[A CASE OF A GIRL WITH ANAPHYLAXIS INDUCED BY INHALATION OF SOYBEAN DUST].

The patient was a 3-year-old girl whose father was employed sorting and washing soybeans. She exhibited transient respiratory distress and loss of activity on the same day or the next day after her father came home wearing work clothes with soybean dust on them. One day, she developed anaphylaxis after being lifted into her father's arms while he was wearing his work clothes. Although a blood test was positive for soybean and Gly m 4-specific IgE antibodies, the girl was able to consume soy products (not including soy milk, which she had never consumed) without any issues. The father was instructed to change clothes before leaving work and bathe immediately upon returning home, and the girl has not had any further episodes of respiratory distress, loss of activity, or anaphylaxis. Though reports of anaphylaxis from soybean antigen inhalation are extremely rare, it is very likely that inhalation of soybean dust from the father's work clothes induced anaphylaxis in this case.

An Utstein-style examination of out-of-hospital cardiac arrest patients in Saga Prefecture, Japan.

INTRODUCTION: The Utstein-style guidelines have been used in various countries around the world, because they are suitable for evaluating regional emergency medical systems (EMSs) for patients who have an out-of-hospital cardiac arrest (OHCA). This report examined the present status of treating OHCA in Saga Prefecture and examined policies that can contribute to improving the rate of the return of spontaneous circulation (ROSC). METHODS: This study examined 800 cases of OHCA by means of the Utstein-style guidelines submitted for medical control verification by firefighting organizations in Saga Prefecture from July 1, 2010, to June 30, 2011. The firefighting organizations were divided into 5 areas (A-E) according to each medical classification. The 5 areas were compared in terms of the ROSC rate and background factors (patient age and sex, cardiac arrest cause, place, witnesses, initial electrocardiogram [ECG], hospital ECG, prehospital medical treatment, transfer time, oral instruction, and bystander cardiopulmonary resuscitation [CPR]). RESULTS: The ROSC rate was significantly lower in areas D (24.2%) and E (26.8%). Age, sex, cardiac arrest cause, place, witnesses, initial ECG, hospital ECG, shock, and adrenaline administration did not differ significantly among the 5 areas. The response time was significantly shorter in areas A (8: 25), D (8: 07), and E (8: 12). There were significantly fewer examples of oral CPR instruction in area E (42.1%), and there were fewer examples of CPR in areas A (44.0%), D (41.9%), and E (37.9%). CPR was performed by lay person in approximately 70% of the cases in which oral instructions were provided, but it was not performed in 90% of cases in which no oral instructions were provided. CONCLUSIONS: The Utstein-style guidelines were used to clarify differences in the ROSC rate in Saga Prefecture, thus making improvements in regional EMSs possible. Improvements in the quality of oral instruction and a reexamination of the oral instruction manual are expected to improve the ROSC rate, in parallel with education in basic life support for lay person and in advanced cardiac life support for medical personnel. In addition, it is important to reaffirm the effectiveness of CPR and encourage the participation of lay person by providing instructions by telephone from an ambulance that is en route to the scene.

A case of S-100-positive juvenile xanthogranuloma: a longitudinal observation.

We present the case of a 9-month-old boy with yellow-brown papules that gradually increased in number over a period of 6 months without systemic involvement. Our case was clinicopathologically diagnosed as S-100-positive juvenile xanthogranuloma, and longitudinal observation revealed that strong S-100 reactivity disappeared in parallel with maturation of the lesions within 2 years after the initial diagnosis. These findings add to the complexity in cells of origin of this disorder.

Primary localized cutaneous amyloidosis with unusual clinical features in a patient with Sjögren's syndrome.

A 69-year-old woman presented with a 2-year history of an eczematous lesion covering the genital area. Histopathological examination showed deposits of amorphous, eosinophilic material and an infiltrate of plasma cells through the entire dermis into the subcutaneous fatty tissue. Congo red-stained deposits showed apple-green birefringence with polarizing microscopy. On immunohistochemistry, the deposited material was positively stained with anti-lambda light chain antibodies but not with anti-lambda light chain. A diagnosis of primary localized cutaneous amyloidosis (PLCA) was made, and the patient was also diagnosed as having Sjögren's syndrome (SjS) based on clinical and laboratory findings. The lesion of PLCA has spontaneously regressed over a period of 18 months. We report a unique case of PLCA and SjS that clinically demonstrated genital eczematous features and spontaneous involution, and we also describe a possible association between PLCA and SjS.

Clomipramine-induced hypersensitivity syndrome with unusual clinical features.

Drug-induced hypersensitivity syndrome is a severe drug eruption with fatal visceral organ failures associated with human herpesvirus-6 (HHV-6) reactivation. We present a case of clomipramine-induced hypersensitivity syndrome, which displayed in succession two different reactions akin to those described for Gianotti-Crosti syndrome and infectious mononucleosis. HHV-6 reactivation was confirmed serologically after the latter reaction, suggesting that our case may have represented a biphasic reaction to HHV-6 reactivation.

A case of docetaxel-induced erythrodysesthesia.

Chemotherapy-induced acral erythema (CIAE) is a rare cutaneous reaction to high-dose chemotherapy, clinically featuring painful erythema on the palms and soles. Docetaxel (Taxotere), an anticancer agent, is known to cause various reactions, including CIAE. We experienced a case of docetaxel-induced acral erythema with facial edematous erythema that coincidentally emerged and regressed with appearance and disappearance of the acral lesions. Docetaxel-induced acral erythema exhibits a widespread distribution and intense sensations of intolerable pain and numbness. Therefore, some authors use the term erythrodysesthesia instead of acral erythema. We speculated that the facial erythema might be part of the spectrum of erythrodysesthesia. Our case was finally diagnosed as decetaxel-induced erythrodysesthesia. Although CIAE is self-limiting, the patients frequently require treatment because of intolerable pain. Reported treatments for CIAE include topical or systemic steroids, elevation of the legs, and application of cold compression to the lesion. In our case, application of a steroid ointment with the occlusive dressing technique (ODT) alleviated the clinical manifestations and was also prophylactic for the erythrodysesthesia.

A case of pustulosis palmaris et plantaris that began as generalized pustular eruption.

A 65-year-old woman suddenly developed a widespread sterile pustular outbreak with high pyrexia. Many pustules appeared on her hands, including both the dorsal and the palmer side, and a few pustule appeared on her trunk and arms in the pattern of acute generalized pustular bacterid. Histopathology of the eruption showed subcorneal pustules. The eruption and pyrexia did not resolve with any of several antibiotics and NSAIDs, but resolved with the oral etretinate. Thereafter, pustules and scaly erythema remained on the arch of the foot and thenar of the palm, typical of pustulosis palmaris et plantaris.