Shigeru Tada

Isolation of Multiple Cytomegalovirus Strains from a Patient with Adult T Cell Leukemia

A 66-year-old male with adult T cell leukemia had an ulcer on the left medial thigh. The biopsy of the skin lesion revealed enlarged endothelial cells with acidophilic intranuclear inclusion bodies, suggesting cytomegalovirus (CMV) infection. At autopsy, CMV was isolated from a nodular skin lesion of the scrotum. The urine constantly tested positive for CMV. Restriction endonuclease cleavage analysis of DNA of the isolates from the skin and urine indicated that this patient was infected with two different strains of CMV.

THE BROAD SPECTRUM OF DOWLING DEGOS DISEASE, INCLUDING HABER'S SYNDROME—A HEREDITARY ABNORMAL REACTIVITY TO STIMULATION, INCREASING WITH AGE?—CASE REPORTS AND MANAGEMENT

Four cases of Dowling Degos disease (DDD) in one family and five cases of Habers syndrome (HS) in two families were compared. DDD and HS share many symptoms and findings in common; histopathological features of downgrowths of epithelial cells, papules of either brown or natural skin color, and various kinds of skin pigmentation. Some had pitted scars, cysts, pruritus, telangiectasia, red cheeks, xerosis, and photosensitivity. Another feature common to both conditions is the progressive course of the disease; patients and their children should be followed over their lifetimes. One case of DDD had basal cell epithelioma within the area of reticular pigmentation, but an 83‐year‐old patient with DDD indicated that general health is not involved in DDD.

A UNIQUE ERYTHERMALGIA IN A PATIENT WITH VON RECKLINGHAUSEN NEUROFIBROMATOSIS

We report a 58‐year‐old female patient with von Recklinghausen neurofibromatosis who developed a condition similar to that of erythermalgia in many respects, especially on her hands. The distress worsened upon exposure to cold and improved when warmed. She felt pain over the hands restricted to the time of urination when her bladder was full. It was found that her distress was felt when blood was unstably forced through partial closing of abnormal a‐v shunts into diseased blood vessels of the distal extremities and that the a‐v shunts of this patient apparently worked differently.

Four Patients of Rheumatoid Arthritis Associated with Leg Ulcers.

慢性関節リウマチ(RA)に併発した下腿潰瘍の4例の病態と治療について報告した。RA患者に併発する下腿潰瘍の頻度は増加の傾向にあり, その発症因子も多要因が関与している。自験4症例については, 症例1は末梢性血管炎型, 症例2は悪性関節リウマチ(MRA)の全身性動脈炎型, 症例3は静脈瘤性症候群, 症例4はコルチコステロイドによる皮膚萎縮(コーチゾン·スキン)が著明で易出血性, 易外傷性がそれぞれ主因と推定された。その治療には成因を的確に把握し, 病態に応じた適切な治療が必須である。末梢性血管炎型MRAでは植皮に際してコルチコステロイドの適量処方, 全身性動脈炎型MRAではICU的治療の最優先, 静脈瘤性潰瘍では切除範囲の術前検討, コーチゾン·スキンによる潰瘍では植皮後の日常生活指導の重要性を自省した。

The cutaneous type of Munchausen syndrome: a puzzling and perplexing condition to doctors.

A 29‐year‐old woman with Munchausen syndrome developed its cutaneous type.