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S100-negative, CD1a-positive histiocytosis is a rare histiocytic disorder characterized by proliferation of histiocytic cells possessing a phenotype of epidermal Langerhans cells except for the lack of S100 expression and Birbeck granules. We report the case of a Japanese man suffering from S100-negative, CD1a-positive histiocytosis. The patient showed numerous smooth erythematous 5-10-mm papules/nodules on most of his body. The key histopathological feature was the presence of dermal infiltrates of non-epidermotropic S100-negative CD1a-positive mononuclear cells. No systemic involvement was detected. Initially bath-psoralen plus ultraviolet A therapy was effective, but the lesions became recalcitrant to this treatment. Methylprednisolone pulse therapy followed by low-dose methotrexate (up to 30 mg/week) in combination with prednisolone (15 mg/day) effectively controlled the skin lesions.

Background Open reduction and internal fixation using an interlocking plate system has gained popularity for the treatment of dorsally displaced distal radius fractures. Purpose To evaluate the functional and radiological results of treating unstable distal radius fractures with the volar locking plate. Patients and methods A retrospective review was conducted of patients from one institution using the volar locking plate to treat intra-articular and extra-articular distal radius fractures. Unstable distal radius fractures in 15 patients, comprising 3 men and 12 women with a mean age of 64.4 years (34–76 years), were treated with a volar locking compression plate (Acu-Loc distal radius plate system; Acumed, Oregon, USA) and followed up for a minimum of 1 year. Fractures were classified using the AO classification. Radiographic parameters of preoperative, postoperative, and final follow-up radiographs were compared. The time to initiation of active range of motion was determined. Final follow-up range of motion and complications were reported. Results At final functional assessment, the scores of 5 patients were excellent, 7 patients good, and 3 patients fair according to Cooney's Clinical Scoring Chart. No non-union or infection occurred. Rupture of the flexor pollicis longus tendon occurred in 1 patient. Conclusion Treatment of unstable distal radius fractures with a volar locking plate leads to satisfactory results, provided the operative technique is carefully performed to prevent complications.

Papular elastolytic giant cell granuloma (PEGCG) is a rare variant of annular elastolytic giant cell granuloma (AEGCG). Since Kato et al. [1] reported the first case of PEGCG, only eight additional cases have been reported. Herein, we report a case of PEGCG and review the literature of reported cases.A 75-year-old Japanese man presented with multiple pruritic eruptions on his back that recurred for 2 months. Past medical history included hypertension and hyperlipidemia. Physical examination disclosed [...]

Rationale: Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a benign, inflammatory dermatosis with distinct histopathological features often observed in patients with systemic diseases. There were no reports of PNGD without underlying systemic diseases as an underlying cause of hypercalcemia. Herein, we report a case of a 62-year-old man with hypercalcemia due to PNGD, but with no underlying systemic diseases, including tuberculosis, sarcoidosis, or vasculitis. Patient concerns: Laboratory tests showed an elevated C-reactive protein level, an elevated corrected calcium level, a normal 25-hydroxyvitamin D level, and an elevated 1,25-dihydroxyvitamin D level. There were no other abnormalities to explain the hypercalcemia. Positron emission tomography–computed tomography showed abnormal uptake in his skin. Histopathological examination of the skin showed palisaded granulomatous infiltrate in the dermis. Neutrophils, degenerated collagen, and fibrin were present in the centers of the palisades without prominent mucin. There were no eosinophils, central necrosis, or necrotizing vasculitides. These features were consistent with PNGD. Diagnoses: A diagnosis of PNGD with hypercalcemia was established. Interventions: Oral prednisolone was administered to the patient. Outcomes: After treatment, his symptoms resolved, and his calcium, 1,25-dihydroxyvitamin D and CRP levels returned to normal. Skin specimens before and after treatment were assessed using immunohistochemistry for 1a-hydroxylase. Granuloma and epidermal cells were 1a-hydroxylase-positive before treatment. After treatment, the granuloma diminished in size and the 1ahydroxylase-positive areas of the epidermal cells decreased. Lessons: This case was particularly unique because increased 1a-hydroxylase expression in the granuloma and epidermal cells seemed to result in hypercalcemia due to excessive transformation of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. Physicians should consider PNGD as an underlying cause of hypercalcemia.

ヒト歯肉由来の培養ケラチノサイトを無血清培地で培養し, 各種テトラサイクリン (TCs) 作用後の細胞生存率と取り込まれたTCsの細胞内濃度を調べた。その結果,1) TCs作用後の細胞生存率は, 各TCs間で異なり, ミノサイクリン (MINO) 作用群で最も低く, テトラサイクリン (TC), クロルテトラサイクリン (CTC) 作用群の順で高くなった。2) MINO作用群の細胞生存率は培地中のCa2+濃度に依存し, 高Ca2+存在下より低Ca2+存在下で低かった。3) 細胞内TCs濃度も, MINO作用群で最も高く, TC, CTC作用群の順で低くなった。4) 各TCsの細胞内への取り込み速度は, 作用開始24時間目までは, MINO作用群で最も速く, TC, CTC作用群の順で遅くなった。5) 細胞内に取り込まれたTCsの細胞内停留性をMINOとTC間で比較したところ, MINOの方が高い停留性を示した。これらの結果は, (1) ヒト歯肉由来培養ケラチノサイトの細胞生存率に及ぼす効果は各TCs間で異なること, 2) 細胞生存率の低下は, 細胞内に取り込まれたTCsの細胞内濃度や細胞内停留性と関連していることを示している。

1991年4月から1993年3月までの2年間に, 帯広厚生病院皮膚科で経験した転移性皮膚癌9例を検討した。平均年齢は男性4例66歳, 女性5例63歳であった。原発巣としては肺癌4例 (44.4%), 子宮癌2例 (22.2%), 胃癌, 乳癌, 腎癌がそれぞれ1例 (11.1%) ずつであった。臨床型は結節型5例, 硬化型3例, 炎症型1例であった。原発巣確認から皮膚転移までの期間は平均約30±25か月であった。また, 皮膚転移後死亡までの期間は平均約6.8±5.6か月であった。診断時あるいは手術時の進行度と生存期間にははっきりした因果関係はなかった。なお, 転移巣が原発巣より先に発見された症例はなかった。

1977年に米国コネチカット州ライム地方で確認され, ライム関節炎として報告されたスピロヘータの全身感染症であるLyme病は, 本邦でも報告例が増加している。本疾患はBorrelia burgdorferiに起因する感染症であるが, 皮膚症状である慢性遊走性紅斑をはじめ, 神経症状, 関節症状, 心電図異常など種々の症状を併発することが知られている。Lyme病の診断には血清抗体価の上昇と, 明らかな本症の臨床症状が一つ以上あれば診断が確定する。しかし, 慢性遊走性紅斑のみの軽症例や, 早期に抗生剤が投与された患者, または感染後1か月以内の患者では, 十分に抗体価の上昇がみられない場合もあり, 診断は必ずしも容易ではない。自験例は臨床像や症状は合致するが, 抗体価の有意な上昇はみられなかった。しかし, 慢性遊走性紅斑が抗生剤投与に反応して軽快したこと、心電図の異常があり, これはLyme病で生じる症状の一つであることから, 自験例もLyme病であると推測した。