A case of cutaneous protothecosis successfully treated with local thermal therapy as an adjunct to itraconazole therapy in an immunocompromised host.

We report a case of human protothecosis in an immunocompromised host which was caused by Prototheca wickerhamii and was successfully treated with thermal adjunct therapy combined with systemic itraconazole therapy. A 78-year-old man taking 30 mg prednisolone daily had a 1-week history of erythematous plaques on the dorsal aspect of his right hand and forearm after sustaining a small traumatic injury. Histopathology of the lesions revealed granulomatous inflammatory changes with numerous microorganisms that had multiple septations in their cytoplasm. On the basis of mycological features and the results of the sugar assimilation test, the etiologic agent was identified as Prototheca wickerhamii. Although the lesion showed no response to the systemic itraconazole therapy and topical ketoconazole treatment, a complete resolution was achieved by the use of thermal therapy as an adjunct to systemic itraconazole.

Epstein-Barr virus-infected malignant T/NK-cell lymphoma in a patient with hypersensitivity to mosquito bites.

We report an autopsy case of Epstein-Barr virus (EBV)-infected malignant lymphoma in a young male who had hypersensitivity to mosquito bites. The autopsy revealed multiple confluent lymphoma lesions in the lungs, and on the right leg irregular-shaped skin ulcers were seen. The left pleural effusion also contained a large number of lymphoma cells. The lymphoma cells were determined as T/NK-cell type cells by immunohistochemistry. EBV DNA was detected most intensively in the lungs and EBV-encoded small RNAs-positive lymphoma cells were also observed in the lungs at a high frequency. EBV latent membrane protein-1 expression and a high Ki-67 labeling indices were noted in the lymphoma cells of the lung lesions. These findings indicate that the development of the malignant lymphoma was associated with the proliferation of EBV-infected lymphoma cells, and the cells that infiltrated the whole the body, especially the lungs, caused the patient's death.

Two arthroderma benhamiae isolates showing mitochondrial DNA type of Trichophyton verrucosum.

Two Trichophyton mentagrophytes isolates from skin lesions on a girl and her rabbit, which were identified as Arthroderma benhamiae by mating tests, were studied by mtDNA (mitochondrial DNA) analysis and sequencing of ITS (internal transcribed spacer) regions of nuclear ribosomal RNA genes. The mtDNA-RFLP (restriction fragment length polymorphism) patterns showed the two isolates to be T. verrucosum rather than A. benhamiae. The ITS sequence showed the isolates to be closer to A. benhamiae Americano-European race than to T. verrucosum and closer to T. verrucosum than to their mating partner A. benhamiae African race. These results suggest that there are three genetic types of A. benhamiae - an Americano-European type, an African type and a T. verrucosum type - and that T. verrucosum is an anamorph of A. benhamiae.