IgA vasculitis complicated by cytomegalovirus enteritis: a case report.

A 61-year-old man was admitted to our department with purpura and hemorrhagic bullae on his lower limbs, dull pain affecting the entire abdomen, and hematochezia. Histopathological examination and immunostaining revealed leukocytoclastic vasculitis of the small blood vessels of the dermis and IgA deposition; multiple ulcers were observed in the ileum during lower gastrointestinal (GI) endoscopy, so we made a diagnosis of IgA vasculitis (Henoch-Schönlein). Treatment with oral prednisolone (PSL) at a dose of 80 mg/day (1 mg/kg/day) for one week resolved the symptoms almost completely. However, when the PSL dose was later reduced, dull epigastric pain and discomfort flared up again. Multiple punched-out ulcers were observed in the duodenum during upper GI endoscopy, and immunostaining revealed cytomegalovirus (CMV) in vascular endothelial cells and infiltrating cells. The patient's serum was positive for CMV antigenemia. On the basis of these findings, we concluded that the CMV enteritis had developed as a complication arising from the patient's immunosuppressed state, which was itself a result of the steroid therapy. We treated the patient with ganciclovir, which relieved the abdominal symptoms.

Cutaneous small vessel vasculitis accompanied by pustulosis palmaris et plantaris.

We present the case of a 64-year-old woman who has suffered from pustulosis palmaris et plantaris for 10 years. At the first examination, many erythematous lesions with purpura, blood crusts, and blisters were present in the lower legs and dorsum of the feet. Painful swelling in the sternal region and dorsal pain were also noted. Elevation of the CRP and myogenic enzyme levels, and liver and renal dysfunctions were noted on blood testing. Histopathologically, leukocytoclastic vasculitis was noted in small blood vessels in the whole dermal layers, and deposition of IgM and C3 in the vascular wall was detected by the direct immunofluorescence techniques. Based on these findings, cutaneous small vessel vasculitis was diagnosed. Because the patient complained of a toothache during the clinical course, an X-ray examination was performed. On pantomography, a radicular cyst and apical periodontitis were noted. The tooth symptoms changed with exacerbation and remission of the skin symptoms. These findings indicate that odontogenic infection is very likely to be a cause of cutaneous small vessel vasculitis in a manner similar to pustulosis palmaris et plantaris.

An ulceronecrotic foot lesion in a patient with essential thrombocythemia: successful treatment with hydroxyurea.

The patient was a 47-year-old woman with a painful ulcer that had appeared on the right 5th toe two weeks before she visited our hospital. Histopathological examination showed that thrombi were present in small blood vessels in the dermis and pancytosis was detected in a blood test, suggesting polycythemia-associated ulceration of the toe. Essential thrombocythemia was diagnosed based on bone marrow puncture and chromosomal test findings. Platelet count and the ulcer were improved by oral hydroxyurea.

Effect of smooth pulsed light at 400 to 700 and 870 to 1,200 nm for acne vulgaris in Asian skin.

BACKGROUND: Intense pulsed light (IPL) treatment is effective for acne in Caucasians, but no significant improvements have been observed in studies on Asian skin. OBJECTIVE: To evaluate the efficacy and safety of IPL on acne vulgaris in Asian skin. METHODS: Twenty-five Japanese patients, mainly of skin phototypes III or IV and moderate to severe acne, were treated five times with IPL at wavelengths of 400 to 700 nm and 870 to 1,200 nm. Results were evaluated in terms of changes in numbers of noninflammatory comedones and inflammatory papules, pustules, and cysts and acne grade before and after treatment. RESULTS: After the first exposure, numbers of noninflammatory and inflammatory acne lesions decreased to 36.6% and 43.0%, respectively, of their pretreatment values. After five treatments, they decreased to 12.9% and 11.7%, respectively, of their pretreatment values. Acne grade improved significantly over the course of the study. Transient erythema, with or without burning or stinging, was noted in 20 (80%) patients, but no major adverse reactions were observed. CONCLUSION: IPL with dominant wavelengths of 400 to 700 nm had a satisfactory effect on acne vulgaris in Asians.

Case of Sweet's syndrome with extensive necrosis and ulcers accompanied by myelodysplastic syndrome.

A 43-year-old woman presented with a persistent high fever of 39 degrees C and edematous erythema accompanied by pustules on the face, trunk and extremities. Conjunctivitis and nodules were also observed in the right eye. On the basis of the clinical symptoms and histopathological findings. Sweet's syndrome was diagnosed. Eruptions quickly progressed to extensive necrosis and ulcers, mimicking clinical features of pyoderma gangrenosum. A bone marrow biopsy indicated myelodysplastic syndrome. Oral administration of 50 mg/day of prednisolone induced epithelialization of ulcers, with remaining scarring and pigmentation. Six months later, myelodysplastic syndrome had progressed to acute myelogenous leukemia.

Histological hair removal study by ruby or alexandrite laser with comparative study on the effects of wavelength and fluence.

BACKGROUND: Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences. METHODS: Unwanted hairs were treated with a ruby laser (Chromos 694, ICN PhotonIcs, UK) at 10, 14 or 18 J/cm2 or with an alexandrite laser (LPIR, Cynosure, USA) at 11, 14 or 17 J/cm2. A 3 mm skin punch biopsy was taken immediately after each laser exposure and also 1 month later. Specimens were stained for histological observation. They were observed using immunohistochemistry with antibodies recognizing factor VIII related antigen or PCNA, and also by the TUNEL method. Similarly, electron microscopic observation was examined. RESULTS: Immediately after the laser exposure, moderate follicular damage was observed following treatment with either type of laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either type of laser. A similar fluence with either laser treatment resulted in similar histological changes. CONCLUSION: In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence are similar.

[Histological changes elicited by hair removal lasers].

Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences. Unwanted hairs were treated with a ruby laser (ICN, Photon Ics, UK) at 10, 14, 18 J/cm(2) or an alexandrite laser (Cynosure, USA) at 11, 14, 17 J/cm(2). A 3 mm punch biopsy was taken immediately after each laser exposure and one month later. Specimens were stained for histological observations. They were observed using immunohistochemistry to Factor VIII related antigen and PCNA, and also by the TUNEL method. Immediately after the laser exposure, moderate follicular damage was observed following treatment with either laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either laser. The similar influence of each laser treatment resulted in similar histological changes. In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence were considered to be similar.