Yasuyuki Sugita

Familial cluster of cutaneous Mycobacterium avium infection resulting from use of a circulating, constantly heated bath water system

We describe familial cases of cutaneous infection caused by Mycobacterium avium. A 45‐year‐old father, his 14‐year‐old son and 11‐year‐old daughter, among five persons in a family, presented with a 2‐month history of inflammatory subcutaneous nodules and ulcerations. Histology of skin biopsy specimens showed granulomatous inflammation, and mycobacterial colonies isolated from the skin of each patient were identified as M. avium by DNA hybridization analysis. The patients were all treated successfully with combined drug therapy consisting of rifampicin, isoniazid and clarithromycin. Their lesions were purely cutaneous M. avium infection, without any visceral involvement. Neither systemic disease nor immunological impairment was detected in the family. However, they all used a circulating, constantly heated bath water system. The bath water was continuously heated to about 40 °C without changing the water for a few months, and M. avium was isolated from the filter of the bath tub heating unit. It is considered that this unusual familial cluster of cutaneous M. avium infection in healthy persons may have resulted from the use of contaminated bath water.

INTERLEUKIN-6 (IL-6) IN PATIENTS WITH BEHCET'S DISEASE

We have examined the levels of interleukin-6 (IL-6) in plasma and supernatants of peripheral blood mononuclear cells (PBMC) from patients with Behçets disease and healthy controls using a sensitive enzyme-linked immunosorbent assay (ELISA). Plasma IL-6 level was not detected in any subjects. The IL-6 concentrations in culture supernatants of patients with active Behçets disease were significantly high compared with patients with inactive disease and healthy controls. Moreover, we investigated IL-6 gene expression in cultured PBMC from patients with Behçets disease. IL-6 gene expression was enhanced in active patients compared with inactive patients. These results show that IL-6 may play a role in the pathogenesis of Behçets disease.

Chondrodermatitis nodularis helicis in childhood dermatomyositis.

positive results of Schirmer test, positive sialography and presence of anti-Ro and anti-La antibodiesÐto enable a diagnosis of SS in the present case to be made. Annular erythema with Ro positivity is recognized as one of the cutaneous manifestations in SS. Although the annular erythema of subacute cutaneous lupus erythematosus (SCLE) is also associated with anti-Ro antibody and clinically mimics that of SS, the former reveals the liquefaction degeneration and positive lupus band test, histologically. To our knowledge, no cases of SCLE with MG have been reported to date, thus the relationship between Ro positivity and SCLE with MG remains unclear. When the patients MG worsened to a myasthenia crisis, the number of SS skin lesions increased synchronously, which suggests some similar mechanism in the pathogenesis of the two diseases. If a patient with SS complains of some neuromuscular symptoms, the possibility of MG should be considered.

A case of carotenodermia caused by a diet of the dried seaweed called Nori.

Carotenodermia may arise from excessive dietary intake of carotene containing foods. We reported a 22‐year‐old woman who had eaten excessive amount of carotene‐rich seaweed to lose weight. Her skin color changed to orange‐yellow, and her serum β‐carotene was 573 μg/dl. After stopping the ingestion of seaweed, her skin color returned to normal.

Gene expression of tumour necrosis factor-α (TNF-α) and heat-shock protein (HSP) 70 in patients with BehÇet's disease

Department of Dermatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236, Japan 2 Third Department of Internal Medicine, Yokohama City University School of Medicine, 3 9 Fukuura, Kanazawa-ku, Yokohama 236, Japan 3 Department of Ophthalmology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236, Japan 4 Department of Bacteriology, Yokohama City University School of Medicine, 3 9 Fukuura, Kanazawa-ku, Yokohama 236, Japan

Suppression of tumour necrosis factor‐α expression in leprosy skin lesions during treatment for leprosy

The expression of tumour necrosis factor (TNF)‐α in leprosy skin lesions was examined before and during successful treatment in a patient with borderline lepromatous leprosy. Before treatment, immunohistochemical staining of a skin biopsy specimen showed diffuse TNF‐α deposits in granulomas and significant TNF‐α deposits on infiltrated mononuclear cells. After 1 years treatment, the skin lesions exhibited a reduction in granulomas, and a concomitant reduction in deposits of TNF‐α.

Modulation of bullous pemphigoid antigen gene expression by γ-interferon in cultured keratinocytes

Bullous pemphigoid (BP) is characterized by the production of autoantibodies against BP antigens, γ‐interferon (γ‐IFN), a T‐cell lymphokine, is known to enhance the expression of several cell‐surface proteins. In this study, keratinocytes were cultured in the presence of γ‐IFN. the expression of BP antigen protein was examined by flow cytometry and BP antigen messenger RNA (mRNA) (encoding 230‐kDa protein) was quantified by slot‐blot hybridization. The results indicated that BP antigen gene expression by keratinocytes was upregulated by γ‐IFN. This enhancement of gene expression was I detected at both the protein and mRNA level, suggesting pretranslational regulation. These results imply the involvement of not only humoral immunity but also cell‐mediated immunity in the development of BP.

A case of cold abscess due to disseminated tuberculosis in an AIDS patient

Sir, We read with interest the recent report by Cox et al. on the association of atopic dermatitis with the beta subunit of the high-affinity IgE receptor (Fc1RI-b). The gene was originally identified as a candidate for atopy on human chromosome 11q. Fc1RI-b has been shown to be involved in the amplification of Fc1RI-mediated signalling that might be related to the pathogenesis of atopic disease. Because of the predominantly maternal transmission of atopy, it has been strongly suggested that the gene for Fc1RI-b may show a parent-of-origin effect such as genomic imprinting. One previous report consistent with this notion showed maternal transmission of the I181L allele in a British population, while another showed no parent-of-origin effect of the transmission of the E237G allele in an Australian population. The report by Cox et al. again raises this issue by demonstrating exclusive maternal transmission of Fc1RI-b alleles to offspring with atopic dermatitis. None the less, as far as we know, there has been no direct test of possible allele-specific expression of this gene. To study the possible involvement of a genomic imprinting mechanism, we have used the widely applicable mouse model system. We find, as detailed below, that the Fc1RI-b gene shows no parent-of-origin-specific expression, using F1 hybrids between a laboratory mouse strain (C57BL/6J) and wild mouse strains [either Mus musculus molossinus (MOLF/Ei) or M. spretus (SPRET/Ei)]. The parental mouse strains (C57BL/6J, MOLF/Ei, SPRET/ Ei) were purchased from Jackson Laboratory (Bar Harbor, ME, U.S.A.). Cloning, sequencing, total RNA extraction and reverse transcription±polymerase chain reaction (PCR) analysis of Fc1RI-b were done as described previously. Based on a human genomic DNA sequence (GenBank M89796) and a mouse cDNA sequence (GenBank J05019), we designed a PCR primer pair spanning exon 6, intron 6 and exon 7 of the Fc1RI-b gene, so that an intron could be included in the PCR target. This allowed us to measure the gene expression directly, without interference by possible contamination of genomic DNAs in RNA samples. Sequence polymorphisms among C57BL/6J, MOLF/Ei and SPRET/Ei were identified by sequencing PCR products from each strain (deposited in GenBank; accession numbers U90217±U90219). A 395-base pair (bp) fragment of the gene for Fc1RI-b was amplified from cDNAs with primers up6: 5 0-ATCCTGGCCTTTTGCAGTGC-3 0 and dn10: 5 0-TGTATGTGAAATTGTGACAC-3 0. To obtain enough DNA for analyses, a shorter fragment (361 bp) was reamplified from the PCR products with primers up6 and dn4: 5 0-GGAGTGAATGATATCCGCAA-3 0. Allele-specific expression in reciprocal crosses between C57BL/6J and MOLF/Ei was examined by using a Sau3AI restriction fragment length polymorphism (RFLP) in a 361-bp PCR product (Fig. 1A). For RFLP analysis, 3 mL of unpurified PCR products were digested with 5 U of Sau3AI in a 15-mL reaction mixture at 37 8C for 3 h, then electrophoresed in a 12% polyacrylamide gel. The gel was stained by ethidium bromide and photographed under ultraviolet radiation. Both paternally and maternally derived alleles were expressed in all examined tissues, i.e. embryo, placenta and yolk sac at 14 ́5 days postconception, whole body and skin at the newborn stage (Fig. 1B), and spleen, lung and colon in adults (not shown). The data clearly demonstrate the biallelic expression of the gene for Fc1RI-b. To confirm these data, interspecific hybrids between a laboratory mouse strain and M. spretus were used. In these crosses, the C57BL/6J-specific allele (296 bp) can be distinguished from the SPRET/Ei-specific allele (279 bp) by length

Genetic control of immune responses to HIV-1 env DNA vaccine

We investigated the genetic control of immunoglobulin production and the delayed‐type hypersensitivity (DTH) response produced by an HIV‐specific DNA vaccine using several strains of mice. Murine antigen‐specific immunoglobulin production was determined by ELISA. The DTH response was assessed in terms of the footpad swelling reaction. All strains of mice, except for B10.RIII and B10.T(6R), exhibited strong immunoglobulin production and footpad swelling in response to the DNA vaccine. In vitro treatment of lymphoid cells with monoclonal antibodies showed that the footpad swelling response was mediated by CD4+8− and Ia— T cells. However, CD8+ T cells did not suppress footpad swelling. There was no difference in the induction of HIV‐specific immunoglobulin production or DTH response induced by the DNA vaccine among the strains, suggesting that HIV‐specific DNA vaccine is useful for immunizing various populations against HIV‐1.

Sparfloxacin in the treatment of leprosy patients

Seven men (age range, 20-33 years) with leprosy visited our dermatologic clinic at Yokohama City University Hospital (Table 1) and were entered into a trial of sparfloxacin (SPFX), 100-200 mg daily for up to 1 year. Five patients were Japanese Brazilians or Paraguayan from South America, and two patients were Filipinos. Examination procedures included a detailed medical history, pretreatment, clinical examinations, and body charting of the characteristic skin lesions, areas of anesthesia, and enlarged peripheral nerves. There were no deformities observed in any patient. All had presented with eruptions and neurologic problems. The diagnosis of leprosy and its type were determined by the above examination, skin smear, and histopathologic study, as well as Mitsuda reaction. The first patient came from the Philippines and presented to our clinic in 1993. There were many elevated erythemas with central healing on his whole body. Sensory nerves were impaired. His type was lepromatous (LL) leprosy. The second patient was followed for only 1 month because of a change in residence. The third and fourth patients were brothers. The fifth patient came from Paraguay. The sixth patient was from the Philippines. The seventh patient came to our clinic in April 1995.