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We describe a case of a 23-year-old female patient with no apparent underlying diseases. She showed a discoloration of the proximal portion of the left big toenail with paronychia. Direct microscopy revealed septate hyphae with conidiophores, and a periodic acid-Schiff-stained nail specimen revealed septate hyphae branching at angles of approximately 45°. On the basis of phylogenetic analysis, we finally arrived at the diagnosis of ungual aspergillosis caused by Aspergillus subramanianii. After p.o. administration of terbinafine and topical application of 10% efinaconazole solution, the disease resolved in 6 months. A. subramanianii is one of the new species in the genus Aspergillus section Circumdati. Reported clinical isolates have been isolated from lung tissue, wounds and feet. This is the first documented case of onychomycosis caused by A. subramanianii. Onychomycosis due to Aspergillus species is uncommon. We summarized the reported cases of ungual aspergillosis in Japan., (© 2018 Japanese Dermatological Association.)

Objective: To describe spirochaetal infections in the feet and colon of cattle affected with papillomatous digital dermatitis (PDD) and colitis respectively., Procedure: Eighty-two slaughtered animals were macroscopically examined for the presence of PDD. Tissues of two cattle affected with PDD were examined by histology, immunohistochemistry, electron microscopy and bacteriology for spirochaetal infection., Results: Two adult cattle (a 2-year-old beef bullock and 7-year-old Holstein dairy cow) were affected with PDD. Histologically, numerous argyrophilic and gram-negative filamentous or spiral spirochaetes were found deep in the PDD lesions. Epithelial and goblet cell hyperplasia and oedema of the lamina propria mucosa with macrophage and lymphocyte infiltration were observed in the caecum and colon in the cattle. Numerous spirochaetes were present in the crypts and some had invaded epithelial and goblet cells, and caused their degeneration. Immunohistochemically the organisms stained positively with polyclonal antisera against Treponema pallidum and Brachyspira (Serpulina) hyodysenteriae. Ultrastructurally, the intestinal spirochaetes were similar to the spirochaetes in PDD. They were 6 to 14 pm long, 0.2 to 0.3 pm wide and had 4 to 6 coils and 9 axial filaments per cell. Campylobacter species were isolated from the PDD and intestinal lesions, but spirochaetes were not., Conclusion: Concurrent infections with morphologically similar spirochaetal organisms may occur in the feet and colon of cattle in Japan.

The dyschromatoses are a group of disorders characterized by the presence of both hyperpigmented and hypopigmented macules, many of which are small in size and irregular in shape. There are two major forms-dyschromatosis symmetrica hereditaria (DSH) and dyschromatosis universalis hereditaria (DUH), both of which are seen most commonly in Japan. DSH was first described by Toyama in 1929 and is characterized by a symmetrical distribution of hyperpigmented and hypopigmented macules on the extremities, especially over the dorsa of the hands and feet. In 1933, Ichikawa and Hiraga were the first to describe DUH as well-demarcated brown macules admixed with various-sized hypopigmented macules in a generalized as opposed to acral distribution. DUH was noted to appear within the first month of life. Some clinicians have suggested that DSH might be a subtype of DUH; however, we have to wait for the cloning of the causal genes of these diseases before coming to any definite conclusions. The differential diagnosis of dyschromatosis includes xeroderma pigmentosum, dyschromic amyloidosis, and exposure to chemicals such as diphenylcyclopropenone and monobenzyl ether of hydroquinone.

Background: Acral lentiginous melanoma is the most common type of malignant melanoma in the Japanese population. In most instances, classic acral lentiginous melanoma or acral lentiginous melanoma in situ can be readily distinguished from other benign pigmented lesions by virtue of its atypical clinical appearance., Observation: We present three cases of seemingly malignant pigmented lesions on the foot, all arising in Japanese females. Clinically, the lesions are characterized by irregular borders and variegated pigmentation closely mimicking those of acral lentiginous melanoma in situ. However, the histologic findings revealed only focal slight melanocytic hyperplasia with minimal cytologic atypia along the basal layer. Despite the malignant clinical features, thorough histologic examination failed to disclose any area with significant melanocytic atypia or evidence of malignancy., Conclusions: To the best of our knowledge, similar lesions with the clinical appearance of melanoma in situ and completely lacking histologic evidence of malignancy have not been reported. We, therefore, prefer to designate these lesions as atypical melanosis of the foot to highlight the clinically apparent atypical findings and to distinguish them from malignant melanoma in situ of the foot.

We have suggested that pigmented macules on the palms and/or soles occur in response to various systemic diseases. In the present paper, we evaluated the influences of clinical severity and duration of illness in Japanese subjects. In males, cases who suffered from cerebral vascular accident (CVA) for long periods and/or severely tended to have numerous pigmented macules. In females, cases with CVA did not show any similar tendency. As the result of our prior and present studies, we conclude that underlying systemic disease itself can play a pivotal role in the development of pigmented macules on the palms and/or soles of Japanese subjects. We emphasize that such a pigmented macular eruption with characteristic clinical features is an important sign of internal disorders, including malignancy.

A case of phaeohyphomycosis caused by Phialophora richardsiae is presented. The patient was a 30-year-old man with end stage malignant lymphoma. A subcutaneous abscess that developed on the dorsum of the right foot was removed surgically but immediately recurred. The causative mold was isolated from the pus in the lesion and identified as P. richardsiae. This is the fifth known case of phaeohyphomycosis caused by P. richardsiae and the first recorded in Japan.