RESUMEN
Immune checkpoint inhibitors (ICIs), such as nivolumab and ipilimumab, have drastically changed treatments of advanced melanoma. However, ICI-related enterocolitis is often the most common adverse event, and represents the main reason for ICI discontinuation and mortalities. Here, we report the case of a metastatic melanoma treated with vedolizumab for ICI-induced colitis. A 67-year-old man treated with ipilimumab and nivolumab developed ICI-induced colitis and grade 3 diarrhea refractory to methylprednisolone and infliximab. After his third dose of vedolizumab, oral prednisolone ceased, and the colitis had completely resolved with no recurrence. This case report supports vedolizumab use in treating severe colitis which failed to resolve with first- and second-line immunosuppressive therapy.
Asunto(s)
Artritis Reumatoide/inmunología , Interleucina-17/inmunología , Interleucina-23/inmunología , Nódulo Reumatoide/inmunología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/metabolismo , Humanos , Inmunohistoquímica , Interleucina-17/metabolismo , Interleucina-23/metabolismo , Linfocitos/inmunología , Linfocitos/metabolismo , Nódulo Reumatoide/complicaciones , Nódulo Reumatoide/metabolismo , Transducción de Señal/inmunología , Piel/inmunología , Piel/metabolismo , Piel/patologíaAsunto(s)
Pustulosis Exantematosa Generalizada Aguda/etiología , Antibacterianos/efectos adversos , Erupciones por Medicamentos/etiología , Interleucina-23/inmunología , Piel/efectos de los fármacos , beta-Lactamas/efectos adversos , Pustulosis Exantematosa Generalizada Aguda/diagnóstico , Pustulosis Exantematosa Generalizada Aguda/tratamiento farmacológico , Pustulosis Exantematosa Generalizada Aguda/inmunología , Anciano , Biopsia , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/tratamiento farmacológico , Erupciones por Medicamentos/inmunología , Femenino , Humanos , Piel/inmunología , Piel/patología , Esteroides/uso terapéutico , Resultado del TratamientoAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Antígeno Ki-1/análisis , Seudolinfoma/inducido químicamente , Enfermedades de la Piel/inducido químicamente , Piel/efectos de los fármacos , Anciano , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/inmunología , Biomarcadores/análisis , Biopsia , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunohistoquímica , Seudolinfoma/tratamiento farmacológico , Seudolinfoma/inmunología , Seudolinfoma/patología , Inducción de Remisión , Piel/inmunología , Piel/patología , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/inmunología , Enfermedades de la Piel/patología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Bloqueadores de los Canales de Calcio/efectos adversos , Erupciones por Medicamentos/diagnóstico , Pregabalina/efectos adversos , Anciano de 80 o más Años , Biopsia , Erupciones por Medicamentos/tratamiento farmacológico , Erupciones por Medicamentos/etiología , Glucocorticoides/administración & dosificación , Humanos , Masculino , Pomadas , Piel/patología , Resultado del TratamientoAsunto(s)
Microsporum , Células Th17/metabolismo , Tiña del Cuero Cabelludo/sangre , Tiña del Cuero Cabelludo/microbiología , Anciano , Antifúngicos/uso terapéutico , Femenino , Humanos , Inmunofenotipificación , Recuento de Linfocitos , Microsporum/inmunología , Fenotipo , Células Th17/inmunología , Tiña del Cuero Cabelludo/diagnóstico , Tiña del Cuero Cabelludo/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Agonistas de Dopamina/efectos adversos , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/etiología , Indoles/efectos adversos , Enfermedad de Parkinson/complicaciones , Biopsia , Femenino , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/tratamiento farmacológico , Piel/patologíaAsunto(s)
Antagonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/etiología , Indoles/efectos adversos , Biopsia , Humanos , Masculino , Persona de Mediana Edad , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Piel/patología , Resultado del TratamientoRESUMEN
Psoriasis is a chronic inflammatory skin disease that involves various systemic organs and tissues and is characterized by scaly erythematous skin. Among the different types of psoriasis, psoriatic arthritis (PsA) is frequently reported, and occasionally develops into severe arthritis leading to joint dysfunction. There are various tools, especially questionnaires, to identify the presence of PsA in European and American populations; however, little is known about the utility of these tools in the Asian population. In this study, we investigated the utility of a representative tool, the psoriasis epidemiology screening tool (PEST) questionnaire, to identify PsA among Japanese patients with psoriasis. A total of 143 patients with psoriasis were enrolled in this study. Among them, 29 patients were diagnosed with PsA. The frequency of PsA was significantly increased in patients with PEST scores > 3, with a sensitivity of 93.1% and a specificity of 78.9%. Among the questions in the PEST questionnaire, "Have you ever had a swollen joint?" showed the highest frequency to answer "Yes" among patients with PsA. Univariate and multivariate analyses revealed that high PEST scores (> 3) was an independent variable in PsA patients. Taken together, our study suggests that the PEST questionnaire is a useful tool to identify PsA among Japanese patients with psoriasis.
Asunto(s)
Artritis Psoriásica/epidemiología , Psoriasis/epidemiología , Artritis Psoriásica/diagnóstico , Pueblo Asiatico , Femenino , Humanos , Japón/epidemiología , Modelos Logísticos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Análisis Multivariante , Encuestas y CuestionariosRESUMEN
Telaprevir used as a protease inhibitor against hepatitis C virus is frequently associated with cutaneous adverse reactions. To explore a histological biomarker of cutaneous adverse events induced by telaprevir, we systematically searched for genes that were dysregulated by telaprevir in normal human epidermal keratinocytes (NHEKs). Microarray analysis and real-time polymerase chain reaction (PCR) revealed the significant increase in the expression of S100 calcium-binding protein A2 (S100A2) gene following treatment of NHEKs with telaprevir. Immunohistochemical analysis demonstrated that the expression of S100A2 was dominant in the spinous layer of the epidermis in patients with telaprevir-mediated severe-type drug eruptions and limited to the basal layer of the epidermis in healthy subjects. Furthermore, S100A2 expression increased after treatment with trichloroethylene and other medications, and the degree of S100A2 expression correlated with the severity of cutaneous adverse events. S100A2 expression also significantly increased in the skin of patients with atopic dermatitis and psoriasis. Taken together, S100A2 is highly expressed in the epidermis under inflammatory conditions and drug eruptions and may serve as a marker for keratinocyte damage in response to any inflammatory or toxic condition.
Asunto(s)
Factores Quimiotácticos/biosíntesis , Erupciones por Medicamentos/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Queratinocitos/metabolismo , Oligopéptidos/farmacología , Proteínas S100/biosíntesis , Anciano , Erupciones por Medicamentos/patología , Femenino , Hepacivirus/metabolismo , Hepatitis C/tratamiento farmacológico , Hepatitis C/metabolismo , Hepatitis C/patología , Humanos , Queratinocitos/patología , Masculino , Persona de Mediana EdadRESUMEN
Atypical lipomatous tumor (ALT) has been defined as a well-differentiated liposarcoma exhibiting a higher frequency of a local recurrence after surgical resection. ALT is mainly classified into deep type and superficial type. Compared with deep type ALT, superficial type ALT is rarely observed. One of the most important issues is that little has been known about superficial type ALT and it is not easy to predict the presence of superficial type ALT before surgical resection. To clarify the clinical manifestations of superficial type ALT, we examined 15 cases with superficial type ALT and 118 cases with benign lipoma, and analyzed their differences in clinical characteristics and the findings of MRI test. In clinical characteristics, the tumor size of superficial type ALT was significantly greater than that of benign lipoma, and superficial type ALT showed a significantly higher frequency of the tumor size of more than 4 cm. Superficial type ALT exhibited poor tumor mobility and hardness with elastic soft. In addition, a significantly higher frequency of tumor location of superficial type ALT was observed in extremities. Among tumor sites at the trunk, buttocks, and shoulder were high frequent location in superficial type ALT. In an MRI examination, superficial type ALT exhibited a significantly higher frequency of the septal structures compared with benign lipoma. The combinations of clinical characteristics, including physical examinations, MRI, and histological examinations, are helpful for the diagnosis of superficial type ALT.
RESUMEN
BACKGROUND: An anaphylactoid purpura affects small capillaries in the skin and other organs. Although two cases of anaphylactoid purpura exacerbated by cellulitis have been reported in Japanese literatures, its prognosis remains still unclear. Because cellulitis exacerbates various cutaneous inflammations, it has been speculated that cellulitis might also exacerbate cutaneous inflammation, such as vasculitis. FINDINGS: In this article, we report that 78-year-old woman exhibited anaphylactoid purpura, following cellulitis. We also reviewed the literature concerning about this subject. CONCLUSIONS: This type of anaphylactoid purpura is thought to have a favorable prognosis dependent on the treatment for cellulitis.
RESUMEN
BACKGROUND: Calciphylaxis following acute renal failure is rare. FINDINGS: We report A 57-year-old male with an acute renal failure associated with necrotizing fasciitis. We also review the cases of calciphylaxis due to acute renal disorder further. CONCLUSIONS: It should be kept in mind that calciphylaxis is observed in patient with not only chronic renal disease but also acute renal failure.
RESUMEN
Nivolumab was developed as a monoclonal antibody against programmed death receptor-1, an immune checkpoint inhibitor which negatively regulates T-cell proliferation and activation. Intravenous administration of nivolumab was approved for the treatment of unresectable malignant melanoma in 2014 in Japan. When advanced melanoma patients were treated with nivolumab, median overall survival became longer. Overall survival rate was significantly better in nivolumab-treated melanoma patients than dacarbazine-treated melanoma patients. Nivolumab had an acceptable long-term tolerability profile, with 22% of patients experiencing grade 3 or 4 adverse events related to the drug. Therefore, nivolumab can become an alternative therapy for advanced malignant melanoma.
Asunto(s)
Asma/epidemiología , Dermatitis Atópica/epidemiología , Eccema/epidemiología , Dermatosis de la Mano/epidemiología , Enfermedades Profesionales/epidemiología , Urticaria/epidemiología , Asma/complicaciones , Dermatitis Atópica/complicaciones , Eccema/complicaciones , Femenino , Industria de Alimentos , Dermatosis de la Mano/complicaciones , Humanos , Japón/epidemiología , Masculino , Prevalencia , Urticaria/complicacionesRESUMEN
OBJECTIVE: Epidemiologic evidence on long working hour and diabetes has been conflicting. We examined the association between overtime work and prevalence of diabetes among Japanese workers. METHODS: The subjects were 40,861 employees (35,170 men and 5,691 women), aged 16 to 83 years, of 4 companies in Japan. Hours of overtime were assessed using self-reported questionnaires. Diabetes was defined as a fasting plasma glucose ≥126 mg/dl (7.0 mmol/l), hemoglobin A1c ≥6.5% (48 mmol/mol), or current use of anti-diabetic drug. Multiple logistic regression analysis was used to calculate odds ratio of diabetes for each category of overtime. RESULTS: After adjustment for age, sex, company, smoking, and BMI, there was a suggestion of U-shaped relationship between overtime work and prevalence of diabetes (P for quadratic trendâ=â0.07). Compared with those who worked <45 hours of overtime per month, the adjusted odds ratios (95% confidence interval) of diabetes were 0.86 (0.77-0.94), 0.69 (0.53-0.89), and 1.03 (0.72-1.46) for those who worked 45-79, 80-99, and ≥100 hours of overtime per month, respectively. In one company (nâ=â33,807), where other potential confounders including shift work, job position, type of department, alcohol consumption, sleep duration, leisure time physical activity, and family history of diabetes was additionally adjusted for, similar result was obtained (P for quadratic trendâ=â0.05). CONCLUSIONS: Long hours of overtime work may not be associated with increased prevalence of diabetes among Japanese workers.