Ryukichi Nagai

Mycobacterium marinum infection of the skin in Japan.

Based on several reviews in Japanese dermatological journals, seventy‐five cases of bacteriologically confirmed Mycobacterium marinum infection of the skin from 1969 through 1980 have been accumulated. These 75 cases accounted for 82% of all reported cases of atypical mycobacterial infections of the skin in Japan (1).

A case of cutaneous plasmacytosis.

A sixty‐six‐year‐old woman has had numerous macules all over her body for a year without any systemic involvements. Plasma cells had infiltrated into the dermis and perivascular region, but showed no mitotic figures nor atypicalities. Laboratory examinations for Bence Jones protein, serum gammaglobulin, and immunoglobulins demonstrated no abnormal findings. The surface markers of the plasma cells were polyclonal; they were stained by anti IgA, IgG, IgM, kappa, and lambda. We consider this case not to be one of a true tumor but one of rather benign reactive proliferation of plasma cells in the skin, although its etiology is unclear.

PENICILLIN AND CEPHALOSPORIN—INDUCED RASH IN GUINEA PIGS

Guinea pigs primed for delayed type hypersensitivity (DH) to antibiotics such as penicillin G (PCG), carbenicillin (CBPC), sulbenicillin (SBPC), ampicillin (ABPC), cephalexin (CEX), cephalothin (CET) and cephazolin (CEZ) by immunization in mycobacterial adjuvant developed a generalized rash (GR) and flare‐up of previous test sites when challenged peritoneally with high doses of specific antigen. The GR was delayed in time, and histologically characterized by dilated and compacted small vessels and leucocytic infiltrations into the upper dermis. Animals immunized with CEX or CET developed a strong GR despite the absence of detectable antibodies.

A Case of Contact Dermatitis Due to Betamethasone Valerate: -With a Review of Japanese Articles-

A patient with contact dermatitis due to betamethasone valerate and povidone iodine is reported. The Japanese literature concerning contact dermatitis caused by corticosteroids is reviewed. For diagnosis, a patch test (twice if possible) is recommended. Reading should be done at 72h and on day 4 or 5. Erythematous (?+) reaction should be regarded positive when corticosteroids are patched.

An unusual case of extramammary Paget's disease. Paget's disease of the glans penis probably originating from a prostatic duct carcinoma (transitional cell carcinoma of the prostate).

A patient, having been treated by total cystectomy and Brickers conduit operation for prostatic duct carcinoma with intraepithelial extension into the prostatic urethra and bladder, developed an annular, psoriasiform eruption around the external orifice of the urethra two and one‐half years later. A biopsy of this lesion showed pagetoid changes of the epidermis. Microscopic examination of the surgical specimen, consisting of the glans penis and corpus spongiosum, demonstrated intraepithelial‐tumor permeation into the glans penis, penile urethra, and periurethral glands (Littre). It seems reasonable to conclude that this is an unusual case of Pagets disease of the glans penis which probably originated from a prostatic duct carcinoma.

Amikacin Treatment for Mycobacterium Marinum Infection

This report describes a case of Mycobacterium marinum skin infection. A granulomatous plaque on the dorsum of the left hand of a 71‐year‐old man who kept a tank of tropical fish was followed by erythema and induration on the left forearm of the lymphocutaneous type. The lesion was successfully treated with 6 weeks of administration of amikacin (28 intramuscular injections) a total of 3500 mg. The isolated M. marinum strain was sensitive in vitro to amikacin at 0.78 μg/ml. Furthermore, another 15 clinical strains of M. marinum showed high sensitivity in vitro to this drug (93% of the 16 strains were sensitive to between 0.78 and 1.56 μg/ml).

EXPERIMENTAL DRUG-INDUCED RASH AND SYSTEMIC CUTANEOUS BASOPHIL HYPERSENSITIVITY

Guinea pigs immunized with antibiotics (sodium cephalothin, CET) developed a systemic, delayed‐onset rash or so called generalized rash (GR) when challenged intraperitoneally with large amounts of CET seven weeks later.

Genetic Control of Contact Hypersensitivity

The characteristics of suppressor cells induced by 2,4‐dinitrophenyl (DNP)‐coupled syngeneic lymphocytes (syninduced suppressor cells) were studied. 2,4‐dinitro‐1‐fluorobenzene (DNFB) contact hypersensitivity was completely suppressed when the syninduced suppressor cells were transferred intravenously. These syninduced suppressor cells had surface markers of Thy‐1, FcR− and Lyt‐2+, 3+ antigens, as well as I‐J gene products on their cell surfaces. The suppression of DNFB contact hypersensitivity was abrogated when these suppressor T cells were incubated in Petri dishes coated with the DNP‐syngeneic lymphoid cell membrane, which suggests that these suppressor T cells had the specific antigen‐binding receptors on their cell surfaces.

Three cases of sporotrichosis with numerous fungal elements.

Three cases of sporotrichosis with numerous fungal elements were reported. Clinically these cases showed nodules to plaques with ulceration. Histologically, they showed unusual features, including histiocytic granuloma in the upper to middle dermis which contained few neutrophils but were surrounded by lymphocytes and epithelioid cells. There was no formation of an abscess. Fungal elements were found in abundance in the histiocytic granuloma, mainly in the form of oval or round spores of varying sizes, some of them produced germ tubes. No asteroid bodies were found. The spores stained positively with HE and PAS, and, in case 1, with anti‐Sporothrix schenckii antiserum. All three cases had been treated with topical corticosteroid ointment. In one case, after the topical corticosteroid treatment was stopped, the histological pattern returned to the usual features seen in sporotrichosis, and fungal elements decreased significantly. This unusual histological pattern was also observed in a specimen from a healthy control infected with Sporothrix schenckii and treated with steroid ointment. These histological and fungal patterns may be possibly induced by the local immunodeficiency following topical steroid treatment.

Protein AL Origin in Amyloidosis Cutis Nodularis Atrophicans

A case of amyloidosis cutis nodularis atrophicans (ACNA) was reported. The characteristics of the amyloid deposit were examined using the unlabeled immunoperxoidase method (peroxidase‐antiperoxidase method, so called PAP). The study revealed that the amyloid deposit contained A type protein AL, and the surrounding plasma cells contained λ and κ types of both immunoglobulin light chains and Bence Jones protein, with strong preference toward the λ type of each protein. These results suggest that, in ACNA, the plasma cells produce and secrete immunoglobulin light chains and/or Bence Jones protein, and that the protein degenerates into protein AL and then accumulates in the tissue to form nodules. ACNA seems to be a localized form of AL type amyloidosis, since patients with ACNA have no signs of systemic involvement.