Wataru Naka

A case of chromoblastomycosis: with special reference to the mycology of the isolated exophiala jeanselmei

Summary: A 23‐year‐old male patient with a plaque‐like lesion of chromoblastomycosis on the left buttock is described. Sclerotic cells were demonstrated in the scales and tissue sections. Both granular and mould‐like colonies were isolated from the same material of the lesion. Moreover, a part of the granular colony was transformed into the mould‐like colony which showed the same morphology and other characteristics as those of the originally isolated mould‐like colony. The mould‐like colony was identified as E. jeanselmei on the basis of morphology, physiology, thermotolerance and serologic test The granular colony was identified as the granular form of E. jeanselmei because of its transformation into the mould‐like colony which should be considered as the mycelial form of E. jeanselmei from now on. It was of interest to note that E. jeanselmei can be a causative organism of chromoblastomycosis and has a granular form.

Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D

We report a Healthy, 73‐year‐old Japanese woman who presented with primary cryptococcosis on the skin of both cheeks. She had initially developed an erythematous, partly ulcerated lesion on the right cheek 2 weeks earlier following an injury. There was no regional lymphadenopathy, and chest X‐rays were normal. Histopathological findings showed granulomatous cell infiltration, Periodic acid Schiff staining revealed spores that were identified by the indirect immunoperoxidase staining method as Cryptococcus neoformans. The isolate was identified as C. neoformans var. neofarmans serotype D. The skin lesions healed in 1 month without antifungal therapy. A literature review indicates that this serotype tends to produce cutaneous lesions without systemic involvement.

Application of neutral red staining for evaluation of the viability of dermatophytes and Candida in human skin scales

The fungal elements observed by direct microscopic examination sometimes fail to grow on subsequent culture. To elucidate the cause of this discrepancy, the viability of dermatophytes and Candida in skin scales was evaluated by neutral red staining. Autoradiographic study using 3H-thymidine confirmed that grain-positive cells (viable cells) were stained with neutral red, whereas negative cells (non-viable cells) were not stained. Taking this as a baseline, the correlation between neutral red-positive fungal elements in scales taken from 211 patients with tinea and 27 patients with cutaneous candidosis and cultures on Sabouraud glucose agar was studied. Strong positive correlations were found in both mycoses. These findings suggest that neutral red staining provides a useful method for evaluating the viability of dermatophytes and Candida in human skin scales.

Unusually located lymphocutaneous nocardiosis caused by Nocardia brasiliensis.

Summary We report a patient with primary lymphocutaneous Nocardia brasiliensis infection affecting the face and left arm. The mode of infection was via skin abrasions which occurred 2 weeks prior to the development of the skin lesions. Treatment with intravenous minocycline for 4 weeks resulted in a cure. We also review 12 previously reported Japanese cases of lymphocutaneous nocardiosis.

Aggressive B‐cell lymphoma induced by Epstein‐Barr virus infection in erythrodermic cutaneous T‐cell lymphoma

The coexistence of two cutaneous non‐Hodgkins lymphomas of different lineage is rare. We report a patient with an indolent erythrodermic cutaneous T‐cell lymphoma followed by an aggressive B‐cell lymphoma. To our best knowledge, this is the first report describing Epstein‐Barr virus‐associated B‐cell lymphoma in a patient with cutaneous T‐cell lymphoma. We suggest that the long‐standing cutaneous T‐cell lymphoma, as well as the long‐term chemotherapy, suppressed host immunity and caused reactivation of latent Epstein‐Barr virus.

Cutaneous T-cell lymphoma arising from parakeratosis variegata : long-term observation with monitoring of T-cell receptor gene rearrangements

BACKGROUND Parakeratosis variegata is a rare skin disease first described in 1890. Even today, the disease entity remains confusing because various names indicating similar skin conditions have been used. Several cases of parakeratosis variegata have been reported to develop into cutaneous T-cell lymphoma, but there have been no reports describing the occurrence of lymphoma after a long-term follow-up period nor have T-cell receptor gene rearrangements been monitored in this disease. OBJECTIVE Our purpose was to determine whether parakeratosis variegata (long-standing premycotic condition) can develop into cutaneous T-cell lymphoma. METHODS We analyzed skin specimens from a patient with a 33-year history of parakeratosis variegata by Southern blotting using a T-cell receptor gene probe. RESULTS We could detect apparent rearranged bands of T-cell receptor gene in the skin specimens taken in 1993 in contrast to the DNA analysis in 1988 which featured no such rearranged band. CONCLUSION This case represents a critical stage of parakeratosis variegata converting to lymphoma. Our results indicate that parakeratosis variegata generated monoclonality of T cells in its chronic course.

Angiosarcoma with dermal melanocytosis.

We report a case of angiosarcoma and dermal melanocytosis occurring simultaneously in the same lesion. We examined the primary and 2 metastatic lesions. Histopathologically, the anaplastic angiosarcoma cells had a tendency to form irregularly shaped small cavities. Immunohistochemically, they were strongly reactive with Ulex europaeus agglutinin (UEAI) stain. The mid and deep dermis of the same lesion had spindle or elongated slender melanocytes containing melanin granules. The melanocytes were positive with S‐100 protein stain. Ultrastructurally, pinocytotic vesicles, fine filaments, and Weibel‐Palade body‐like dense granules were observed in the cytoplasm of angiosarcoma cells. Dermal melanocytes had external lamina and melanosomes in various stages. The melanocytes showed no similarity to the neoplastic tumor cells and there was no apparent intermediate form between the 2 kinds of cells. The etiological implications of dermal melanocytosis with a tumor of vascular origin are discussed.

Association of the Acral Type of Pustular Psoriasis, Sjögren's Syndrome, Systemic Lupus Erythematosus, and Hashimoto's Thyroiditis

We describe a case of a 53‐year‐old Japanese female suffering from Sjögrens syndrome, systemic lupus erythematosus, and Hashimotos thyroiditis who developed pustules, erythema, and erosions on her fingers and toes. The histological specimen showed psoriatic changes. Indirect immunofluorescent study using anti‐human IL (interleukin)‐8 antibody produced positive staining patterns in the lesional epidermis. These findings suggested the diagnosis of acral pustular psoriasis. Diaminodiphenylsulfone at 75 mg orally daily for 20 days and the application of 0.12% betamethasone valerate ointment led to gradual improvement.

Neutral red assay in minimum fungicidal concentrations of antifungal agents

We assayed the fungicidal effects of antifungal agents using neutral red staining. Fungal elements of Trichophyton mentagrophytes and T. rubrum were treated with various concentrations of antifungal agents in 96-well filtration plates and then stained with neutral red. The amount of neutral red incorporated by the surviving viable cells was determined from the automated spectrophotometric readings at 550 nm. The minimum fungicidal concentrations (MFCs) of antifungal agents determined by this assay correlated well with those determined by conventional assay. This newly developed procedure should provide a rapid, reproducible, quantitative, qualitative and semi-automated susceptibility test for determination of the MFCs of the fungicidal agents.

Differential expression of the 45 kDa protein (actin) during the dimorphic transition of Sporothrix schenckii

We investigated the gene expression of a protein during the dimorphic transition from yeast to mycelial form of Sporothrix schenckii. Yeast cells were converted to mycelial cells in Sabouraud glucose broth at 25 degrees C. After 1, 3 and 5 days of culture, the intermediate form of cells between yeast and mycelium was obtained, and after 7 days these cells were morphologically similar to the mycelial cells. Proteins having the molecular weight of 45 kDa were found to by synthesized preferentially by intermediate form of day 7 and mycelial cells. On the other hand, the 45 kDa proteins were predominantly translated by the RNA isolated from the intermediate of day 7 and mycelial cells using in vitro cell-free translation assay. The 45 kDa proteins synthesized by mycelial cells were found to be identical with the 45 kDa translation products directed by the mRNA isolated from the intermediate and mycelial cells by V8 protease peptide mapping. The 45 kDa protein was considered to be actin by Western blot analysis using an anti-actin monoclonal antibody. These results suggest that the intermediate form of day 7 has the same phenotypes in the morphology and biosynthesis of actin as those of mycelial cells. The expression of the actin gene may be involved in the dimorphic transition of S. schenckii.