Toshiki Fujii

Silicone granuloma on the entry points of acupuncture, venepuncture and surgical needles

We describe a case of epithelioid granuloma on the entry points of needles used for acupuncture, venepuncture and for taking skin biopsy. The acupuncture needles used at each session were silicone coated. Silicon was detected in the vacuoles of macrophages and multiple nucleated giant cells by X‐ray microanalysis. To our knowledge, this is the first case of silicone granuloma arising on the entry points of acupuncture, venepuncture and surgical needles.

Case of cutaneous phaeohyphomycosis caused by Phaeoacremonium sp. in a renal transplant recipient

We describe a case of cutaneous phaeohyphomycosis in a 61‐year‐old man receiving re‐dialysis treatment for renal failure of a transplanted kidney. He was immunocompromised with steroid and cyclosporin A at onset of an asymptomatic abscess on his right forearm. The abscess arose at the site of a skin injury approximately 1 year prior. Grayish molds isolated from the lesion were morphologically compatible with Phaeoacremonium sp. but nucleotide sequence data of internal transcribed spacer regions of ribosomal RNA gene, actin and β‐tubulin genes were unlike those of any described species. He was successfully treated with a total of 3 weeks of liposomal amphotericin B, but died of pneumonia approximately 3 months after cure of phaeohyphomycosis.

Case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome) showing dermatomyositis-like eruption

A 73‐year‐old woman developed linear erythema at the sites of scratching‐induced scars on the bilateral thighs 2 weeks before the initial consultation. Subsequently, edematous erythema developed in the upper eyelids, dorsum of the nose and the face, and pitting edema in the dorsum of the bilateral hands and feet. The C‐reactive protein (CRP) level was 8.2 mg/dL and erythrocyte sedimentation rate (ESR) 121 mm/h. The antinuclear antibody titer was 1:160, and rheumatoid factor (RF) and anti‐Jo‐1 antibody were negative. X‐ray examination of the bilateral hands showed neither narrowing of the joint spaces nor bone erosion. Ga scintigraphy showed synovitis of the bilateral wrists. A diagnosis of remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE) was made. The erythema disappeared after diclofenac sodium administration. However, because the joint swelling and pitting edema did not improve, p.o. administration of prednisolone (20 mg/day) was initiated. The CRP and ESR levels normalized 2 months after the initiation of administration, and pitting edema disappeared after 3 months. We report this case because linear erythema like that observed in dermatomyositis has not been described as eruptions associated with RS3PE.

Bacterial Interdigital Scaly Erythema (Kitamura): A Possible New Clinical Entity

Four patients with scaly erythema on their finger webs and sides of their fingers during summer are described. These patients were working in either butcher’s shops or a sushi bar, where they handled raw meat, chicken or fish for many hours. The eruptions first appeared as scaly erythema, sometimes accompanied by small pustules, on the second, third and fourth finger webs, and later the erythema extended to the sides of the fingers and palms. Maceration and/or shallow erosion sometimes appeared on the finger webs. Symptoms were usually mild; the patients complained of slight itching, irritation or pain. Direct examination of specimens stained with Parker blue-black ink containing KOH revealed scales containing bacterial granules or filaments. Several species of bacteria were cultured including Corynebacterium sp. Fungus was not detected in either KOH specimens or in cultures. The lesions responded rapidly to topical or oral antibiotics; however, they recurred frequently during hot and humid weather. Hitherto a similar condition has not been described and is possibly a new clinical entity.