomyositis or rheumatoid arthritis. We observed a patient with pemphigus vulgaris accompanied with silicosis. The patient was a 75-year-old man with a 2-month history of repeated oral erosions and blisters on the back, thighs and axillas. Histological examination showed suprabasal cleavage with acantholysis. Immunoblotting analysis demonstrated binding of the patient’s serum to the 130-kD pemphigus vulgaris antigen (desmoglein 3) and the 160-kD pemphigus foliaceus antigen (desmoglein 1). The patient has radiographically been diagnosed as having silicosis. An elevated serum IgG, antinuclear antibody, anti-ssDNA, antimicrosomal antibodies and a biologically false-positive reaction to the Wassermann test were also detected. Although the clinical symptoms improved after treatment with systemic steroids, the patient died due to pneumonia. This is the first reported case in which the characteristics of both pemphigus vulgaris and silicosis could be detected.

IMMUNOPATHOLOGICAL STUDIES ON PSORIASIS

In vivo deposits of fibrin, fibrinogen, plasminogen, complements and immunoglobulins were observed using immunofluorescent (IF) staining of psoriatic lesions. Deposits of fibrin were seen in either the horny layer or the dermal papillae. A linear cytoplasmic appearance of fluorescence in the psoriatic scales was a common pattern of the staining. IF staining of the psoriatic horny layer for fibrinogen and plasminogen yielded essentially the same pattern as those of fibrin and IgG.

The localization of immune complexes in epidermis and upper dermis: Electron microscopic studies on reversed passive Arthus reaction

A reversed passive Arthus reaction was induced in guinea pigs using horseradish peroxidase as antigen. An electron microscopic study on the cutaneous localization of the immune complexes was performed applying a peroxidase reaction. Precipitates of immune complexes were found within the walls of small blood vessels and among the collagen bundles in the dermis. The adherence of immune complexes to numerous eosinophils was observed and some of immune complexes were phagocytosed by neutrophils. The adherence of immune complexes to fibroblasts and the deposits of immune complexes in some areas of the basement membrane zone, especially in the zona diffusa, were found in the upper dermis and in the papillae. In the lower layers of the epidermis, we observed immune complexes adhering to the cell membranes of keratinocytes.

A case of Schönlein-Henoch-purpura: an immunopathological study.

A case of Schönlein‐Henoch‐purpura is presented. The immunofluorescent study of skin lesions of the patient showed granular deposits of IgA and C3 in the blood vessel walls perivascular deposits of plasminogen and diffuse localization of fibrin and fibrinogen in the upper dermis. Complement activation via the alternative pathway through IgA, C3 and plasminogen deposits was suggested.

Induction of delayed reaction to dinitrophenylated lymphocytes in guinea pigs with contact sensitivity to DNCB.

The incidence of dinitrophenylated cells in guinea pig lymphocytes incubated with 0-30 mM concentrations of DNBSO3Na in phosphate-buffered saline was examined by an immunofluorescence method using fluorescence-labelled anti-DNP antibody. Under our experimental conditions, the incidence was roughly proportional to the concentration used. Using DNP-lymphocytes as an antigen for skin testing, a marked delayed reaction was induced in guinea pigs sensitized by painting with DNCB and intradermal injection of Freunds complete adjuvant. The significance of these findings is discussed.

Decreased CD4+CD45RA+ lymphocytes in peripheral blood of systemic lupus erythematosus can recover after separation from patient's sera

Decrease in CD4+CD45RA+ lymphocytes in peripheral blood of systemic lupus erythematosus (SLE) patients has been reported. In this study, mononuclear cells were separated from peripheral blood of SLE patients, and the CD4+CD45RA+ cells were counted by flow cytometry just after separation and also 1 week after incubation in vitro. Furthermore, healthy lymphocytes were incubated with SLE patients sera, and the Ca2+ level was measured to investigate the interaction of patients sera with healthy lymphocytes. The CD4+CD45RA+ lymphocytes were found to be decreased in number on the first day just after separation of lymphocytes, but recovered to normal levels after 1 week culture without patients sera. The intracellular Ca2+ level in normal lymphocytes increased 1 min after incubation with patients sera, but not with healthy control sera. These results suggest that CD4+CD45RA+ cells are persistently activated in the peripheral blood of SLE patients, and that their sera contain some extrinsic factors which could activate the lymphocytes.

Therapeutic indication for ingrown nail.

130例, 234患部の陥入爪を治療した。治療成績は, 手術療法(爪甲を含めた爪一部切除術)では94.7%が完治し, 保存療法(爪甲先端の角を爪廓皮膚よりのばす)では40.8%が完治し, 抜爪では大部分が再発していた。最終的に行つた治療方法と, 重症度, 罹患期間, 抜爪歴の有無の相関を調べ, 治療適応を検討した。(1)軽症で罹患期間の短いものは保存療法をする, (2)中等症, 重症でも抜爪歴がなく, 爪甲の変形が軽度のものは保存療法を試み, 2週間程度で軽快傾向のないものは手術療法を勧める, (3)抜爪歴を有し, 爪甲の変形が強いものは早期に手術療法を施行する, という方針が得られた。抜爪や爪切りでは, ほとんど再発し, むしろ悪化する傾向があるので, 施行すべきではないと考えた。