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In recent years, cases of IgG/IgA pemphigus, a rare subtype of pemphigus characterized by circulating IgG and IgA autoantibodies against the keratinocyte cell surface have been reported.1-6 The cutaneous manifestations of IgG/IgA pemphigus were reported to resemble those of IgA pemphigus in form, including the presence of pustules and annular lesions.1 However, no consensus on what eruptions are typical of IgG/IgA pemphigus has been established, due to the rarity of this disease. In this report, we describe a case of IgG/IgA pemphigus who developed severe crusted lesions on the seborrheic area that closely resembled facial crusted impetigo. This article is protected by copyright. All rights reserved.

Purpose: To report a novel mutation of the OPA1 gene in a Japanese family with optic atrophy type 1 (OPA1) and to describe the clinical features of this family. Methods: Standard ocular examinations were performed on the proband and his two affected sons. The DNA sequence of all exons and splice sites of the OPA1 gene was determined to detect mutations. Results: The proband and his sons had a heterozygous mutation of the OPA1 gene in the third nucleotide of intron 12 (IVS12+3A→T). Clinically, each patient had reduced visual acuity (onset within the first 6 years of life) and optic nerve pallor. The proband showed bilateral central scotomas and generalized dyschroatopsia. This is the first report of OPA1 gene mutation in Japanese patients with familial optic atrophy. Conclusions: A mutation of the OPA1 gene was detected in a Japanese family with OPA1, which follows the same pattern as reported in Western countries. It is suggested that mutations of the OPA1 gene contribute to the development of optic nerve atrophy regardless of ethnic groups. Screening for the OPA1 gene mutation will be useful for diagnosis of OPA1 in Japanese patients.

We report a case of bullous erythema multiforme caused by an exotic wood, pao ferro (Machaerium scleroxylon). A 25-year-old female, a luthier (guitar maker) who often handles a variety of woods, developed bullous erythema multiforme. A patch test confirmed a positive reaction to one of the exotic woods, pao ferro. A subsequent accidental short contact with pao ferro 5 months following the first incidence induced a similar exudative erythema. Exotic woods such as pao ferro should be added to the list of contact allergens that can induce bullous erythema multiforme.

Multiple endocrine neoplasia type 1 (MEN1) is a familial cancer syndrome inherited as an autosomal dominant trait. Various heterozygous germline mutations of the responsible gene, MEN1, have been identified within its exons in many, but not all, affected individuals. We here demonstrate, by DNA polymorphism analysis and gene dosage analysis with polymerase chain reaction (PCR), a large heterozygous germline MEN1 deletion in a kindred with MEN1, in whom no mutation could be detected in the PCR-amplified exons. The deletion spanned an at least 7 kb region containing the entire MEN1 gene. These findings indicate that a large germline deletion of the MEN1 gene, which escapes detection in PCR-based sequence analysis, should be considered as a potential cause of MEN1.

Multiple endocrine neoplasia type 1 (MEN1) is an autosotnal dominant familial cancer syndrome. The responsible gene MEN1 has recently been isolated, and its germline mutations have been identified in affected individuals in the United States, Canada and Europe. We screened for MEN1 mutations by direct nucleotide sequencing of all protein‐coding regions, and identified five distinct germline mutations in five among six Japanese kindreds with familial MEN1 or familial hyperparathyroidism. The mutations were dispersed across the gene. These findings suggest that, because of the absence of an obvious founder effect, the entire MEN1 gene region should be examined for germline mutations in the probands of MEN1 and related syndromes in Japanese families.

We describe a Japanese patient with cutaneous plasmacytosis whose clinical course we observed for 5 years. We also review 26 patients with this condition, including 24 Japanese and two non-Japanese, reported in detail. This review revealed that this condition has characteristic clinical and pathologic features and should be considered a distinct clinical entity. The reason for the predominant occurrence of cutaneous plasmacytosis in Japanese patients is unknown.

To examine the effect of the presence of γ-hydroxymethyl groups on the rate of the β-O-4 bond cleavage during the alkaline pulping process, the rates of the β-O-4 bond cleavage of non-phenolic lignin model compounds without a γ-hydroxymethyl group, 2-(2-methoxyphenoxy)-1-(3,4-dimethoxyphenyl)ethanol (G’G) and 2-(2,6-dimethoxyphenoxy)-1-(3,4-dimethoxyphenyl)ethanol (G’S), were compared with those of analogous model compounds with a γ-hydroxymethyl group, 2-(2-methoxyphenoxy)-1-(3,4-dimethoxyphenyl)propane-1,3-diol (GG) and 2-(2,6-dimethoxyphenoxy)-1-(3,4-dimethoxyphenyl)propane-1,3-diol (GS), under alkaline pulping conditions. The disappearance of G’G or G’S was accompanied by the quantitative liberation of 2-methoxyphenol or 2,6-dimethoxyphenol, respectively, indicating that the disappearance resulted from the β-O-4 bond cleavage. The disappearance rate of G’G or G’S was in between those of the erythro and threo isomers of GG or GS, respectively. This result seems to be reasonably explained when the steric repulsions of the three staggered conformations are taken into consideration. The disappearance rate of G’G or G’S increased, but the increment became moderate with increasing hydroxide concentration.

In January 2014, a 34-year-old man was referred to our hospital with hypothermia and mental fog. Clinical examination revealed his legs to be dirty, foul-smelling, red and covered with exudate and accumulated scurf that formed granular brown plaques (figure 1A). Pink nodules were aggregated into cauliflower-like plaques on the ankle joints (figure 1B). The histopathology of a biopsy specimen taken from the dorsal aspect of the ankle joint showed hyperkeratosis, pseudoepitheliomatous hyperplasia, [...]

The establishment of organ boundaries is a fundamental process for proper morphogenesis in multicellular organisms. In plants, the shoot meristem repetitively forms organ primordia from its periphery, and boundary cells are generated between them to separate their cellular fates. The genes CUP-SHAPED COTYLEDON1 (CUC1) and CUC2, which encode plant-specific NAC transcription factors, play central roles in establishment of the shoot organ boundaries in Arabidopsis thaliana. Here we show that CUC1 protein activates expression of LIGHT-DEPENDENT SHORT HYPOCOTYLS 4 (LSH4) and its homolog LSH3 in shoot organ boundary cells. Both genes encode nuclear proteins of the Arabidopsis LSH1 and Oryza G1 (ALOG) family, the members of which are widely conserved in land plants. Expression of LSH4 and LSH3 is detected in the boundary cells of various shoot organs, such as cotyledons, leaves and floral organs, and requires the activity of CUC1 and CUC2. Experiments using the glucocorticoid receptor system indicate that transcription of LSH4 and LSH3 is directly up-regulated by CUC1. Constitutive expression of LSH4 in the shoot apex causes inhibition of leaf growth in the vegetative phase, and formation of extra shoots or shoot organs within a flower in the reproductive phase. Together, our results indicate that CUC1 directly activates transcription of the nuclear factor genes LSH4 and LSH3, which may suppress organ differentiation in the boundary region.

A malignant epithelioid schwannoma occurred on the right second toe of a 30-year-old Japanese man. It was a firm, flesh-colored, benign-appearing nodule and measured 13 x 9 mm in diameter and 6 mm in height. To our knowledge, this is the first case of malignant epithelioid schwannoma occurring on the toe. Histopathology was characterized by a circumscribed nodule in the dermis that predominantly consisted of atypical large epithelioid cells with some spindle cells whose proliferation was similar to that of the Verocay bodies seen in ordinary schwannoma. Fontana-Masson staining demonstrated no melanin pigment in the tumor at the light microscopic level. The eosinophilic cytoplasm contained abundant glycogen and was positive for S-100 protein and HMB-45, as usually seen in melanomas. Electron microscopy revealed that there was an abundance of long-spacing collagen in the extracellular matrix, and the cells contained numerous dense-cored granules. But no definite melanosomes were observed in any stage. As far as we are aware, this is the first case of a malignant epithelioid schwannoma showing HMB-45 positivity.

Linear IgA/IgG bullous dermatosis (LAGBD) is an auto-immune blistering disease characterized by the local accumulation of IgA- and IgG-class anti-basement membrane autoantibodies. It typically presents as a generalized pruritic vesiculobullous eruption. No cases of localized LAGBD have yet been reported. We report a case of a 78-year-old man with LAGBD localized to the perianal area. The patient complained of suffering from persistent ulcers around the anus for more than 3 years. Physical examination revealed several blisters and ulcers up to 2-cm in diameter around the anus. No lesions were found elsewhere on the body. Histological analysis of a skin biopsy revealed subepidermal blistering, while direct immunofluorescence showed the linear deposition of IgA and IgG antibodies at the dermoepidermal junction. Indirect immunofluorescence of normal human skin whose layers had been separated using 1M NaCl showed the binding of both IgA and IgG to the epidermal side. Immunoblotting demonstrated the presence of circulating IgA and IgG autoantibodies that bound to a 120-kDa protein. This is the first case of localized LAGBD whose skin lesions were restricted to the perianal region.

OPA1 mutations are known to cause autosomal dominant optic atrophy (ADOA), and some types of OPA1 mutations also cause auditory neuropathy. In the present study, we evaluated the vestibular dysfunction that accompanied auditory neuropathy in a patient with an OPA1 mutation. A caloric test failed to elicit nystagmus or dizziness in either ear. Vestibular evoked myogenic potentials (VEMPs) in the right ear were characterized by a normal biphasic waveform. In contrast, no VEMPs were evoked in the left ear. Model building suggested that the OPA1 mutation, p.R445H, indirectly distorts the catalytic structure of the GTPase reaction center and decreases GTPase activity. The patient complained of instability while walking or moving but thought these symptoms were caused by visual dysfunction. This is the first report of a detailed evaluation of vestibular dysfunction in a patient with an OPA1 mutation. This case suggests that vestibular dysfunction may be involved in motor instability in patients with an OPA1 mutation, even when patients do not complain of vestibular symptoms. Based on this case, we suggest that vestibular evaluation should be performed in auditory neuropathy patients carrying an OPA1 mutation, even if the patients are free of symptoms of vestibular dysfunction.

We describe a 10-month-old boy with 22q13 deletion syndrome. Chromosomal analysis showed a partial duplication of 22p11.2-pter and a terminal deletion of 22q13.31-qter. Maternal chromosomal analysis showed a pericentric inversion of chromosome 22, with breakpoints at p11.2 and q13.31 [inv(22)(p11.2q13.31)]. The deleted chromosome resulted from a recombinant chromosome inherited from his mother. This is a rare case of 22q13 deletion syndrome associated with parental pericentric inversion of chromosome 22.

Adult T-cell leukemia/lymphoma (ATLL) often involves the skin. Cases with skin lesions without either leukemic nor lymph node involvement have been categorized into a cutaneous type. While the clinical manifestations of the cutaneous-type ATLL are variable, including multiple papules, nodules, plaques, or erythroderma, a solitary skin nodule alone is rare, and only 2 cases have been reported in the literature. We present a 58-year-old Japanese patient with cutaneous-type ATLL that presented as a large, solitary skin nodule as the sole clinical feature. The skin tumor was completely resolved after treatment with x-ray and electron beam irradiation.

Epithelioid angiosarcoma (EA) is a rare histological variant of angiosarcoma, composed almost exclusively of endothelial cells with an epithelioid morphology [1]. A case of multicentric epithelioid angiosarcoma in a young woman, whose skin lesion was solitary and mimicked a benign subcutaneous nodule, is reported.A 22-year-old woman presented with a 6-month history of induration on the abdomen. A slightly tender, 10-mm-diameter, subcutaneous nodule with a brownish-red skin surface was seen on the [...]

To report recurrent mutation of the KIF21A gene in three Japanese families in which some members have congenital fibrosis of the extraocular muscles type 1 (CFEOM1), and to describe the clinical characteristics of the families. Standard ocular examinations were performed on 18 normal and affected members of three unrelated families. To detect mutations, we determined the DNA sequence of exons 8, 20, and 21 and the splice sites of the KIF21A gene. All affected members had a heterozygous mutation of the KIF21A gene in exon 21 (R954W). Clinically, each patient had congenital bilateral ptosis, an infraducted primary position of each eye, and the inability to raise either eye above midline. The KIF21A gene mutation R954W was detected in the patients with CFEOM1 screened in this study, all of whom were Japanese, reflecting similar reports from Europe, America, the Middle East, and Japan. We suggest that mutations of the KIF21A gene contribute to the development of CFEOM1 regardless of ethnicity. We also found that the delimitation of the KIF21A gene mutation site enabled us to efficiently detect the KIF21A gene mutation despite the large number of KIF21A gene exons. Jpn J Ophthalmol 2005;49:443–447 © Japanese Ophthalmological Society 2005

We determined whether endothelial nitric oxide synthase (eNOS) plays an important role in the renal protective effect of ischemic preconditioning (IP) against the ischemia/reperfusion-induced acute renal failure (ARF) by using eNOS-deficient (eNOS(-/-)) and wild-type (eNOS(+/+)) mice. Ischemic ARF was induced by occlusion of the left renal artery and vein for 45 min followed by reperfusion, 2 weeks after contralateral nephrectomy. IP, which consists of three cycles of 2-min ischemia followed by 5-min reperfusion, was performed prior to 45-min ischemia. In eNOS(+/+) mice, IP treatment markedly attenuated the ischemia/reperfusion-induced renal dysfunction and significantly improved histological renal damage such as tubular necrosis, proteinaceous casts in tubuli, and medullary congestion. Constitutive nitric oxide synthase activity in the kidney without IP was markedly decreased 6 h after reperfusion, but this decreased response was not observed in eNOS(+/+) mice with IP treatment. The improvement of renal dysfunction in eNOS(+/+) mice with IP treatment was abolished by pretreatment with N(G)-nitro-l-arginine, a nonselective NOS inhibitor, whereas aminoguanidine, an inducible NOS inhibitor, had no effect. Finally, no protective effects of IP on ischemia/reperfusion-induced renal dysfunction and histological damage were observed in eNOS(-/-) mice. These findings strongly support the view that eNOS-mediated NO production plays a pivotal role in the protective effect of IP on ischemia/reperfusion-induced ARF.

Elastofibroma is an uncommon fibroelastic tumor or tumorlike process that usually occurs between the scapula and the chest wall of elderly patients. This condition is rarely reported in the dermatologic literature, because it infrequently arises in the skin or within the subcutaneous tissue. We present a 78-year-old man with 15 separate subcutaneous nodules on the buttocks and upper extremities together with bilateral subscapular nodules. All specimens taken from different lesions were histologically confirmed as elastofibromas. As far as we know, this case with 17 distinct elastofibromas demonstrates the largest number ever reported in a single patient. Although the pathomechanism of the occurrence of multiple elastofibromas is unknown, it should be included in the differential diagnosis of multiple subcutaneous nodules.

Purpose To evaluate the clinical history, histopathology, and genetics of posterior polymorphous corneal dystrophy (PPMD) in a woman with a prominent retrocorneal membrane. Design Observational case report and genetic analysis of her family, UM:139. Methods Records were reviewed from a case and associated family members. The diagnosis of PPMD was based on clinical examination, immunohistochemical staining, electron microscopy, and screening of genetic markers from regions previously reported to be associated with PPMD. Results Over 17 years, the proband with PPMD had 25 ocular procedures performed for glaucoma, cataract, cornea, retina, and postoperative problems. A prominent retrocorneal membrane grew onto the crystalline lens and intraocular lens (IOL). Histopathology revealed stratified epithelial-like cells on iris from an iridectomy and stratified corneal endothelium on a corneal button. Electron microscopy on the cornea revealed microvilli, tonofilaments, and desmosomes consistent with endothelial transformation, which was confirmed by positive anticytokeratin (CK) AE1/AE3 and CAM 5.2 immunoreactivity. Negative immunoreactivity in epithelium and positive in endothelium with anti-CK 7 supported the diagnosis of PPMD rather than epithelial downgrowth. Multiple relatives were affected with PPMD with apparent autosomal dominant inheritance, but surprisingly, the PPMD, congenital hereditary endothelial dystrophy 1 (CHED1) and CHED2 loci on chromosome 20 and the collagen, type VIII, α-2 (COL8A2) gene were excluded by linkage and haplotype analyses. Conclusions We are unaware of previous PPMD reports describing the unusual feature of a retrocorneal membrane extending onto the crystalline lens and IOL. In addition, this family suggests another PPMD locus.

We describe an unusual case of hidradenoma papilliferum on the chest of a man and discuss the rare sites of the tumor.

Purpose To report a novel mutation of the OPA1 gene in a Japanese patient with optic atrophy and to describe the clinical features of the patient. Design Observational case report. Methods Genomic DNA was extracted from leukocytes of four unrelated Japanese patients with optic atrophy. All the exons and splice sites of the OPA1 gene were amplified by polymerase chain reaction and directly sequenced. Results One patient with optic atrophy had a heterozygous Arg445His mutation in the OPA1 gene. The Arg445His mutation was detected neither in 110 control subjects nor in the patient's healthy family members. Conclusions A novel mutation of the OPA1 gene, similar to those reported in Western countries, was detected in a Japanese patient with optic atrophy. Mutations of the OPA1 gene may contribute to the development of optic nerve atrophy in Japanese cases of optic atrophy.

Background: Although various mucocutaneous manifestations have been reported in patients infected with HIV by sexual transmission or intravenous drug use, the prevalence and characteristics of skin disorders in HIV-positive hemophiliacs coinfected with hepatitits C virus (HCV) have rarely been described. Objective: The purpose of this study was to clarify the characteristics of skin disorders in HIV-positive hemophiliacs and to identify differences in comparison with other HIV-positive groups. Methods: A prospective study of the prevalence of mucocutaneous manifestations in 110 Japanese hemophiliacs (53 HIV-positive hemophiliacs including 24 AIDS and 57 HIV-negative hemophiliacs) was performed from July 1997 to July 1998. Result: None of the hemophiliacs developed Kaposi’s sarcoma or sexually transmitted skin diseases. Eosinophilic folliculitis was observed in 3 AIDS patients. The incidence of folliculitis, common warts, seborrheic dermatitis, generalized eczema, oral candidiasis and herpes zoster was higher in HIV-positive than in HIV-negative hemophiliacs (p < 0.05). Although anti-HCV antibody was positive in all HIV-positive hemophiliacs, HCV-related dermatoses such as lichen planus and porphyria cutanea tarda were not observed. Conclusion: Although Kaposi’s sarcoma and sexually transmitted skin diseases such as molluscum contagiosum, condyloma, and scabies are frequently associated with HIV, they were not found in the HIV-positive hemophiliacs in our study. HIV infection-related mucocutaneous manifestations are influenced not only by the presence of HIV but also by other factors such as the mode of transmission and sexual habit.

Auteur(s) : Satoko Shimizu1, Chikako Yasui1, Koichi Shiroshita2, Kimihito Ichimura3, Kikuo Tsuchiya1 1Department of Dermatology, 2Department of Nephrology, 3Departments of Plastic Surgery, Sapporo City General Hospital, North 11, West 13, Chuo-Ku, Sapporo 060-8604, Japan Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare, highly morbid vasculopathic disorder characterized by vascular calcification and cutaneous ischemic necrosis [1]. It is usually recognized clinically [...]

c PURPOSE: To screen a population with primary openangle glaucoma for mutations in the gene that encodes the trabecular meshwork inducible glucocorticoid response protein (TIGR), also known as myocilin (MYOC). c METHODS: Ophthalmologic information was collected for study subjects with primary open-angle glaucoma and their relatives. Mutation screening of 74 primary openangle glaucoma probands was conducted by sequencing TIGR/MYOC coding sequence and splice sites. c RESULTS: In 23 families we detected 13 nonsynonymous sequence changes, nine of which appear to be mutations likely to cause or contribute to primary openangle glaucoma. Two mutations, Arg272Gly and Ile499Ser, and one nonsynonymous sequence variant, Asn57Asp, are novel. We found mutations in nine of 25 juvenile glaucoma probands (36%) and two of 49 adultonset glaucoma probands (4%). Age classification of families rather than individual probands revealed mutations in three of nine families with strictly juvenile primary open-angle glaucoma (33%), and no mutations in 39 families with strictly adult-onset primary open-angle glaucoma (0%). In families with mixed-onset primary open-angle glaucoma containing both juvenile primary open-angle glaucoma and adult-onset primary open-angle glaucoma cases, we found mutations in eight of 26 families (31%). c CONCLUSIONS: Our data suggest that Gly252Arg, Arg272Gly, Glu323Lys, Gln368STOP, Pro370Leu, Thr377Met, Val426Phe, Ile477Asn, and Ile499Ser are likely to play roles that cause or contribute to the etiology of autosomal dominant primary open-angle glaucoma. Our finding of more TIGR/MYOC mutations in families with mixed-onset primary open-angle glaucoma than in the families with strictly adult-onset primary open-angle glaucoma implies that the presence of relatives with juvenile primary open-angle glaucoma in a family could be used as a basis for identifying a subset of the population with adult-onset primary open-angle glaucoma with higher prevalence of TIGR/MYOC mutations. To address this issue, and to refine estimations of mutation prevalence in these age-defined subpopulations, prospective study of a larger population ascertained entirely through adult-onset primary open-angle glaucoma probands will be needed. (Am J Ophthalmol 2000;130: 165‐177. © 2000 by Elsevier Science Inc. All rights reserved.)

Primary open angle glaucoma (POAG) is of great diagnostic concern because it is so common and because often the disease is asymptomatic, even in the presence of irreversible ocular damage. Though assessing known risk factors - including age, race, ocular signs, family and medical history - can aid in calculating a patient’s risk for developing glaucoma, there has been no screening/testing available to accurately predict who will develop glaucoma. The advent of DNA diagnostics offers the potential to accurately test for the presence of mutations that lead to the development of glaucoma. As is the case with any diagnostic test, a specificity and sensitivity of less than 100% means that both false negatives and false positives will occur. In addition, there are potential pitfalls specific to testing for disease-causing genes. In this paper, we discuss testing for the first cloned POAG gene, TIGR/MYOC (trabecular meshwork inducible glucocorticoid response/myocilin) [1, 2], and pitfalls in interpretation of the test results.

Germline MEN1 gene mutations are responsible for multiple endocrine neoplasia type 1 (MEN1), a dominantly inherited cancer syndrome. We identified a MEN1 germline mutation 894-9 G --> A in three MEN1 patients from two unrelated families. This mutation was not present in any of the 100 blood samples from normal volunteers. The wild type MEN1 sequence was lost in the patient's pancreatic tumor. Abnormal mRNA was identified in the tumor, which retained an intronic sequence indicating aberrant mRNA splicing at a newly created splicing acceptor site. These findings indicate that this nucleotide substitution is, though previously reported to be a polymorphism, a causative splicing mutation.

Choriocarcinoma is a malignant growth of trophoblastic cells characterized by secretion of human chorionic gonadotropin. Choriocarcinoma usually arises from fetal trophoblasts and rarely arises from germ cells in the testis or ovary or derives from dedifferentiation of other carcinomas. Skin metastasis of choriocarcinoma is rare: only seven cases have been reported in the English and Japanese literature. We report the case of a 22-year-old Japanese man with pure choriocarcinoma of the testis who developed skin metastases that presented as multiple reddish nodules. Microscopic examination of both the primary lesion of the testis and the cutaneous metastasis demonstrated the typical histologic features of pure choriocarcinoma. The patient died 3 months after the initial onset of skin metastasis. Review of the literature indicates that skin metastasis of choriocarcinoma usually occurs as a nodular lesion with the histologically typical feature of the primary disease and signals of poor prognosis.

Purpose : To report a novel mutation of the typel optic atrophy(OPA1) gene in a Japanese family with OPA1 and to describe the clinical features of this family. Methods : Standard ocular examinations were performed on the proband and his two affected sons. The DNA sequence of all exons and splice sites of the OPA1 gene was determined to detect mutations. Results : The proband and his sons had a heterozygous mutation of the OPA1 gene in the third nucleotide of intron 12(IVS12+3A→T). Clinically, each patient had reduced visual acuity (onset within the first 6 years of life) and optic nerve pallor. The proband showed a central scotoma and generaact lized dyschromatopsia. This is the first report of OPA1 gene mutation in Japanese patients with familial optic atrophy. Conclusions: A mutation of the OPA1 gene was detected in a Japanese family with OPA1, which follows the same pattern as reported in Western countries. It is suggested that mutations of the OPAL gene contribute to the development of optic nerve atrophy regardless of ethnic groups. Screening for the OPA1 gene mutation will be useful for diagnosis of OPA1 in Japanese patients.

Photoallergy to vitamin B6 is very rare; only a few cases of contact dermatitis and one case of photosensitive dermatitis due to pyritinol have been reported. We report here the first case of photoallergy drug eruption due to pyridoxine hydrochloride. A 71-year-old man developed papulo-squamous erythemata which were confined to sun-exposed sites. Photopatch testing, together with the clinical course, was helpful in reaching the initial diagnosis; this was confirmed by an oral challenge test. Photoallergic drug eruption due to vitamin B6 should be considered a rare cause of photosensitive dermatitis.

1,2-α- d -Mannosidase from Aspergillus saitoi was inactivated by chemical modification using water-soluble carbodiimide (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide) (EDC) and glycine ethyl ester (GEE). The inactivation rate increased in proportion to the concentration of EDC. Kinetic analysis suggested that inactivation of the enzyme occurred by modification of one essential carboxyl group.

To the Editor.— The concept of nodular cutaneous mucinosis with lupus erythematosus (LE) has been proposed as a distinct variant of cutaneous LE because of its specific clinical features and the histologic evidence of mucin deposition. 1-5 Recently, we examined two patients with systemic LE (SLE) in whom large indurated plaquelike lesions developed that measured 10 to 20 cm in diameter on the trunk. These lesions also had a histologically abundant mucin deposition throughout the dermis. The characteristic large plaquelike skin lesions reported here should be classified as a new clinical variant of cutaneous LE. Report of Cases.—Case 1.— A 60-year-old Japanese man with nephrotic syndrome associated with SLE was referred to our department with a large plaquelike skin lesion with a hard cutaneous induration about 10 to 20 cm in diameter on his lower back (Fig 1). The onset of the lesion was unknown and was not preceded by