Shohei Inoue

Jejunal perforation associated with cytomegalovirus infection in a patient with adult T-cell leukemia-lymphoma.

A patient with adult T‐cell leukemia lymphoma suffered a jejunal perforation, which we believe was directly attributable to cytomegalovirus (CMV) infection. In the areas of ulceration and perforation in the small bowel, blood vessels penetrating the muscularis propria showed extensive lining of cytomegalic endothelial cells with CMV inclusions, accompanied by occasional disruption of the walls, partial occlusion of the lumina, fibrin thrombi, and hemorrhage. The CMV‐induced vascular damage seemed to be closely related to the occurrence of ulcers and perforation. The recognition of CMV as a cause of lethal gastrointestinal lesions in immunocompromised hosts has become more important with the advent of anti CMV therapy. Acta Pathol Jpn 42: 267 271, 1992.

Aeromonas sobria infection with severe soft tissue damage and segmental necrotizing gastroenteritis in a patient with alcoholic liver cirrhosis

A 49‐year‐old man, who had a 3‐year history of liver dysfunction but had not been treated, was admitted to the hospital with a sudden onset of fever and generalized muscle pain. He subsequently developed generalized purpura with scattered hemorrhagic bullae of the skin and massive bloody stools. Aeromonas sobria was proven by culture of both blood and bullous fluid. In spite of the extensive treatment with antibiotics and other medications in the intensive care unit (ICU), the patient went into septic shock and died 2 days after admission. Pathological examination on autopsy revealed segmental necrotizing gastroenteritis with bacterial colonies and alcoholic liver cirrhosis, in addition to extensive severe soft tissue damage involving cellulitis and rhabdomyolysis and epidermolysis. Although the prognosis for Vibrio vulnificus infection with severe soft tissue damage in patients with liver cirrhosis, malignancy, diabetes mellitus or other pre‐existing diseases is poor, the unfavorable progression of Aeromonas species, especially A. sobria infection is rare. This is thought to be the first report of an autopsied case.

A Case of Cryoglobulinemic Gangrene in Myeloma with Fatal Outcome Despite Successful Skin Grafting

Extensive necrosis of the skin, muscle and bone was produced after prolonged cooling in a case of myeloma with cryoglobulinemia. Skin grafting was beneficial.

REFLECTION ULTRAVIOLET PHOTOGRAPHY IN DERMATOLOGY: PART 1: EQUIPMENT

Our experiences in reflection ultraviolet (UV) photography with special and conventional equipment are described. Although special lenses have advantages over conventional lenses such as in the transmission of ultraviolet radiation, it is established that reflection UV photography is possible with usual 35 mm single lens reflex cameras and 60 mm twin lens reflex cameras. Photography of semitranslucent material revealed that ultraviolet radiation is reflected from upper layers than visible light.

Two sisters with guttate psoriasis responsive to tonsillectomy: case reports with HLA studies.

An 11‐year‐old girl and her 7‐year‐old sister, both with guttate psoriasis, both showed chronic tonsillitis and proteinuria. The ASO titer of the elder sister was 480 units and that of the younger sister 320 units. Tonsillectomies were performed on both sisters because they developed guttate psoriasis after colds with severe sore throats and proteinuria. Skin lesions improved markedly and proteinuria disappeared, but ASO titers did not change significantly. HLA studies were made of the sisters and their parents; A1 and B37 were confirmed in both sisters and their mother.

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.

Nodular fasciitis. A spontaneously regressing tumor

A 53‐year‐old Japanese male construction worker developed a hard mass subcutaneously on the right thigh 2 months prior to first examination. Biopsy of a small part of the lesion was followed by moderate inflammation at the lesion, associated with regional lymphadenopathy. By the time the inflammation subsided, the mass had reduced in size. IgE was elevated, and the delayed type hypersensitivity was increased after the inflammation. The mechanism of spontaneous regression of nodular fasciitis, unclarified at present, should be studied in further cases.

Motorcycle passenger's burn of the right foot: prevention of a peculiar type of accident

The right feet of two children, passengers on small motorcycles, were caught between the rear wheels and the exhaust boxes, leading to deep burns. This type of accident is on the increase in Japan. Treatment and prevention of such burns are discussed. We suggest that an improvement in the motorcycle will be a solution.

X-LINKED ICHTHYOSIS: FIVE FAMILIES IN SOUTHERN KYUSHU

We report 5 families with X‐linked ichthyosis, of whom 14 individuals were examined. The onset was between 1 month and 3 months after birth in seven cases out of 11. Ichthyosis was marked on the head, ears, abdomen and limbs. In some cases, the antecubital, popliteal and axillary fossae were affected. Dark brown scales, characteristic of X‐linked ichthyosis, were observed in 11 cases out of 14. Histological examination revealed 3 to 5 layers of the granular layer in all of the nine cases examined. Ophthalmological slit lamp examination revealed bilateral deep corneal opacities in 5 cases out of 14 cases of X‐linked ichthyosis. Punctate corneal clouding was observed in two out of 10 identified carriers of X‐linked ichthyosis.