Multiple Intestinal Ulcers Associated with Primary Epstein-Barr Virus Infection in a Patient with Rheumatoid Arthritis Undergoing Methotrexate Therapy.

A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.

Cutaneous lesions of Kikuchi's disease: evolution of histopathological findings.

We report a 38-year-old male patient who presented with cutaneous lesions mimicking widespread discoid lupus erythematosus with high-grade fever, arthralgia and lymphadenopathy. Additional lymph node and skin biopsies, however, revealed karyorrhectic debris without neutrophils and numerous CD68-positive cells, a characteristic finding of Kikuchi's disease (KD). Comparing skin biopsies on different occasions, we could see different forms of histopathology. The histopathology of skin lesions of KD may vary during the clinical course, which may reflect the stage of the disease.

Tumor necrosis factor alpha (TNF-alpha)-induced RANTES chemokine expression via activation of NF-kappaB and p38 MAP kinase: roles of TNF-alpha in alcoholic liver diseases.

BACKGROUND/AIMS: Increased concentration of plasma tumor necrosis factor alpha (TNF-alpha) correlates with the clinical course of alcoholic liver diseases. In addition, hepatic RANTES which migrates CD4 T lymphocytes to liver is increased in patients with alcoholic hepatitis. We investigated that roles of TNF-alpha on RANTES expression in hepatocytes. METHODS: HLE cells were treated with TNF-alpha in the presence, or absence of several inhibitors. Enzyme-linked immunoassay and reverse transcriptase-polymerase chain reaction were performed for the measurement of protein production and mRNA of RANTES, respectively. Moreover, DNA-binding activity of NF-kappaB was investigated using electrophoretic mobility shift assay. To examine effects of TNF-alpha on RANTES gene expression, luciferase assay was performed. RESULTS: TNF-alpha clearly up-regulated RANTES expression in a time-dependent fashion and induced DNA-binding activity of NF-kappaB. Moreover, TNF-alpha-induced RANTES expression was completely inhibited by SB203580, but not calphostin C and wortmannin. Luciferase assay showed that TNF-alpha increased RANTES gene expression and mutation of NF-kappaB binding sites in the RANTES promoter ablated TNF-alpha inducibility. CONCLUSIONS: We showed that RANTES was transcriptionally induced in human hepatoma cells by treatment with TNF-alpha via activation of NF-kappaB and p38 MAP kinase, presumably suggesting that TNF-alpha-induced expression of RANTES plays important roles in cell-mediated liver injury in alcoholic liver diseases.