Sayaka Yamaguchi

Allergic contact dermatitis due to diclofenac sodium in eye drops

Eyelid dermatitis and/or periocular dermatitis (ED/PD) is commonly seen in a variety of skin diseases such as seborrheic dermatitis, atopic dermatitis and psoriasis, but is most often associated with allergic contact dermatitis (ACD). Here, a case of ACD in an 82‐year‐old man is described; he used 0.1% diclofenac sodium eye drops and exhibited pruritic erythema on the eyelids. Patch test for diclofenac sodium eye drops was positive. Further patch tests revealed a positive reaction to diclofenac sodium (monosodium 2‐[2, 6‐dichlorophenylamino] phenylacetate), which was the main component in the eye drop medicine. Diclofenac sodium is a non‐steroidal anti‐inflammatory drug (NSAID), and is frequently used in everyday oral medications, topical ointments, gel agents and eye drops. Case reports on ACD caused by diclofenac sodium eye drops are extremely rare. Nevertheless, it is necessary to consider ACD due to diclofenac sodium when a patient with ED/PD has a history of use of diclofenac sodium eye drops.

Fixed eruption due to quinine in tonic water: A case report with high‐performance liquid chromatography and ultraviolet A analyses

Fixed drug eruption is a common cutaneous adverse reaction in young patients with a characteristic clinical appearance. However, the diagnosis and identification of the substance may be difficult if food or food additives provoke the fixed eruption. A 26‐year‐old man had a history of two episodes of cutaneous erythema with residual pigmentation. Close examination of the history including his diet in addition to an oral challenge test and patch testing led to the diagnosis of fixed eruption secondary to quinine in tonic water. We examined for the presence of quinine in commercially available brands of tonic water using ultraviolet A and irradiation and high‐performance liquid chromatography. Both Schweppes and CANADA DRY brands of tonic water emitted fluorescent light upon ultraviolet A irradiation, and contained quinine at concentrations of 67.9 and 61.3 mg/L, respectively. Quinine contained in some tonic waters may trigger fixed eruption.

Tinea corporis caused by Microsporum gallinae: first clinical case in Japan.

We report herein a case of tinea corporis caused by Microsporum gallinae in a 96‐year‐old, otherwise healthy Japanese man. The patient had a long working history as a breeder of fighting cocks, and he suffered from two erythematous macules after being bitten by a cock. M. gallinae was identified as the infectious agent based on the morphology of isolates cultured on slides and analysis of DNA sequences of the internal transcribed spacers (ITS) from ribosomal DNA from cultured isolates. The patient was successfully treated with antifungal ointments. To our knowledge, this is the first case of M. gallinae infection in a human reported in Japan.

Dermoscopic observation of acquired digital fibrokeratoma developed on the dorsum of the fourth left toe

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Primary cutaneous mucormycosis caused by Mucor irregularis in an elderly person

Primary cutaneous mucormycosis is a rare but often lethal severe fungal infection, which usually occurs in immunocompromised patients. We report a case of primary cutaneous mucormycosis caused by Mucor irregularis in an elderly patient. Seven months after the surgical dissection of the involved skin, cutaneous mucormycosis recurred at the peripheral edge of the skin graft. Shortly subsequent to the administration of liposomal amphotericin B, the remaining skin lesion was excised again. M. irregularis is rarely but increasingly reported as a cause of mucormycosis in immunocompetent individuals, especially in Asian farmers. M. irregularis may be largely disseminated in the soils of Asia and thus the trivial trauma at the time of farm work may be a trigger for the onset. These cases tend to leave severe cosmetic damage even in healthy individuals, although the vital prognosis is not affected.

Isolation of Microsporum gallinae from a fighting cock (Gallus gallus domesticus) in Japan

A case of tinea corporis caused by Microsporum gallinae was found in 2011 in Okinawa, located in the southern part of Japan. The patient was a 96-year-old, otherwise healthy, Japanese man, who had been working as a breeder of fighting cocks for more than 70 years. He was bitten on his right forearm by one of the cocks and a few weeks later, two erythematous macules appeared on the right forearm, accompanied by a slight itchy sensation. While the first isolate of this dermatophyte was recovered from the region by Miyasato et al. in 2011, it was not obtained from the same fighting cock owned by the patient. However, frequent exchanges of fighting cocks and special domestic breeds of chickens related to fighting, mating, and/or bird fairs are common among the fans and breeders. We investigated 238 chickens and 71 fighting cocks in Okinawa and in the suburbs of Tokyo (Chiba, Tokyo, Ibaraki, and Sizuoka). One isolate of M. gallinae from a fighting cock in Chiba Prefecture in the Tokyo metropolitan area exhibited a different genotype, with a single base difference from the patient isolate based on the internal transcribed spacer 1-5.8s-ITS2 regions (ITS1-5.8S-ITS2) of the ribosomal RNA gene sequence. The isolation of M. gallinae from a fighting cock on the mainland of Japan is the first such finding in animals in our country.

Deep venous thrombosis and pulmonary embolism secondary to co‐administration of thalidomide and oral corticosteroid in a patient with leprosy

A 58‐year‐old Japanese man with a 2‐year history of multidrug therapy for borderline lepromatous leprosy presented with skin lesions suggestive of erythema nodosum leprosum (ENL) and was treated with an oral corticosteroid. As attempts to taper the oral corticosteroid resulted in the appearance of new lesions, thalidomide was added along with cyclosporin. Two months after the introduction of thalidomide, deep venous thrombosis (DVT) occurred in both legs and anticoagulant therapy was started without cessation of thalidomide. Pulmonary embolism developed 1 month after the appearance of DVT, and these thromboembolic events were believed to be due to thalidomide. This case highlights the need for vigilance against venous thromboembolism when corticosteroid and thalidomide are co‐administrated for the treatment of ENL.

Immunohistochemical Cross-Reactivity Between Paracoccidioides sp. from Dolphins and Histoplasma capsulatum

Paracoccidioidomycosis ceti is a cutaneous disease of cetaceans caused by uncultivated Paracoccidioides brasiliensis or Paracoccidioides spp. Serological cross-reactions between paracoccidioidomycosis ceti and paracoccidioidomycosis, paracoccidioidomycosis and histoplasmosis, and paracoccidioidomycosis and coccidioidomycosis have been reported before. The present study aimed to detect immunohistochemical cross-reaction between antibodies to Paracoccidioides sp. and Histoplasma capsulatum, and vice versa. Thirty murine sera, obtained from experimental infections of 6 isolates of H. capsulatum, were reacted with paraffin-embedded yeast-form cells of Paracoccidioides sp. derived from a case of paracoccidioidomycosis ceti in Japan. The murine sera were also reacted with human isolates of H. capsulatum yeast cells, with P. brasiliensis yeast cells, and with fungal cells of Coccidioides posadasii. Three dolphins’ sera from cases of paracoccidioidomycosis ceti, two human sera from patients with paracoccidioidomycosis, and a serum from a healthy person with a history of coccidioidomycosis were used in order to determine that the tested fungal cells reacted properly. Sera derived from mice infected with an isolate of H. capsulatum reacted positively against yeast cells of Paracoccidioides sp., yeast cells of P. brasiliensis, and fungal cells of C. posadasii, while those derived from other strains were negative. The present study recorded for the first time the cross-reaction between the yeast cells of H. capsulatum and antibodies against Paracoccidioides spp., the yeast cells of Paracoccidioides sp. and antibodies against H. capsulatum, the yeast cells of Paracoccidioides sp. and antibodies against Coccidioides sp., and fungal cells of C. posadasii and antibodies against Paracoccidioides spp.

Cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis in a Japanese patient with cardiac sarcoidosis

hydroxide preparation of the scales was positive for fungi. Then, we rechecked the histology of the previous hospital. As a result, many transparent small clefts in the stratum corneum were observed, in which periodic acid-Schiff staining clearly demonstrated many fungal elements (Fig. 1e). The fungal culture of skin scrapings yielded a rapidly growing, brownish-white, granular colony on Sabouraud’s dextrose agar. Slide culture revealed numerous elliptical macroconidia with rounded tips (Fig. 1f,g). The sequence of the internal transcribed spacer region of rDNA was 99% identical to that of the Nannizzia gypsea (formerly Microsporum gypseum) complex in GenBank. Accordingly, we confirmed the isolated dermatophyte as N. gypsea. She was treated with topical application of the antifungal agent luliconazole alone. The skin lesions mostly resolved 1 month after treatment of luliconazole without systemic therapy. Nannizzia gypsea is a geophilic fungi and infects directly from soil. N. gypsea is a newly termed fungus by molecular methods. It was formerly known as M. gypseum. N. gypsea infection predominantly affects females and children, causing tinea corporis or tinea capitis with intense inflammatory responses. The present case is characterized by a widespread erythematous eruption mimicking psoriasis in an elderly woman without immunodeficiency. Tinea corporis with extensive lesions due to N. gypsea as the present case is extremely rare. There are several articles of disseminated or atypical manifestation of N. gypsea infection in AIDS patients. Most of these patients were recalcitrant and required systemic antifungal therapy including terbinafine and itraconazole. The present case showed good response to topical luliconazole alone because she had no immune deficiency. Inappropriate topical corticosteroids therapy might have been involved in the dissemination of the skin lesions over the entire trunk in the present case. It has been known that immunosuppressive status can cause extensive dermatophytosis by Trichophyton rubrum, which is the most prevalent dermatophyte species as a causative fungus of tinea corporis in adults. In the present case, the causative fungus was identified as N. gypsea, not T. rubrum. Fungal culture enabled us to clarify the possible infection root of the case. The present case was supposed to be infected from her cat indirectly. We emphasize that fungal culture is essential not only to confirm the diagnosis but also to clarify the infection root in atypical forms of dermatophytosis. Dermatologists should be aware that dermatophytosis by N. gypsea may manifest disseminated erythematous eruption mimicking psoriasis to make an accurate diagnosis and provide early treatment.

Subcutaneous phaeohyphomycosis caused by Veronaea botryosa in a Japanese patient with adult T-cell lymphoma

Dear Editor, We report the second case of phaeohyphomycosis caused by Veronaea botryosa in Japan. An 84-year-old Japanese male farmer presented with two subcutaneous nodules of approximately 10 mm 9 10 mm in size on the right forearm, which initially appeared 2 months previously without tenderness or burning sensation (Fig. 1a). Initial laboratory studies revealed a white blood cell count of 6500/lL (adult T-cell leukemia– lymphoma [ATL]-like cells, 5.0%). Biochemical analysis and urinalysis yielded normal results, including b-D-glucan level 9.5 pg/mL (reference range, <20.0 pg/mL; Fungitec G-test MK II [Seikagaku, Tokyo, Japan]), with positive serum antibodies against human T-lymphotropic virus 1 only. He was diagnosed with smoldering type ATL. Histopathology of the excised lesion revealed granuloma formation comprising dense inflammatory infiltrates of neutrophils, lymphocytes, histiocytes, multinucleated giant cells and epithelial granulomatous cells. Within the multinucleated giant cells, brown-walled, septate hyphal elements and a few sclerotic cells were observed (Fig. 1b). Mycological cultures of the skin lesion grew villous, black-gray colonies at 25°C (Fig. 1c). Slide culture showed brown septate hyphae bearing lateral and terminal conidiophores (Fig. 1d). DNA of the cultured fungal hyphae was used as a template for polymerase chain reaction amplification of the internal transcribed spacer (ITS) region (ITS5–ITS4). The amplified fragment was 99% consistent with V. botryosa (accession no. JX566723.1). He was diagnosed with subcutaneous phaeohyphomycosis caused by V. botryosa. Antifungal susceptibility testing revealed that the strain was sensitive to itraconazole and terbinafine, and resistant to amphotericin B. Surgical excision of the nodules was performed with a 5-mm margin, and voriconazole 200 mg/day was subsequently administrated for