Anti-MDA-5 antibody-positive bullous dermatomyositis with palmar papules complicating rapidly progressive interstitial lung disease.

We present the first case of dermatomyositis showing both vesicle formation and palmar papules. The association of bullous formation and internal malignancy, and palmar papules and interstitial lung disease (ILD) is well known in dermatomyositis, respectively. This patient presented with vesicles; however, the immunoprecipitation assays detected anti-MDA-5 antibody and the patient complicated rapidly progressive ILD, but no malignancy. We propose that palmar papules might be regarded as more critical than blister formation.

Mycobacterium shigaense sp. nov., a novel slowly growing scotochromogenic mycobacterium that produced nodules in an erythroderma patient with severe cellular immunodeficiency and a history of Hodgkin's disease.

A novel slow-growing scotochromogenic mycobacterium was isolated from skin biopsies from a patient with a history of Hodgkin's disease and severe cellular immunodeficiency as an opportunistic pathogen. Clinical characterization of these lesions revealed papules and nodules with pathological granuloma formation. Genotypic analysis using 16S rRNA misidentified this isolate as Mycobacterium simiae. However, multiple gene analysis using the internal transcribed spacer between the 16S and 23S rRNA genes, and the rpoB and hsp65 genes revealed the presence of a novel mycobacterium. The antimicrobial susceptibility of this isolate was completely different from that of M. simiae. On the basis of these findings, we propose naming this new species Mycobacterium shigaense sp. nov., and conclude that multiple gene analysis is required for the appropriate diagnosis and treatment of non-tuberculous mycobacterial infections.

Case of muscle abscess due to disseminated nocardiosis in a patient with autoimmune hemolytic anemia, and review of the published work.

Although disseminated nocardiosis has been increasing with the expansion of immunosuppressive therapy and improvement in diagnostic methods, muscle abscess is a rare complication. There have been only nine case reports of muscle abscess due to Nocardia infection in the English-language published work. We present a case of muscle abscess with disseminated nocardiosis, and review the published work. The patient had been taking prednisolone at 20 mg a day for autoimmune hemolytic anemia for 14 years. She presented with erythema on her thigh resembling cellulitis. Computed tomography showed muscle abscess. The isolated organism was identified as Nocardia farcinica employing polymerase chain reaction and antibiotic sensitivity testing. The diagnosis of muscle abscess due to nocardiosis can be easily missed because there are no characteristic symptoms.

A case of acne fulminans in a patient with ulcerative colitis successfully treated with prednisolone and diaminodiphenylsulfone: a literature review of acne fulminans, rosacea fulminans and neutrophilic dermatoses occurring in the setting of inflammatory bowel disease.

A 19-year-old Japanese man had been treated for ulcerative colitis for 2 years. He was admitted to our hospital with nodulocystic inflammatory papules and pustules on his face and chest, high-grade fever, arthralgia and general malaise. A biopsy specimen from a pustule showed prominent infiltration of neutrophils in the epidermis and dermis, particularly around hair follicles. We made a diagnosis of acne fulminans. The systemic administration of prednisolone at 30 mg daily for 1 week immediately improved his skin lesions and other symptoms; however, during tapering of prednisolone at 20 mg daily, skin lesions flared up. The addition of oral diaminodiphenylsulfone improved the skin lesions. Although there have been a few reports of acne fulminans associated with Crohn's disease, this is the first case report of acne fulminans in a patient with ulcerative colitis. It is noteworthy that the addition of diaminodiphenylsulfone was effective for treating the relapse of acne fulminans in this case.