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1.
Tokai J Exp Clin Med ; 48(1): 5-9, 2023 Apr 20.
Article in English | MEDLINE | ID: mdl-36999387

ABSTRACT

A 69-year-old Japanese woman visited Tokai University Oiso hospital with cutaneous ulcers on her left upper arm that appeared in January 2013, and on her right nose that appeared in December of 2013. Neither the two biopsies and tissue culture from the arm lesion nor the biopsy and tissue culture from the nose lesion detected any organism. In December of 2013, she was diagnosed as cutaneous sarcoidosis at Oiso hospital and treated with oral prednisolone for six months, however, did not show improvement. In June of 2014, third skin biopsy and culture from her left upper arm was done at our hospital, and also could not detect any organism. After six months of continuing treatment with oral steroids and steroid injections, the cutaneous ulcers became enlarged, with purulent exudate, requiring a fourth skin biopsy and culture from left upper arm, which finally detected Sporotrichosis. After one-month administration of itraconazole, in January of 2015, cutaneous ulcers of both the arm and nose shrunk. Sporotrichosis mimics sarcoidosis as well as other skin conditions clinically and histologically, therefore recognizing the importance of carrying out multiple skin biopsies and cultures are imperative to prevent misdiagnosis and improper treatments and possible dissemination.


Subject(s)
Sarcoidosis , Sporotrichosis , Humans , Female , Aged , Sporotrichosis/diagnosis , Sporotrichosis/drug therapy , Sporotrichosis/pathology , Antifungal Agents/therapeutic use , Ulcer/drug therapy , Sarcoidosis/diagnosis , Sarcoidosis/drug therapy , Biopsy
2.
Tokai J Exp Clin Med ; 46(1): 26-28, 2021 Apr 20.
Article in English | MEDLINE | ID: mdl-33835472

ABSTRACT

Ticks have a cosmopolitan distribution and, as such, are also found in Japan. Ticks are typically ectoparasites of wild animals, however, humans can also be bitten when visiting environments inhabited by ticks. Herein, we describe two cases with atypical tick bites. Case 1 was an elderly Japanese male patient who presented with a fully engorged tick measuring 20 × 17 × 8 mm; it is rare for ticks to attain a length of 20 mm. Case 2 was an elderly Japanese female with severe dementia who presented with multiple tick bites, which is rare, after going missing for 6 days before being found in a densely wooded area. Ticks are responsible for the transmission of many infectious agents, such as bacteria, viruses and parasites. The National Institute of Infectious Diseases and the Ministry of Health, Labour and Welfare regularly inform citizens of the risks posed by tick bites. However, the tick bites could not be prevented in our patients. Further edification about tick bites, tick-borne diseases, and their prevention are considered necessary in Japan.


Subject(s)
Amblyomma/anatomy & histology , Amblyomma/pathogenicity , Skin/pathology , Skin/parasitology , Tick Bites/diagnosis , Tick Bites/pathology , Aged, 80 and over , Animals , Dermatologic Surgical Procedures/methods , Female , Humans , Japan , Male , Tick Bites/parasitology , Tick Bites/surgery
3.
Tokai J Exp Clin Med ; 40(4): 165-8, 2015 Dec 20.
Article in English | MEDLINE | ID: mdl-26662668

ABSTRACT

A 71-year-old man was referred to us from another hospital for endoscopic treatment of a IIc lesion at the anterior wall of the lower body of the stomach. In November 2008, he underwent resection of this lesion with endoscopic submucosal dissection (ESD). Follow-up endoscopy revealed a IIc lesion in the posterior wall of the lower body of the stomach, and ESD was again performed in February 2009. At the same time, Helicobacter pylori was detected, and successful first-line eradication therapy was verified in May 2009. Subsequent follow-up endoscopy detected multiple ectopic and metachronous gastric cancers at three sites, all of which were endoscopically resected (quintuple gastric cancer). Although ectopic and metachronous recurrence of gastric cancer was detected immediately after H. pylori eradication, recurrence of gastric cancer has not been detected in the 5 years since eradication. Future directions include determining the time point at which the preventative effects of H. pylori eradication therapy appear against gastric cancer recurrence. We report our findings herein, along with a review of the related literature.


Subject(s)
Adenocarcinoma/surgery , Gastroscopy/methods , Neoplasm Recurrence, Local/prevention & control , Neoplasms, Multiple Primary , Stomach Neoplasms/surgery , Adenocarcinoma/etiology , Follow-Up Studies , Gastritis/complications , Gastritis/drug therapy , Gastritis/microbiology , Helicobacter Infections , Helicobacter pylori , Humans , Male , Stomach Neoplasms/etiology , Treatment Outcome
4.
Tokai J Exp Clin Med ; 38(2): 52-4, 2013 Jul 20.
Article in English | MEDLINE | ID: mdl-23868735

ABSTRACT

Disseminated herpes zoster is not rare in immunocompromised patient. It is defined as at least 20 lesions in multiple dermatomes that occur within a week of the onset of local eruption. Herein, we report that a case of disseminated vesicles of herpes zoster (HZ) that developed one day before the onset of local eruption in an immunocompromised patient. A 44 year-old Japanese male, who had been in the hospital with acute myelocytic leukemia, developed disseminated hemorrhagic vesicles of 5 to 10 mm in diameter. The next day, grouped vesicles, including hemorrhagic vesicles erupted on the right side of the second to third cervical (C2-C3) dermatomes. At this point, the diagnosis was made as disseminated herpes zoster. The activation of varicella-zoster virus (VZV) is believed to be due to waning of VZV-specific memory T cell responses. In our case, the memory immunity to VZV which had been increased by last episode of HZ might affect on the appearance of skin eruptions.


Subject(s)
Dermatitis/virology , Herpes Zoster/immunology , Herpes Zoster/virology , Herpesvirus 3, Human/physiology , Hospitalization , Immunocompromised Host/immunology , Immunologic Memory/immunology , T-Lymphocytes/immunology , Virus Activation/immunology , Adult , Dermatitis/immunology , Dermatitis/pathology , Herpes Zoster/pathology , Humans , Leukemia, Myeloid, Acute/immunology , Male , Skin/immunology , Skin/pathology , Skin/virology , Time Factors
5.
J Dermatol ; 40(9): 700-5, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23802993

ABSTRACT

To evaluate the diagnostic usefulness of Doppler sonography for amelanotic melanoma (AM), the correspondence between the findings of dermoscopy and Doppler sonography was investigated in AM in comparison with other hypopigmented tumors. Seven cases with AM and 11 cases with squamous cell carcinoma (SCC), 10 cases with non- or hypopigmented basal cell carcinoma (NP-BCC) and six cases with eccrine poroma (EP) as hypopigmented tumors were investigated. EP is readily recognized by differences from AM and SCC based on a single vertical and non-torvtuous vessels. NP-BCC is distinguished from AM based on tortuosity running in a vertical direction. Though findings of tortuosity in vessels and heterogeneity of vessel size are recognized both in AM and SCC: (i) abundant blood flow was recognized more clearly in AM; (ii) total blood flow was more than 40% in most cases of AM (average, 60.9%); and (iii) more vessels which flow into a tumor are found in AM (85.7%). There is no relationship between dermoscopic findings of vessel types and Doppler sonography findings of vessels. In this study, the diagnostic usefulness of the above-mentioned specific findings in examination may suggest using Doppler sonography for AM as one non-invasive method.


Subject(s)
Melanoma, Amelanotic/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Carcinoma, Basal Cell/diagnostic imaging , Carcinoma, Squamous Cell/diagnostic imaging , Dermoscopy , Humans , Poroma/diagnostic imaging , Retrospective Studies , Ultrasonography, Doppler
7.
Tokai J Exp Clin Med ; 37(1): 6-10, 2012 Apr 20.
Article in English | MEDLINE | ID: mdl-22488556

ABSTRACT

Chromomycosis is a chronic fungal disease of the skin and subcutaneous tissues caused by a group of dematiaceous black fungi. Small lesions can be removed with excision, but other cases are difficult to treat. We report a case of chromomycosis caused by Fonsecaea pedrosoi (F. pedrosoi). The case involved a 74-year-old man, who had noted a lesion on the back of the right thigh, that was gradually enlarging and reaching up to 30 cm in diameter, in 20-years. From microscopic examination, sclerotic cells were seen. We diagnosed this case as chromomycosis caused by F. pedrosoi on mycological examination. The patient was initially treated with oral terbinafine (250 mg/day) as the lesion was very large. After the 18 months treatment, the size of the lesion reduced to 1 cm, then the remaining lesion was excised.


Subject(s)
Antifungal Agents/therapeutic use , Chromoblastomycosis , Naphthalenes/therapeutic use , Aged , Antifungal Agents/administration & dosage , Ascomycota/isolation & purification , Chromoblastomycosis/drug therapy , Chromoblastomycosis/microbiology , Chromoblastomycosis/surgery , Combined Modality Therapy , Humans , Male , Naphthalenes/administration & dosage , Terbinafine , Treatment Outcome
8.
Biochem Biophys Res Commun ; 412(4): 626-32, 2011 Sep 09.
Article in English | MEDLINE | ID: mdl-21864505

ABSTRACT

CADM2, a candidate gene for psoriasis, was identified by a genome-wide association study using microsatellites in the Japanese population (561 cases and 561 controls). Moreover, haplotype analysis included an additional 68 SNPs and indicated that a 110-kb haplotype block was detected for the protective risk haplotype of psoriasis. We also identified an initial exon of novel splicing variants in this haplotype block. A functional analysis by qRT-PCR using RNAs from the blood of 56 cases and 64 controls significantly demonstrated an inverse correlation between expression frequencies in a novel splicing variant and the number of alleles associated with psoriasis. To confirm these results, we must perform replication studies using other ethnic groups and more functional analysis particularly for skin tissues.


Subject(s)
Alternative Splicing , Cell Adhesion Molecules/genetics , Genetic Predisposition to Disease , Psoriasis/genetics , Alleles , Amino Acid Sequence , Chromosomes, Human, Pair 3/genetics , Genome-Wide Association Study , Humans , Molecular Sequence Data
9.
J Dermatol ; 38(7): 702-6, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21729147

ABSTRACT

Nocardiosis is caused by gram-positive aerobic actinomycetes that live in soil and are known to be responsible for opportunistic infections. The condition mostly affects the lung, brain or skin. Here, we present a 24-year-old Japanese woman who had had systemic lupus erythematosus since the age of 20 years, and lupus nephritis since the age of 23 years. She developed cutaneous lymph duct-type nocardiosis due to Nocardia araoensis while on immunosuppressant therapy. The patient had cutaneous findings from the right inguinal region to the right lower thigh and did not have lesions on the rest of the body. Minocycline and co-trimoxazole were co-administrated, and her condition improved. To our knowledge, this is the first case in which N. araoensis was detected by analysis on rRNA base sequence in skin lesions.


Subject(s)
Nocardia Infections/microbiology , Skin Diseases, Bacterial/microbiology , Female , Humans , Lupus Erythematosus, Systemic/complications , Lupus Nephritis/complications , Nocardia/classification , Nocardia/genetics , Nocardia/isolation & purification , Nocardia/pathogenicity , Nocardia Infections/complications , Nocardia Infections/pathology , Opportunistic Infections/complications , Opportunistic Infections/microbiology , Opportunistic Infections/pathology , Phylogeny , Skin Diseases, Bacterial/complications , Skin Diseases, Bacterial/pathology , Young Adult
10.
Tokai J Exp Clin Med ; 36(2): 53-7, 2011 Jul 20.
Article in English | MEDLINE | ID: mdl-21769774

ABSTRACT

A 81-year-old man with a patch of scaly erythema on his scrotum visited Hiratsuka Kyosai Hospital in June 2006. Reddish, scaly plaques, which were untreated, were present on his back and lower legs since 1999. Pathological examination of the lesions on the scrotum revealed Bowen's disease; therefore he was referred to our clinic for further treatment. During his visit Tokai University Hospital, irregularly bordered scaly erythematous patches were observed on his back, left arm, right knee, and right foot, sizing from 2 to 4 cm in diameter. He was treated with phenol and liquid nitrogen cryotherapy; however, he dropped out of clinic after receiving treatment for a year. At this point, most lesions were cured and only scars remained. In June 2009, he revisited Tokai University Hospital, and this time, multiple scaly erythematous patches were noted on his back and both the arms and legs. The results of the biopsies of 4 lesions obtained from the back, right arm, right knee, and the right foot led to the diagnosis of multiple Bowens' disease. During the inquiry, we learned that since birth, he has resided in Hiratsuka City and had often used water from wells. We researched the possibilities of water and soil contaminations in the Hiratsuka area.


Subject(s)
Arsenic/toxicity , Bowen's Disease/etiology , Environmental Exposure/adverse effects , Skin Neoplasms/etiology , Water Pollutants, Chemical/toxicity , Aged, 80 and over , Arsenic Poisoning/complications , Arsenic Poisoning/diagnosis , Bowen's Disease/pathology , Bowen's Disease/therapy , Cryotherapy , Humans , Japan , Male , Skin Neoplasms/pathology , Skin Neoplasms/therapy , Treatment Outcome
11.
Tokai J Exp Clin Med ; 35(4): 152-64, 2010 Dec 20.
Article in English | MEDLINE | ID: mdl-21319047

ABSTRACT

Oxidative stress derived from ultraviolet (UV) light in sunlight induces different hazardous effects in the skin, including sunburn, photo-aging and DNA mutagenesis. In this study, the protein-bound lipid peroxidation products 4-hydroxy-2-nonenal (HNE) and the oxidative DNA damage marker 8-hydroxy-2'-deoxyguanosine (8OHdG) were investigated in chronically sun-exposed and sun-protected human skins using immunohistochemistry. The levels of antioxidative enzymes, such as heme oxygenase 1 and 2, Cu/Zn-SOD, Mn-SOD and catalase, were also examined. Oxidative stress is also implicated in the activation of signal transduction pathways, such as mitogen-activated protein kinase (MAPK). Therefore, the expression and distribution of phosphorylated p38 MAPK, phosphorylated Jun N-terminal kinase (JNK) and phosphorylated extracellular signal-regulated kinase (ERK) were observed. Skin specimens were obtained from the surgical margins. Chronically sunlight-exposed skin samples were taken from the ante-auricular (n = 10) and sunlight-protected skin samples were taken from the post-auricular (n = 10). HNE was increased in the chronically sunlight-exposed skin but not in the sunlight-protected skin. The expression of heme oxygenase-2 was markedly increased in the sunlight-exposed skin compared with the sun-protected skin. In contrast, the intensity of immunostaining of Cu/Zn-SOD, Mn-SOD and catalase was not different between the two areas. Phosphorylated p38 MAPK and phosphorylated JNK accumulated in the ante-auricular dermis and epidermis, respectively. These data show that particular anti-oxidative enzymes function as protective factors in chronically sunlight-exposed human skin. Taken together, our results suggest (1) antioxidative effects of heme oxygenase-2 in chronically sunlight-exposed human skin, and that (2) activation of p38 MAPK may be responsible for oxidative stress.


Subject(s)
Heme Oxygenase (Decyclizing)/metabolism , Mitogen-Activated Protein Kinases/metabolism , Oxidative Stress , Skin/metabolism , Skin/radiation effects , Sunlight/adverse effects , Aged , Aged, 80 and over , Aldehydes/metabolism , Cysteine Proteinase Inhibitors/metabolism , Extracellular Signal-Regulated MAP Kinases/metabolism , Female , Humans , JNK Mitogen-Activated Protein Kinases/metabolism , Male , Signal Transduction/physiology , Skin/anatomy & histology , Skin/pathology , p38 Mitogen-Activated Protein Kinases/metabolism
12.
Tokai J Exp Clin Med ; 33(2): 75-7, 2008 Jul 20.
Article in English | MEDLINE | ID: mdl-21318971

ABSTRACT

A 70-year-old Japanese woman visited our clinic with a pigmented patch on her face from her upper lip to under her nose following laser therapy 15 years ago. Physical examination revealed an asymmetrical dark brown macule with a clear border along with irregular black dots measuring 20 mm. A biopsy specimen showed some irregular-sized atypical melanocytes with deep-colored nuclei on staining. There were observed on the basal layer and a few of them in the prickle-cell layer only in the epidermis. We diagnosed this case as lentigo maligna (LM). Total resection and reconstruction with the Abbe flap were carried out. We searched previous literature for reports on laser therapies resulting in LM and determined the following: (1) there were no reports indicating that laser therapy is one of the causes of LM, (2) judging from invalidity of treatment or recurrence of the condition, laser therapies were considered ineffective for LM treatment, and (3) the numbers of patients undergoing laser therapies, who were not diagnosed with LM, were increasing.


Subject(s)
Hutchinson's Melanotic Freckle/etiology , Hutchinson's Melanotic Freckle/pathology , Laser Therapy/adverse effects , Skin Neoplasms/etiology , Skin Neoplasms/pathology , Aged , Female , Humans , Hutchinson's Melanotic Freckle/diagnosis , Hutchinson's Melanotic Freckle/surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Surgical Flaps
13.
Tokai J Exp Clin Med ; 32(1): 42-7, 2007 Mar 20.
Article in English | MEDLINE | ID: mdl-21319056

ABSTRACT

Autoimmune bullous diseases are classified into pemphigus and pemphigoid. Pemphigus is designated as incurable disease by the Ministry of Health, Labor and Welfare, and it is said that pemphigus is difficult to care and can be fatal. The clinical course of bullous pemphigoid (BP) is better than that of pemphigus. However, as to the incidence of internal malignancies, it is well known that there is a significant difference between the two diseases. As the incidence of internal malignancies is high in BP, it is described in textbooks that patients with BP should be followed by a detailed screening for internal malignancies. We investigated the incidence of internal malignancies in 204 Japanese patients with autoimmune bullous disease who visited Tokai University Hospital in Kanagawa, Japan. We found that the incidence of internal malignancies was 11.2% in patients with pemphigus and 10.4% in patients with BP. Among pemphigus variants, the incidence was as high as 20% for pemphigus erythematosus. No relationship was found between malignancies and the severity of the autoimmune bullous diseases. Therefore it is clinically important to carry out a detailed screening for internal malignancies in patients with pemphigus as well as in patients with BP.


Subject(s)
Autoimmune Diseases , Neoplasms/epidemiology , Neoplasms/etiology , Pemphigoid, Bullous , Pemphigus , Adolescent , Adult , Aged , Aged, 80 and over , Autoimmune Diseases/complications , Autoimmune Diseases/epidemiology , Autoimmune Diseases/pathology , Female , Humans , Japan/epidemiology , Male , Middle Aged , Pemphigoid, Bullous/complications , Pemphigoid, Bullous/epidemiology , Pemphigoid, Bullous/pathology , Pemphigus/complications , Pemphigus/epidemiology , Pemphigus/pathology , Young Adult
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