A case of drug-induced hypersensitivity syndrome with multiple organ involvement treated with plasma exchange.

A 53-year-old male patient began treatment for systemic exanthema with diaphenylsulfone (DHS) on 21 November 2002. On 18 December 2002, the patient developed a fever and additional systemic erythematous exanthema. Systemic lymphadenopathy, hepatosplenomegaly, leukocytosis (in particular, an increase in the number of atypical lymphocytes) and liver dysfunction followed. After cessation of the DHS treatment on 25 December 2002, acute renal failure occurred and the patient was transferred to Shinshu University Hospital on 4 January 2003. The patient was diagnosed with drug-induced hypersensitivity syndrome (DIHS). Steroid pulse therapy (methylprednisolone 1000 mg/day for 3 days) was given, followed by 60 mg/day of prednisolone. The patient's renal functions recovered and he was taken off hemodialysis therapy. However, the patient relapsed twice despite two sessions of steroid pulse therapy and an increase in the dose of prednisolone to 100 mg/day. Plasma exchange (PE) was carried out to reduce the activity of the disease. With a total of four plasma exchanges, we were able to reduce the dose of prednisolone from 100 mg/day to 60 mg/day without relapse. There were no adverse effects from the plasma exchanges. Plasma exchange should be considered in the treatment with corticosteroid-resistant DIHS with multiple organ lesions.

Significance of dermoscopic patterns in detecting malignant melanoma on acral volar skin: results of a multicenter study in Japan.

OBJECTIVE: To determine diagnostic variables such as sensitivity and specificity of the major dermoscopic patterns observed in melanocytic lesions on acral volar skin, with particular attention to the significance of the parallel ridge pattern and irregular diffuse pigmentation in detecting acral melanoma. DESIGN: Multicenter, retrospective study. SETTING: University hospitals in Japan. PATIENTS: Patients with melanocytic lesions on acral volar skin. A total of 712 melanocytic lesions (103 malignant melanomas, including 36 in situ lesions, and 609 melanocytic nevi) were consecutively collected from the files of 3 hospitals. Diagnoses of all the lesions had been determined histopathologically. INTERVENTIONS: Dermoscopic examination. MAIN OUTCOME MEASURES: The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the major dermoscopic patterns seen in benign and malignant melanocytic lesions on acral volar skin. RESULTS: The parallel ridge pattern and irregular diffuse pigmentation showed extremely high specificity (99.0% and 96.6%, respectively) and very high negative predictive value (97.7% and 97.5%, respectively) in malignant melanoma. For melanoma in situ, the positive predictive value and diagnostic accuracy of the parallel ridge pattern were significantly higher than those of irregular diffuse pigmentation (P = .009 and P = .006, respectively). In melanocytic nevi, the specificity and positive predictive value of the parallel furrow pattern and/or the latticelike pattern were found to be very high (93.2% and 98.3%, respectively). CONCLUSIONS: Dermoscopy is immensely helpful in differentiating malignant melanomas from melanocytic nevi on acral volar skin. Moreover, the parallel ridge pattern aids in detecting acral melanomas in early, curable stages.

[Inter-hospital teledermatology conference using a videophone network].

We organized an inter-hospital teledermatology conference with images through a digital telephone line (ISDN, 128kbps). Our conference system consists of two videophones. A videophone "Phoenix PICSEND-R" (NTT) in the multi-point connection mode is used for discussion among doctors from five hospitals. In addition, using another videophone "Phoenix mini type-S" (NTT), clinical and dermoscopic findings obtained with a digital video camera and a videomicroscope "VMS-1900" (Scalar, Tokyo) respectively were transmitted to Shinshu University Hospital from four rural sites. We have found that the quality of the images obtained is entirely sufficient to make an accurate diagnosis. To calibrate the color and size of skin lesions, a matching sticker "CASMATCH" (Bearmedic, Tokyo) has proved useful. Forty-one times of conference were held from September 1999 to August 2002. In total, the concordance rate between the telediagnosis and the finally confirmed diagnosis was 69% (77 of 112 cases). In cases limited to pigmented skin lesions, the rate was higher (84%) and it was concluded that such conditions are suited for the telediagnosis. The ease with which the data can be manipulated enables us to discuss difficult cases in detail. This style of teleconference system may have benefits for dermatologists especially at rural hospitals in consultation with senior doctors.

Melanoma maligno en la planta del pie condiferenciación neural e infiltración perineuralconsiderables / Malignant melanoma on the sole showing prominent neural differentiation and prerineural infiltration

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