Ankylosing spondylitis successfully treated with methotrexate.

A 37-year-old man with ankylosing spondylitis (AS) and psoriasis who was successfully treated with methotrexate (MTX) is reported. In 1980, he had low back pain, limited motion in the lumbar spine, radiological findings of bilateral sacroiliitis, and HLA-B27 positivity. In January 1991, he developed psoriasis and he had difficulty in performing desk work in spite of treatment with antirheumatic drugs. In May 1991, MTX 7.5 mg/week per os was started. Joint symptoms, psoriasis, and acute phase reactants improved within 1 month after the treatment and this improvement continued for more than 6 months after the treatment. After discharge he was able to return to his job.

Progressive systemic sclerosis complicated with immune thrombocytopenia during D-penicillamine therapy.

Immune thrombocytopenia is a rare complication of progressive systemic sclerosis (PSS). A 47-year-old female with PSS treated with D-penicillamine developed immune thrombocytopenia, which promptly responded to prednisolone and withdrawal of D-penicillamine. Platelet-associated IgG was elevated and the bone marrow megakaryocyte count was normal. There was an inverse relationship between the level of platelet-associated IgG and the platelet count. A lymphocyte stimulation test sensitized by D-penicillamine was positive. The present case suggests that immune thrombocytopenia may be regarded as one of the D-penicillamine-related immune abnormalities. To our knowledge, its association with PSS has never been reported.

[Adult T cell lymphoma/leukemia with alopecia, huge tumors of scalp and wide destruction of cerebral bone].

We reported rare manifestations of adult T cell lymphoma/leukemia. Patient was 41 year-old woman who has had progressive alopecia from childhood and developed multiple huge tumors (largest 10 x 15 cm) of scalp and wide destruction of cerebral bone at age of 39. A few abnormal lymphocytes (10%) appeared in the peripheral smear. Surface markers of peripheral lymphocytes showed two populations of CD4+/CD8- and CD4+/CD8+. HTLV-1 proviral DNA was demonstrated in the peripheral lymphocytes. Serum anti-ATLA antibodies was positive (X80). Biopsy of tumor revealed diffuse and large cell type of malignant lymphoma. Magnetic resonance imaging of head showed that tumors lysed the bone and invaded into cerebral regions. She was treated with CHOP regimen and irradiation, resulting of decreased tumor size and population of CD4+/CD8+.

[Erythroblastic transformation of chronic myelogenous leukemia associated with an additional chromosome abnormality translocation (6;9].

A 57-year-old female was diagnosed being in the blastic phase of chronic myelogenous leukemia (CML) on her second admission in May 1993. The patient was previously treated with vincristine and prednisolone in the accelerated phase of CML in December 1991 without improvement. Other chemotherapeutic agents such as BHAC-DMP (enocitabine, daunorubicin, mercaptopurine, prednisolone), interferon, mercaptopurine and ranimustine were also administered. After the second chronic phase was achieved, she was treated with busulfan as an outpatient. On her second admission, the diagnosis of erythroblastic transformation was made, and cytogenetic study revealed t(9;22) (q34;q11) with the additional chromosomal abnormalities, t(6;9) (p23;q34). This karyotype rearrangement has been reported neither in Ph-positive CML nor in blastic crisis.

[Nitroglycerin tape for Raynaud's phenomenon of rheumatic disease patients--an evaluation of skin temperature by thermography].

Topical nitroglycerin has been tried for the alleviation of Raynaud's phenomenon in rheumatic diseases, but its effect is not widely recognized. We evaluated the effect of nitroglycerin tape (NTG tape) for peripheral circulatory failure of 7 patients with rheumatic diseases (4 women and 3 men, aged 35-73 years). The underlying rheumatic diseases included: systemic sclerosis 4 patients, polyarteritis nodosa (PN) 1 patient, cutaneous PN 1 patient and digital microinfarction with pulmonary fibrosis 1 patient. An NTG tape (containing 2.5 mg of nitroglycerin) was applied unilaterally on one forearm or leg, and the change in skin temperature was evaluated by thermography. Skin temperature of the extremities significantly increased at 2 and 3 hours after the application of NTG tape. Feeling of cold and/or pain improved in all patients. Adverse effect was headache in one patient. These results suggest that NTG tape may deserve further use in the treatment of peripheral circulatory failure in patients with rheumatic diseases.