A Case of Adult Onset Still's Disease That Presented with Erythema Multiforme-like Eruption / 대한피부과학회지

Adult onset Still's disease (AOSD) is a rare systemic inflammatory disease that is basically an adult onset of juvenile rheumatoid arthritis, and the manifestations include fever, rash, arthritis and other organ involvement. The typical skin rash of AOSD is evanescent, erythematous maculopapular lesions. We report here on a rare case of AOSD in a 29-year-old female patient who presented with high fever, erythma multiforme-like skin eruption, arthritis and sore throat. She was diagnosed with AOSD according to the diagnostic criteria of Yamaguchi.

A Case of Erythema Nodosum Associated with Crohn's Disease / 대한피부과학회지

Erythema nodosum is a reactive dermatosis that occurs in response to various stimuli, such as bacterial, fungal and viral infections, drugs, sarcoidosis and inflammatory bowel disease. Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract. Its etiology is unknown. It has been generally defined as a complex disease resulting from the interaction of multiple genetics and environmental factors. Erythema nodosum is the most common skin manifestation, occurring in about 1~15% of people with inflammatory bowel disease, particularly those with Crohn's disease. However erythema nodosum associated with Crohn's disease has been reported only rarely by Korean dermatologists. Herein, we report the case of a 31-year-old male with Crohn's disease who presented with erythematous, tender, subcutaneousnodules on his lower extremities

A Case of Carcinoid Syndrome with a Scleroderma-like Lesion / 대한피부과학회지

Carcinoid syndrome exhibits a constellation of symptoms typically exhibited by patients with carcinoid tumors that produce neuroendocrine mediators, including serotonin. Carcinoid syndrome is diagnosed by increasing urinary 5-hydroxyindoleacetic acid and manifestations of gastrointestinal tract, respiratory, cardiovascular, and skin involvement, which occurs in <10% of patients. Cutaneous manifestations are flushing, telangiectasias, pellagra dermatitis, and scleroderma-like lesions, which are relatively rare. A 60-year-old woman presented with sclerotic skin lesions on both legs. On examination, a 10x10 cm solid mass was palpable on the right lower abdomen, and she had facial flushing and telangiectasia, but Raynaud's phenomenon was absent. The urinary 5-hydroxyindoleacetic acid was elevated (68.2 mg/day). Abdominal and pelvic CT scans showed a right ovarian tumor which was diagnosed as a carcinoid tumor by CT-guided needle biopsy. Thus, we report, for the first time, a case of carcinoid syndrome with scleroderma-like lesions in a Korean patient. If facial flushing and a scleroderma-like lesion present together, one should consider a carcinoid tumor.

TNF-alpha-induced Increase of Human beta-defensin-2 Expression in HaCaT Cell Lines / 대한피부과학회지

BACKGROUND: Several kinds of epithelial cells and focal lymph nodes are known to be involved in the skin's immune reaction. Especially, internal antimicrobial peptide play an important role in protecting microbial agents. Human beta-defensin-2 (hBD-2) is an antimicrobial peptide which is produced by epithelial cells after stimulation with microorganisms or inflammatory mediators. hBD-2 participates in the increase of the cell-mediated immune reaction. It also affects the proliferation and differentiation of epithelial cells and fibroblasts, resulting in enhancement of wound healing. However, little is known as to whether the TNF-alpha induces the expression of hBD-2 in HaCaT cells through the NF-kappaB or MAPKs pathways. OBJECTIVE: Research was undertaken to investigate the roles of NF-kappaB and MAPKs transcription factors in the molecular pathway of TNF-alpha-induced hBD-2 expression in HaCaT cell lines. METHODS: The expression of hBD-2 in TNF-alpha-treated HaCaT cells was analyzed by immunofluorescence staining and reverse transcription polymerase chain reaction (RT-PCR). The expression of NF-kappaB was analyzed by Western blot analysis and electrophoretic mobility shift assay (EMSA). RESULTS: Strong positive hBD-2 immunofluorescence staining in TNF-alpha-treated HaCaT cells was observed. According to RT-PCR analysis, the expression of hBD-2 increased TNF-alpha-treated HaCaT cells by dose-dependent and time-dependent manners. In addition, according to Western blot analysis and EMSA, NF-kappaB was also activated in TNF-alpha-treated HaCaT cells. Interestingly, the expression of hBD-2 in TNF-alpha-treated HaCaT cells was attenuated in the presence of NF-kappaB inhibitors, PDTC or MG132. Furthermore, MAPKs inhibitors, especially SB (p38 inhibitor), partially attenuated the TNF-alpha-induced hBD-2 expession, but not PD (ERK inhibitor) and SP (JNK inhibitor). CONCLUSION: These results collectively suggest that hBD-2 is up-regulated in TNF-alpha-treated HaCaT cells through activation of NF-kappaB and p38 MAPKs pathway. Our data regarding the up-regulation of hBD-2 may help us to understand the antimicrobial mechanism in normal skin or in skin diseases.

Two Cases of Dermatomyositis Associated with Malignant Tumor / 대한피부과학회지

Dematomyositis is an idiopathic inflammatory myopathy characterized by specific skin manifestations and progressive symmetric proximal muscle weakness. Importantly, dermatomyositis is occasionally associated with the internal malignant tumor, which is clearly correlated with poor prognosis. We report two cases of dermatomyositis, showing characteristic skin lesions, that associated with small cell lung cancer in a 64-year old man and gallbladder cancer in a 54-year old man, respectively. On laboratory findings muscle enzymes and liver function markers were elevated prominently. We tried to treat these patients with systemic corticosteroid and chemotherapy. The patient with small cell lung cancer died of SAH due to head trauma and in the case of the patient with gallbladder cancer, the symptoms of the muscle weakness and the skin lesions are getting better and worse repeatedly fluctuating and regular periodic follow up is required.

A Case of CD30 (+)/ALK (-) Systemic Anaplastic Large Cell Lymphoma / 대한피부과학회지

Systemic CD30 positive anaplastic large cell lymphoma (ALCL), a subtype of non-Hodgkin lymphoma (NHL), developes in the internal organs and invades the skin. There have been many cases of primary cutaneous CD30 positive T-cell lymphoproliferative disorder, but reports of systemic ALCL have been rare. We describe herein CD30 positive ALK negative systemic ALCL in a 90-year-old woman with multiple masses and nodules on the skin, lung and liver, as well as enlargement of the hilar and abdominal lymph nodes, of 3 months duration. She died of sudden aggravation of the general condition after 7 days.

A Case of Dermatophytosis of Trichophyton rubrum Developed on the Scalp and Trunk in an Adult by the Molecular Biologically Same Strain / 대한피부과학회지

The disease of tinea capitis rarely occurs in adults. Cases infected by Trichophyton rubrum (T. rubrum) in the scalp of adults are especially rare. A 71 year-old woman presented who developed inflammatory scaly, erythematous papules and sparsely hairy patch on Rt. Side of scalp and scaly, erythematous patch with central clearing on lower abdomen and trunk. According to her history she had tinea pedis et unguium for a long time. The pruritic scaly patch had developed on scalp and trunk one week previously. We found ectothrix using KOH mount on her hair and hyphae on her toenail, toeweb, palm and trunk. T. rubrum was cultured on Sabouraud dextrose agar. A biopsy was performed on the sparsely hairy patch and we found infiltration of inflammatory cells in upper dermis and around hair follicle. Furthermore T. rubrum, which were cultured from several parts of body, were confirmed the same strain by analysis of DNA sequencing and ribosomal DNA (rDNA) nontranscribed spacer. Herein we proved a rare case of dermatophytosis in adult by the same strain, T. rubrum, identified by analysis of DNA sequencing and rDNA nontranscribed spacer, causing tinea capitis as well as tinea pedis and tinea corporis. We think that this will be useful basic data of epidemiologic study and classification of dermatophytes.

Scrofuloderma Derived from Tuberculous Sternoclavicular Osteoarthritis / 대한피부과학회지

Scrofuloderma, also called tuberculosis cutis colliquativa, is a subacute form of cutaneous tuberculosis, which is characterized by subcutaneously-located, cold abscess formation and secondary changes of the overlying skin. Recently, the occurrence of cutaneous tuberculosis has decrease due to improved quality of life and development of effective anti-tuberculous drugs. However, the tendency of diminution of scrofuloderma has grown smaller because the number of old and immunocompromised patients has increased. We report a rare case of scrofuloderma derived from tuberculous sternoclavicular osteoarthritis in a 71-year old woman.

Effect of Prolonged Thrombus Exposure on the Development of Secondary Venous Wall Changes in a Rat Venous Thrombosis Model

PURPOSE: There is growing evidence that thrombosis and inflammation are closely interrelated and that the inflammatory response may play a role in the development of the syndrome of post-thrombotic, chronic venous insufficiency. A thrombus contains biologically active factors that stimulate cellular and structural alterations and lead to post-thrombotic venous abnormalities. Prolonged exposure to thrombus may result in the development of more severe pathologic conditions. To assess the effect of prolonged thrombus exposure on the development of secondary venous wall changes, the level of D-dimer test and the microscopic findings of thrombosed vein were analyzed in a rat venous thrombosis model. METHOD: The left iliac vein of male Sprague-Dawley rats weighing of 250 to 300 gm were thrombosed by means of either proximal ligation or temporary 24-hour occlusion with a microvascular clamp. The rats were divided into three groups: control group (n=10), thrombosis model by proximal ligation of the iliac vein only; group A (n=10), thrombosis model by proximal ligation of the iliac vein with treatment of low molecular weight heparin (LMWH; Clexane(r) 0.5 mg/kg, s.c.b.i.d); and group B (n=10), thrombosis model by temporary 24-hours clamp of the iliac vein without treatment of LMWH. The vein located 2 cm below from the initial ligation was harvested at time intervals of 7 and 14 days after ligation or clamp. Thrombi were identified by gross findings and indirectly quantitated with D-dimer test. RESULT: The levels of D-dimer test on days 7 and 14 after ligation or occlusion were significantly higher in the control group than in groups A and B (P<0.05). However, gross findings of intraluminal thrombosis were not present only in group B. These findings suggest that injection of LMWH did not prevent the development of thrombi around the ligation area. The neutrophilic infiltration of the perivascular area was evaluated microscopically (Hematoxylin-Eosin stain, x100). Severe perivascular neutrophilic infiltration was found in the control group and group A, whereas in group B neutrophilic infiltration was decreased to a mild or moderate degree. The vein wall thickness was evaluated by counting cells on representative sections through the mid vein area and by direct measuring of the vein wall usinga scale bar. The rat vein walls on days 7 and 14 were significantly thicker in the control group and group A than in group B (P<0.05). CONCLUSION: These results suggest that prolonged exposure of thrombus plays a major role in the development of secondary venous wall changes. However, the injection of LMWH did not prevent the development of secondary venous wall changes during the prolonged exposure of thrombus.