Masumi Tsujiwaki

Warty intralymphatic histiocytosis successfully treated with topical tacrolimus.

References 1 Fujimoto M, Hamaguchi Y, Kaji K et al. Myositis-specific anti-155/140 autoantibodies target transcription intermediary factor 1 family proteins. Arthritis Rheum 2012; 64: 513–522. 2 Kasuya A, Hamaguchi Y, Fujimoto M, Tokura Y. TIF1gamma-overexpressing, highly progressive endometrial carcinoma in a patient with dermato-myositis positive for malignancy-associated anti-p155/140 autoantibody. Acta Derm Venereol 2013; 93: 715–716. 3 Andrieux G, Fattet L, Le Borgne M, Rimokh R, Theret N. Dynamic regulation of Tgf-B signaling by Tif1gamma: a computational approach. PLoS ONE 2012; 7: e33761. 4 Beswick EJ, Pinchuk IV, Earley RB, Schmitt DA, Reyes VE. Role of gastric epithelial cell-derived transforming growth factor beta in reduced CD4 + T cell proliferation and development of regulatory T cells during Helicobacter pylori infection. Infect Immun 2011; 79: 2737–2745. 5 Wahl SM, Hunt DA, Wong HL et al. Transforming growth factor-beta is a potent immunosuppressive agent that inhibits IL-1-dependent lymphocyte proliferation. J Immunol 1988; 140: 3026–3032. 6 Inman GJ. Switching TGFbeta from a tumor suppressor to a tumor promoter. Curr Opin Genet Dev 2011; 21: 93–99. 7 Fleming NI, Jorissen RN, Mouradov D et al. SMAD2, SMAD3 and SMAD4 mutations in colorectal cancer. Cancer Res 2013; 73: 725–735. 8 Zhang H, Yang P, Zhou H, Meng Q, Huang X. Involvement of Foxp3expressing CD4+ CD25+ regulatory T cells in the development of tolerance induced by transforming growth factor-beta2-treated antigenpresenting cells. Immunology 2008; 124: 304–314. 9 Kobie JJ, Wu RS, Kurt RA et al. Transforming growth factor beta inhibits the antigen-presenting functions and antitumor activity of dendritic cell vaccines. Cancer Res 2003; 63: 1860–1864.

Tubular spitz naevus mimicking eccrine spiradenoma.

© 2014 The Authors. doi: 10.2340/00015555-1641 Journal Compilation

Nanoparticle albumin-bound paclitaxel can be useful agent to advanced primary mucinous carcinoma of the skin.

Editor Primary mucinous carcinoma of the skin (PMCS) has a relatively good prognosis, with distant metastasis occurring only rarely, but a high local recurrence rate (30%–40%). Although about 150 cases of PMCS have been reported in the English literature, only five cases associated with organ metastatic lesion excluding the regional lymph node have been described. Once distant metastasis has occurred, PMCS is regarded as being resistant to chemotherapy including 5-fluorouracil, vincristine, cyclophosphamide, mitomysion and methotrexate or radiation therapy. Herein we describe the first case of PMCS with lung metastasis that was treated with the single agent of nanometre-sized albumin-bound paclitaxel (nabpaclitaxel). A 40-year-old pre-menopausal Japanese woman presented with a 1-year history of a dome-shaped, slightly erythematous nodule measuring approximately 2 cm in diameter on the right side of the scalp (Fig. 1a). A biopsy specimen showed small cellular nests of adenocarcinoma lying in pools of extracellular mucin that were separated by fibrocollagenous septae (Fig. 1b). The tumour cells were positive for cytokeratin (CK) 7 (Fig. 1c), epithelial membrane antigen, oestrogen receptor (ER) (Fig. 1d)

Dermoscopic features of tungiasis

Tungiasis is a parasitic infection caused by the sand flea Tunga penetrans. Tungiasis is prevalent in rural Central and South America, the Caribbean and sub-Saharan Africa.1 In some endemic areas, the overall infestation prevalence exceeds 50 percent, and it remains an important public health problem for poor communities.1,2 In some cases, the eruptions can mimic viral warts, furuncles, abscesses and paronychia.1 Dermoscopy is reported to be a useful tool for differentiating between these and tungiasis lesions.3,4 Moreover, the majority of cases have multiple lesions, with the ectoparasites causing more than 50 lesions in a single individual in some cases,5 and dermoscopy can help find the lesions. Despite the clinical utility of dermoscopy, no reports have assessed the significance of each dermoscopic finding in tungiasis. Here we report a case of tungiasis and we review the dermoscopic findings of 11 lesions of the patient to reveal the characteristic findings. This article is protected by copyright. All rights reserved.

Diagnosis at a Glance: Acquired Perforating Dermatosis

A 70-year-old man receiving maintenance hemodialysis presented to the dermatology department with pruritic eruptions on the trunk and limbs. The lesions first appeared 30 months before his referral and had been gradually enlarging in size and increasing in number. His chronic kidney disease due to nephrosclerosis had been first diagnosed 20 years before his visit, and he had been receiving hemodialysis for 3 years. …

Erythema multiforme associated with Trueperella pyogenes bacteremia

Dear Editor, Erythema multiforme (EM) is triggered by several conditions including infections, medication and accompanying disorders such as carcinomas. Regarding the infections, the herpes simplex virus (HSV) and species in the genus Mycoplasma are well-known relevant pathogens. However, bacterial infections that induce EM have seen little study. Here, we present the case of EM associated with Trueperella pyogenes bacteremia. A 61-year-old man presented with a 1-week history of fever and disseminated erythemas on the trunk. Although he had been suffering from fatty liver, he had not been taking any medications. He reported a high fever (>40°C) and malaise, and he was admitted to our hospital. Physical examination revealed non-scaly, slightly elevated, target-like erythemas scattered mainly on the trunk and arms (Fig. 1a). Although the erythemas partially fused, neither vesicles/blisters nor erosions were identified. The mucous membrane was intact. Laboratory tests showed thrombocytopenia (9.2 9 10/lL), elevated bilirubin (total, 1.4 mg/dL), elevated liver enzymes including aspartate aminotransferase (98 U/L), alanine aminotransferase (159 U/L), lactate dehydrogenase (420 U/L), alkaline phosphatase (420 U/L) and c-glutamyltransferase (396 U/L), and elevated C-reactive protein (9.6 mg/dL). Elevated serum antibody titers against HSV or Mycoplasma were not found. Skin biopsy was performed from a dark reddish erythema on the trunk. Histopathologically, interface change with exocytosis and perivascular infiltration in the upper dermis was identified (Fig. 1b). In the epidermis, satellite cell necrosis was found. Perivascular infiltrating cells were lymphocytes and eosinophils. Although the eruption was diagnosed as EM, the coexistence of infection was suspected. We consulted with internal medicine, and i.v. meropenem was started. In 2 days, the body temperature decreased and the laboratory findings improved, although the erythema worsened. Therefore, oral prednisolone at 1 mg/kg per day was added. The erythema rapidly improved within 1 week, and the prednisolone was gradually tapered until cessation on the 18th day. Blood cultures detected Grampositive rods that partially presented V-shaped pairs (Fig. 1c). The bacteria formed colonies on ABHK blood agar medium (Fig. 1d) and were identified as T. pyogenes by the BBL crystal anaerobe identification system (BD Japan, Fukushima, Japan). Judging from the skin manifestations, the absence of drug history and the results of blood culture, we made the diagnosis of EM associated with T. pyogenes bacteremia.

Neutrophilic dermatosis accompanying acute cholecystitis

best of our knowledge, only three published case reports have described subcutaneous HSS. Our case did not satisfy one of the major criteria for classical SS, because there was no histopathological evidence neither of a dense neutrophilic infiltrate nor primary leukocytoclastic vasculitis. Furthermore, our case did not develop leukocytosis and neutrophilia, which are characteristic findings of a rare variant of SS, that is, subcutaneous HSS. This is the fourth report of subcutaneous HSS, and when we see a patient whose presentation and clinical findings are similar to those of SS, we should consider the presence of a variant of SS, even if the criteria for SS are not satisfied. Furthermore, we need to carefully follow up the development of any hematological disorders.

Pompholyx-like skin manifestation of adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive T-cell neoplasm caused by human T-cell lymphotropic virus type 1 (HTLV-1). Although ATLL can show various skin symptoms, we present here a case of ATLL showing pompholyx-like skin manifestations. A 76-year-old Japanese woman with a 2-month history of painful and pruritic vesicular eruptions on the palms and soles was referred to our hospital (Fig. 1a,b). Viral eruption or neutrophilic dermatosis was suspected. Neither topical corticosteroids nor antibiotics were effective, and after six weeks, she worsened dramatically with numerous painful papulonodules, some with vesicles and erosions, scattered on the palms and soles (Fig. 1c). Laboratory data showed leukocytosis (10 020/ll with 24% lymphocytes, 22% atypical lymphoid cells) and elevated lactase dehydrogenase (313 U/l; normal range: 115–245) and soluble interleukin-2 receptor (4070 U/ml; normal range: 145–519). Anti-HTLV-1 antibody was positive (by particle agglutination), and flower cells were identified by peripheral blood smear (Fig. 1d). The skin biopsy from a red papule on the back of her left hand showed dense infiltration of atypical lymphoid cells with epidermotropism. The papillary dermis was edematous. Pautrier’s microabscesses were not seen (Fig. 2a,b). Immunohistochemistry of the atypical lymphoid cells were CD3, CD4, and CD25 positive and CD20 negative (Fig. 2c,d). Through these findings, we suspected the case as ATLL, and the eruptions on her hands and feet were regarded as direct skin infiltration of ATLL tumor cells. We referred her to a hematologist. Bone marrow aspiration demonstrated the infiltration of 7.6% atypical cells, and flow cytometry analysis on both peripheral blood and bone marrow identified atypical lymphoid cells expressing the same CD markers (CD4 and CD25 double positive) as those found in the tissue biopsy. Based on findings from whole body CT scans, elevated lactase dehydrogenase, and large amounts of atypical lymphoid cells in peripheral blood, this case was diagnosed as chronic ATLL with poor prognostic factors (Shimoyama’s classification). Oral VP-16 (etoposide) and prednisolone (20 mg/day) was administered, and the eruptions on the hands and feet largely resolved. A unique clinical aspect of our case was the distribution of vesicles limited to the palmoplantar areas, simulating pompholyx, although as many as 50% of patients with ATLL show skin manifestations such as nodulotumoral, plaque, multipapular, patch, erythrodermic, and purpuric manifestations. There have been only a few

Recurrent Course and CD30 Expression of Atypical T Lymphocytes Distinguish Lymphomatoid Papulosis From Primary Cutaneous Aggressive Epidermotropic CD8 + Cytotoxic T-cell Lymphoma

© 2014 The Authors. doi: 10.2340/00015555-1806 Journal Compilation

Coexistence case of bullous pemphigoid and pemphigus foliaceus

Bullous pemphigoid (BP) and pemphigus foliaceus (PF) are distinct autoimmune blistering diseases characterized by autoantibodies directed against targets within the basement membrane zone (BMZ) and intercellular space of the epidermis (ICS), respectively. The diseases rarely occur together in a same patient. Here, we report a patient with coexisting BP and PF.An 88-year-old male patient was referred to our hospital with erythema and erosions affecting the whole body, in April 2012. Physical examination [...]