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A rare case of POEMS(polyneuropathy,organomegaly,endocrinopathy,M-band,skin changes) syndrome associated with multicentre Castleman's disease and thrombocytosis is reported in a 48-year-old man.Three years prior to the presentation,he developed a series of symptoms without obvious triggers,including persistent myalgia and myasthenia of extremities,abnormal skin sensation (burning),gradually increased roughness and pigmentation of skin,thickening and mild induration of lower-extremity skin giving an ichthyosiform appearance.Two years prior to the presentation,electromyography indicated peripheral neuropathy,and computed tomography(CT) revealed hepatomegaly,splenomegaly,lymphadenectasis,ascites,hydrotborax and hydropericardium.Multiple biopsies of lymph nodes indicated an obvious vascular proliferation between lymphoid follicles with the involvement of lymphoid follicles,which,together with the histochemical findings and special staining results,was suggestive of hyaline-vascular type Castleman's disease.Three months prior to the presentation,painful erythema emerged and gradually spread in both thighs,with a progressive deepening in the colour of central lesions,and flushing of periphery lesions.Two months prior to the presentation,a soybean-sized nodule arised in the erythema on the right inner thigh,which was then ulcerated with a little pus left and a shallow ulcer formed.Physical examination revealed a mild atrophy of lower-extremity muscles,with muscle strength graded as 5 for bilateral upper extremities and as 4 for bilateral lower extremities.The skin was rough,diffusely pigmented and thickened,giving an ichthyosiform appearance,which was more apparent in the extremities than in the trunk.An atropurpureus patch sized 5 cm × 2 cm was seen respectively in bilateral inner thighs; the surface of the central lesions was coarse and covered with dry crusts and scales,giving a rough paperlike appearance,and the peripheral lesions were surrounded by a faint prunosus halo,which faded on pressure.Laboratory examination found hypothyroidation,reduced insulin secretion,abnormal calcium and phosphorus metabolism,and progressive thrombocytosis.Immunofixation electrophoresis showed that the serum was weakly positive for IgG type M protein.This patient was diagnosed with POEMS syndrome associated with multicentre Castleman's disease and thrombocytosis.After treatment with methylprednisolone and thalidomide,the main symptoms of POEMS syndrome were improved,whereas thrombocytosis progressively aggravated.
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Here four cases of folliculotropic mycosis fungoides are reported.Of these patients,one was a female and three were males with the age varying from 32 to 52 vears.Three patients presented with multiple,densely distributed,irregularly shaped,dark red infiltrated plaques,nodules,tumors,follicular papules and acneiform lesions preferentially distributed on the head and neck,as well as patches and mildly infiltrated plaques.foilicular papules and aeneifotin lesions on the trunk and extremities.One patient presented with follicular papules all over the bodv with the exception of head and face.Characteristic findings of histopathology included massive lymphoid cell infiltration.heteromorphism of some cells and migration of infiltrated cells into follicular epithelium.No typical epidermotropism was noticed.Two cases showed mnciprotein deposition in follicular epithelium,which was positive for alcian blue staining.The infiltrates were predominated bv CD4+ T lymphocytes.Folliculotropic mycosis fungoides is a refractory disense with poor response to conventional therapy of classical mycosis fungoides.Relapse is common in patients with partial remission.
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Objective To evaluate the efficacy and safety of 0.03% tacrolimus ointment for the treatment of atopic dermatitis (AD) in Chinese children. Methods A total of 139 children, 2 to17 years of age, with moderate to severe AD from 5 study centres were enrolled in this multicentre, randomized, double-blind, vehicle-controlled, parallel group study. Treatment with 0.03% tacrolimus ointment or vehicle was applied twice daily to the affected areas for 3 weeks. Visits were scheduled on day 1 (base line, before treatment) and 1, 2, 3 weeks after the treatment. The main therapeutic parameter was the efficacy rate at the end of the treatment. Results The efficacy rates were 84.6% and 29.0% for tacrolimus group and vehicle group, respectively (P
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Objective To investigate the colonization features of Staphylococcus aureus (S. aureus) in the skin lesions of eczema and atopic dermatitis (AD), and to evaluate the therapeutic effect of combination topical treatment with mupirocin and hydrocortisone butyrate. Methods A multicentre, double-blind randomi-zed trial was conducted. The SCORAD was evaluated on day 1, 7, 14 and 28. Swabs for bacterial isolation were taken from the lesional skin and non-lesional skin. A combination topical therapy with mupirocin ointment and hydrocortisone butyrate ointment was used in treatment group, with vehicle ointment and hydrocortisone butyrate ointment as a control. Results Three hundred and twenty seven patients were enrolled in the study, including 208 patients with eczema and 119 patients with atopic dermatitis. Bacteria were isolated from 70.19% of lesional skin and 32.69% of non-lesional skin of patients with eczema, in which S. aureus accounted for 47.26% and 27.94% respectively. Bacteria were isolated from 74.79% of the lesional skin and 34.45% of non-lesional skin of patients with atopic dermatitis, in which S. aureus accounted and 79.78% or 80.49% respectively. The amount of S. aureus colonized was markedly higher in the lesional skin than that in non-lesional skin, either in eczema patients or in atopic dermatitis (P 0.05). Conclusions The bacterial colonization, especially S. aureus, is more frequently dectected in the lesional skin of eczema patients and AD patients than that in the non-lesional skin, which may be related in the pathogenesis of eczema and AD. And, early application of combination therapy with topical antibiotics and corticosteroids is beneficial to the patients.
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Objective:To investigate the roles of CD28/B7 molecules expression in the pathogensis of systemic lupus erythematosus and their significance.Methods:Applying reverse transcription polymerase reactin(RT PCR)technique to semiquantitatively analyze CD28?B7 1 and B7 2 mRNA expression in the Peripheral Blood Mononuclear Cells(PBMC)from 35 active SLE patients and 30 cases of healthy subjects.Results:Compared with normal controls,the positive rate of CD28 expression in active SLE patients accounted for 22 86%,which was markedly lower than the normal controls(70 00%),the difference was statistically significant( P
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0 05,both).The mean level of COX 2 mRNA expression in active SLE group was significantly higher than that in normal controls ( P 0 05).Conclusion The level of COX 2 mRNA expression in active SLE group is markedly increased,which may be involved in the pathogenesis of SLE and provides a valuable scientific basis on the clinical use of specific COX 2 inhibitors.
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Objective To investigate the role of IL-6 and IL-6R in the pathogenesis of systemic lupus erythematosus (SLE) and its clinical significance. Methods RT-PCR technique was used to semiquantitatively analyze IL-6R mRNA expression in peripheral blood mononuclear cells (PBMC), and double antibody sandwich ELISA was applied to determine the serum level of IL-6 from 89 SLE patients . Results The positive IL-6R mRNA expression was found in each individuals among active SLE group (groupⅠ), inactive SLE group (groupⅡ) and control group (group Ⅲ). The mean levels of IL-6R mRNA expressions in groupⅠ,Ⅱ or Ⅲ were 0.902 ? 0.273, 0.519?0.11 and 0.573?0.24, respectively. Compared with group Ⅱand group Ⅲ, the mean level of IL-6R mRNA expression in groupⅠ was markedly increased (P = 0.00), while there was no statistical difference between group Ⅱ and group Ⅲ(P = 0.289). The mean serum levels of IL-6 in groupⅠ,Ⅱ and Ⅲ were 71.89 ? 20.02,17.96 ? 6.93, and 0.035 ? 0.035, respectively. Compared with group Ⅱand group Ⅲ, the mean level of IL-6 in groupⅠ was significantly higher than those in groupⅡ and groupⅢ (P = 0.00), while that in groupⅡwas higher than group Ⅲ (P = 0.00). There was a positive correlation between IL-6 and IL-6R in active SLE group and inactive SLE group(r = 0.887, and r = 0.615 P
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Objective To investigate the mRNA espression level of Caspase-1 and Caspase-3 in the patients with systemic lupus erythematosus(SLE) and its association with lymphocyte apoptosis. Methods Reverse transcription-polymerase reaction (RT-PCR) technique was applied to semiquantitatively analyze the mRNA expression of Caspase-1 and Caspase-3 in the peripheral blood mononuclear cells (PBMC) from 34 active SLE patients and 30 healthy subjects. Results Compared with normal controls, the mean levels of Caspase-1 or Caspase-3 mRNA expression in active SLE group was significantly increased(P0.05). Conclusion There are increased expressin of Caspase-1 and Caspase-3 in the PBMC of SLE patients, which may be involved in the lymphocyte apoptosis of SLE patients.
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Objectives To study the role of interleukin-4 (IL-4) and interferon-gamma (IFN-?) in the pathogenesis of atopic dermatitis and eczema,and the changes of serum levels of IL-4 and INF-? with topical treatment of co rticosteroid plus antibiotic cream or corticosteroid cream alone.Methods Seru m levels of IL-4 and IFN-? were detected by enzyme-linked immunosorbent assa y(ELISA).Results Serum levels of IL-4 and INF-? were significantly higher in the patients with atopic dermatitis and eczema than those in the normal control s,respectively(both P