Yoshinao Shibuya

Chronic Fatigue Syndrome after Human Parvovirus B19 Infection without Persistent Viremia

Background: It is unclear how often chronic fatigue syndrome (CFS) appears after human parvovirus B19 (B19) infection and whether prolonged B19 viremia or some other factors cause CFS. Objectives: To determine how often CFS appears after B19 infection and whether prolonged B19 DNA presence, antibody production and persistently reduced complement levels occur in CFS patients after B19 infection. Methods: Clinical findings were examined in 210 patients after B19 infection, and CH50, C3 and C4 levels were determined. B19 DNA and antibodies to B19 were also tested in 38 patients’ sera including 3 with CFS. Results: Serum B19 DNA disappeared after 4–5 months in all 18 patients tested. There are no differences in B19 DNA-positive period between patients with and without persistent symptoms. IgM antibody titers to B19 became reduced after 2 months in all 38 patients. Complement levels persistently decreased in a greater proportion of patients with persistent symptoms. Conclusions: The present study suggests that we should consider the possibility of CFS after B19 infection and that CFS may be derived from several aspects other than prolonged B19 DNA presence in sera.

Efficacy of granulocyte and monocyte adsorption apheresis for three cases of refractory pyoderma gangrenosum.

Abstract:  Pyoderma gangrenosum presents with chronic skin ulcers and is histologically characterized by neutrophil infiltration throughout the dermis. It is also occasionally associated with ulcerative colitis, a type of inflammatory bowel disease, against which granulocyte and monocyte adsorption apheresis (GCAP) has recently shown remarkable efficacy. We performed GCAP on three refractory cases of pyoderma gangrenosum with painful bilateral leg ulcers and hereby report the results obtained. Patient 1 was a 43‐year‐old woman with a four‐year history of recurrent painful skin ulcers treated with prednisolone and cyclosporine. Patient 2 was a 29‐year‐old woman who had been suffering from pyoderma gangrenosum with severe pain for two weeks, associated with an 11‐year history of ulcerative colitis treated with prednisolone and salazosulfapyridine. Patient 3 was a 63‐year‐old man with a three‐year history of recurrent ulcers with pain, suffering from rheumatoid arthritis treated with prednisolone and cyclophosphamide. The sizes of the lesions were reduced in all three patients following a weekly GCAP treatment for 10 or 11 consecutive weeks, and the re‐epithelialization of ulcers were additionally observed in two patients. The pain disappeared dramatically in all three patients following two sessions of GCAP therapy. No adverse effects were observed for up to at least eight months after treatment. We therefore considered GCAP as one effective alternative to currently existing therapies, with regards to refractory cases of pyoderma gangrenosum.

Decreased Factor XIII Activity in a Patient With Subcutaneous Bleeding After Double Filtration Plasmapheresis

Double filtration plasmapheresis (DFPP) is often performed as a treatment for autoimmune diseases including pemphigus vulgaris. We report a pemphigus vulgaris patient with subcutaneous bleeding, gradually spreading over a period of 10 days after DFPP. In this patient, factor XIII activity was markedly decreased. In three other patients, factor XIII activities were markedly reduced the day following DFPP, were but restored by days 7–10. From these findings, subcutaneous bleeding may have occurred in the present patient due to a delayed recovery of the decreased factor XIII activity after DFPP. Therefore, decreased factor XIII activity could be a critical cause of subcutaneous bleeding after DFPP.

Efficacy of Granulocyte and Monocyte Adsorption Apheresis for Pustular Psoriasis

Abstract:  Granulocyte and monocyte adsorption apheresis (GCAP) has recently shown remarkable effects on ulcerative colitis, which is characterized by inflammation and neutrophil infiltration. Pustular psoriasis often shows histological findings of neutrophilic pustules in the epidermis, and in Japan is usually treated with etretinate or immunosuppressive agents. However, there are some resistant cases to these therapies. We performed GCAP on one patient with generalized pustular psoriasis (patient 1) and on one patient with acrodermatitis continua, a subtype of pustular psoriasis limited to acral lesions (patient 2). Patient 1, a 44‐year‐old woman suffering from alcoholic liver cirrhosis and osteoporosis as a result of the liver cirrhosis, received two GCAP sessions because cyclosporine was ineffective. Patient 2, a 66‐year‐old man with hypertension who had suffered from a brain infarction 4 years before, had five GCAP sessions because etretinate was ineffective. GCAP remarkably improved the skin lesions in both patients. No adverse effects were observed either during or after treatment. From these findings, GCAP could be an effective therapy for refractory cases of pustular psoriasis.

Combination Therapy of Infliximab and Granulocyte/Monocyte Adsorption Apheresis for Refractory Pustular Psoriasis with Psoriatic Arthritis

© 2013 The Authors. doi: 10.2340/00015555-1463 Journal Compilation

Time-course of the change in titre of antibodies against type VII collagen in a patient with epidermolysis bullosa acquisita.

© 2012 The Authors. doi: 10.2340/00015555-1339 Journal Compilation

Giant tufted angioma successfully treated with radiation.

oid granulomas associated with Hodgikin’s disease. Clinical correlation in 55 previously untreated patients. Cancer 1978; 41: 562–567. 6 Noro S, Akifumi Y, Yamazaki N et al. [Comparison of the previous UICC-TNM classification (1997) and new UICC-TNM classification (2002) for malignant melanoma: analysis of 342 Japanese patients.]. Skin Cancer 2003; 18: 214–220 (In Japanese). 7 Ishihara K, Saida T, Yamamoto A. [Statistics of malignant melanoma (1992–1996): epidemiology, prognostic factor and survival rates.]. Skin Cancer 2002; 17: 7–15 (In Japanese). 8 Bassler R, Birke F. Histopathology of tumor associated sarcoid-like stromal reaction in breast cancer. An analysis of 5 cases with immunohistochemical investigations. Virchows Arch A Pathol Anat Histopathol 1988; 412: 231–239.

Squamous cell carcinoma possibly originating from a granuloma following vaccination with Bacille Calmette-Guérin

ejd.2013.2137 Auteur(s) : Tomomi Fujisawa, Yoko Okumura, Yoshinao Shibuya, Genichi Kato, Mariko Seishima marikoseishima@yahoo.co.jp Department of Dermatology, Gifu University School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Japan A 64-year-old woman was referred to our hospital with a 6-month history of painful skin tumors on her left hand. She had received a vaccination of Bacille Calmette-Guerin (BCG), an attenuated form of Mycobacterium bovis, in the left upper arm at the age of 18. Following [...]

Major royal jelly protein 3 as a possible allergen in royal jelly-induced anaphylaxis

kines. IL-13 also acts directly on eosinophils and, like IL-5, prolongs eosinophil survival and enhances the pathological effects of these cells at sites of inflammation. This effect seems to be related to an increase of IL-5 and IL-13 production in our patients with DIHS ⁄DRESS, in which marked eosinophilia is observed. The role of increased GM-CSF levels in TEN is obscure. GM-CSF might be increased to compensate for a decrease of peripheral white blood cells, which is sometimes observed in TEN. These observations indicate the importance of controlling serum cytokine levels during the treatment of TEN, especially at the time when serum TNF-a and IL-6 levels are drastically increased together with antiinflammatory cytokines such as IL-10 and IL-1ra. Further studies that include larger numbers of patients are needed to elucidate the roles of cytokine production in the pathogenesis of severe types of ADR.

Contents Vol. 216, 2008

S.M. Aiba, Sendai S. Chimenti, Rome O. Chosidow, Paris B. Cribier, Strasbourg M.A. De Rie, Amsterdam C. Gelmetti, Milano E. Grosshans, Strasbourg K. Holubar, Vienna H. Hönigsmann, Vienna P. Joly, Rouen S. Karpati, Budapest A.D. Katsambas, Athens J.-M. Lachapelle, Brussels H.I. Maibach, San Francisco, Calif. J.M. Mascaro, Barcelona M.C. Mihm, Jr., Boston, Mass. G.E. Piérard, Liège G. Plewig, Munich F.C. Powell, Dublin A.-A. Ramelet, Lausanne J. Revuz, Créteil J. Ring, Munich M. Röcken, Tübingen R.A. Schwartz, Newark, N.J. N. Stavrianeas, Athens H. Traupe, Münster A. Vahlquist, Uppsala D.T. Woodley, Los Angeles, Calif. Offi cial Organ of