Pulmonary hemorrhage associated with Henoch-Schöenlein purpura in an adult patient primary diagnosed of IgA nephropathy.

We describe a case of IgA nephropathy (IgAN) followed by pulmonary hemorrhage associated with Henoch-Schöenlein purpura (HSP) in an adult female. The patient had a history of renal insufficiency and persistent hematuria and proteinuria, without any extra-renal involvement. She was diagnosed with IgAN 7 years before the onset of HSP and had received immunosuppressive therapy for 6 years. One year after discontinuing oral prednisolone and mizoribine, she suffered a pulmonary hemorrhage. She presented with exacerbated urinary findings, and palpable purpura, resulting in the diagnosis of HSP. Intravenous pulse methylprednisolone followed by oral prednisolone (1 mg/kg/day) and a monthly intravenous cyclophosphamide pulse resolved the pulmonary hemorrhage. In a review of 36 HSP patients complicated with pulmonary hemorrhage, 27.8 % of the patients perished [Rajagopala et al., Semin Arthritis Rheum 42:391-400, 1]. While the most efficient therapeutic strategies for these patients have yet to be determined, we speculate that an aggressive therapy of pulse methylprednisolone combined with immunosuppression agents is likely to bring about the best outcome in cases with pathological conditions similar to our patient's. On the other hand, discontinuance of immunosuppressive therapy might have resulted in the aggravation of the disease, hence we should examine patients carefully not to miss the cue.

Flame photometric detector for thin-layer chromatography.

A new flame photometric detector for thin-layer chromatography (TLC) was studied to determine sulfur and phosphorus containing compounds in materials with a high boiling point. The detector was integrated with a flame ionization detector into the Iatroscan TLC-flame ionization detection analyzer. The principle of the detector is based on the photometric detection of flame emission of heteroatom in a hydrogen-air flame. The emission spectra of sulfur and phosphorus were measured using dibenzothiophene (DT) and phosphoric acid as source materials. Interference filters of 394 and 526 nm were chosen for spectral isolation of the sulfur and phosphorus emissions. The effects of variation in air flow-rate and scan speed as related to both sulfur and phosphorus compounds were studied in order to define optimum detection conditions. The best result for the detection of DT as a sulfur compound was obtained under combined hydrogen and air flow-rates of 160 and 500 ml/min, respectively, with a scan speed of 30 s/rod. The response to DT was linear in the range of 0.25-4 microg. On the other hand, the most suitable conditions for detecting phosphatidylcholine (PC) as a phosphorus compound were combined hydrogen and air flow-rates of 160 and 1500 ml/min, respectively, with a scan speed of 40 s/rod. The response to PC was linear in the range of 0.25-16 microg. Application of the instrument with selective detection of sulfur and phosphorus compounds was demonstrated using heavy oils and human serum lipids.

Allergic contact dermatitis caused by gum rosin and wood rosin in Tako-no-Suidashi ointment.

Tako-no-Suidashi ointment (TSO) is an old Japanese over-the-counter drug, used for the drainage of infectious pustular disease, such as furuncles, carbuncles and infectious atheroma, although whether it works well or not is unknown. The ingredients of the TSO compound commonly include rapeseed oil, gum rosin, wood rosin, Japanese wax, paraffin, petrolatum, copper sulfate, Peru balsam, acetic acid, salicylic acid and trace amounts of Guinea green B. We report a case of contact dermatitis in a 38-year-old Japanese woman caused by TSO. The patient presented to our hospital with pruritic erythema on her left cheek. In order to remove a subcutaneous tumor, she had applied TSO 4 days prior to presentation. Clinical examination showed a well-demarcated exudative erythematous macule with yellowish crusts and scales on her left cheek. Patch testing showed a positive reaction to TSO (++), gum rosin (++) and wood rosin (++) at 72 h. As TSO includes highly allergenic material, caution should be made in applying this topical therapy.