MolecuLight i:X® is a handy instrument capable of visualizing the bacterial adhesion over 10,000 CFU/g by recognizing porphyrin and pyoverdine as fluorescence. We took a total of 55 clinical photographs and fluorescence images (20 cases) from May 2021 to December 2021, after which the correlation between fluorescence observation and culture results was investigated. In addition, the course of fluorescent and ulcer status was shown in representative cases. The results suppose that MolecuLight i:X® is in real-time use and would be helpful in determining the range of collection of bacterial cultures as well as in judging therapeutic necessity for intractable skin ulcers.
{"title":"Instantly evaluating bacterial infections on skin ulcers in an Asian population using a fluorescence-emitting device","authors":"Yu Kurokami MD, Yukiho Kurosaki MD, Chigusa Yamashita MD, Kazunori Yokoi MD, Kyoko Tonomura MD, Eiji Kiyohara MD, PhD, Yosuke Ishitsuka MD, PhD, Manabu Fujimoto MD, PhD, Atsushi Tanemura MD, PhD","doi":"10.1002/cia2.12293","DOIUrl":"10.1002/cia2.12293","url":null,"abstract":"<p>MolecuLight i:X® is a handy instrument capable of visualizing the bacterial adhesion over 10,000 CFU/g by recognizing porphyrin and pyoverdine as fluorescence. We took a total of 55 clinical photographs and fluorescence images (20 cases) from May 2021 to December 2021, after which the correlation between fluorescence observation and culture results was investigated. In addition, the course of fluorescent and ulcer status was shown in representative cases. The results suppose that MolecuLight i:X® is in real-time use and would be helpful in determining the range of collection of bacterial cultures as well as in judging therapeutic necessity for intractable skin ulcers.</p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 4","pages":"125-128"},"PeriodicalIF":1.0,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43060890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.37191/mapsci-2582-6549-4(1)-042
Bamigbola F
A considerable number of fungal strains have developed resistant to various available antifungal agents due to CPY, FKS and or ERG11 genes complicating coinfection cases of SAR COV-2 virus. Therefore, this study sought to isolate, identify azole and polyene resistant genes in fungal pathogens isolated from confirmed SARS-CoV-2 individual in Oyo State, Nigeria. Nasopharyngeal samples were collected from symptomatic and asymptomatic SARS-CoV-2 infected adult from September, 2020 to April, 2021. Samples were cultured on Sabouraud Dextrose Agar at room and at 37 oC temperature for 7days. Identification of the fungal isolates were performed using MALDITOF MS VITEK. Antifungal Susceptibility Testing (AFST) were performed using Kirby bauer disc diffusion method. The resistant genes in fugal isolates were determined by Polymerase Chain Reaction with specific primers and resistant genes were amplified using agarose gel electrophoresis. Out of 63(15.8%) fungal isolates recorded from 400 samples collected, Asipergillus flavus 11(17.5%), Aspergillus niger 9(14.3%), Candida albicans 7(11.1%), Candida guillermondii 2(3.2%), Candida parapsilosis 2(3.2%), Candida famata 2(3.2%), Candida tropicalis 5(7.9%) and Lodderomyces elongisporus 25(39%) having highest frequency were recorded respectively. Nystatin (84.1%) had highest susceptibility testing and Ketoconazole (39.7%) had the least phenotypically. 10 (52.6%) isolates possessed CPY gene, 8(42.1%) isolates carried FKS gene, 9(47.4%) isolates had ERG11 gene molecularly.
由于合并感染SAR COV-2病毒的CPY、FKS和/或ERG11基因，相当多的真菌菌株已经对各种可用的抗真菌药物产生耐药性。因此，本研究试图从尼日利亚Oyo州确诊的SARS-CoV-2个体分离的真菌病原体中分离并鉴定唑和多烯耐药基因。于2020年9月至2021年4月采集有症状和无症状SARS-CoV-2感染成人的鼻咽样本。在室温和37℃条件下，在Sabouraud葡萄糖琼脂上培养7天。采用MALDITOF MS VITEK对分离真菌进行鉴定。采用Kirby bauer圆盘扩散法进行抗真菌药敏试验(AFST)。采用特异性引物聚合酶链式反应法测定菌株的耐药基因，并用琼脂糖凝胶电泳法扩增耐药基因。从400份样品中分离出63株真菌(15.8%)，其中黄曲霉11株(17.5%)、黑曲霉9株(14.3%)、白色念珠菌7株(11.1%)、吉勒蒙念珠菌2株(3.2%)、副假丝酵母2株(3.2%)、famata念珠菌2株(3.2%)、热带念珠菌5株(7.9%)和长孢loderomyces elongisporus 25株(39%)的频率最高。制霉菌素敏感性最高(84.1%)，酮康唑敏感性最低(39.7%)。10株(52.6%)携带CPY基因，8株(42.1%)携带FKS基因，9株(47.4%)携带ERG11基因。
{"title":"Detection of Cpy-2, Fks and Erg 11 Genes in Fungal Isolates from Sars Cov-2 Individual in Ibadan, Oyo State, Nigeria","authors":"Bamigbola F","doi":"10.37191/mapsci-2582-6549-4(1)-042","DOIUrl":"https://doi.org/10.37191/mapsci-2582-6549-4(1)-042","url":null,"abstract":"A considerable number of fungal strains have developed resistant to various available antifungal agents due to CPY, FKS and or ERG11 genes complicating coinfection cases of SAR COV-2 virus. Therefore, this study sought to isolate, identify azole and polyene resistant genes in fungal pathogens isolated from confirmed SARS-CoV-2 individual in Oyo State, Nigeria. Nasopharyngeal samples were collected from symptomatic and asymptomatic SARS-CoV-2 infected adult from September, 2020 to April, 2021. Samples were cultured on Sabouraud Dextrose Agar at room and at 37 oC temperature for 7days. Identification of the fungal isolates were performed using MALDITOF MS VITEK. Antifungal Susceptibility Testing (AFST) were performed using Kirby bauer disc diffusion method. The resistant genes in fugal isolates were determined by Polymerase Chain Reaction with specific primers and resistant genes were amplified using agarose gel electrophoresis. Out of 63(15.8%) fungal isolates recorded from 400 samples collected, Asipergillus flavus 11(17.5%), Aspergillus niger 9(14.3%), Candida albicans 7(11.1%), Candida guillermondii 2(3.2%), Candida parapsilosis 2(3.2%), Candida famata 2(3.2%), Candida tropicalis 5(7.9%) and Lodderomyces elongisporus 25(39%) having highest frequency were recorded respectively. Nystatin (84.1%) had highest susceptibility testing and Ketoconazole (39.7%) had the least phenotypically. 10 (52.6%) isolates possessed CPY gene, 8(42.1%) isolates carried FKS gene, 9(47.4%) isolates had ERG11 gene molecularly.","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"34 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84293645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.37191/mapsci-2582-6549-4(1)-041
H. B. Reinfeld
A zoonotic disease, monkeypox virus disease, appeared once in the west and central Africa. On July 23, 2022, the WHO designated the current monkeypox epidemic a public health emergency of worldwide concern in the context of the COVID-19 pandemic. The rapidly growing number of confirmed cases may endanger international society. According to current epidemiological statistics, the high frequency of human-to-human transmission might lead to more epidemics, particularly among males who have sex with men. Despite some therapeutic effects of presently used medications in the clinic, the development of antiviral treatments and vaccines against the monkeypox virus is urgent.
{"title":"Monkeypox Outbreak - Case Report","authors":"H. B. Reinfeld","doi":"10.37191/mapsci-2582-6549-4(1)-041","DOIUrl":"https://doi.org/10.37191/mapsci-2582-6549-4(1)-041","url":null,"abstract":"A zoonotic disease, monkeypox virus disease, appeared once in the west and central Africa. On July 23, 2022, the WHO designated the current monkeypox epidemic a public health emergency of worldwide concern in the context of the COVID-19 pandemic. The rapidly growing number of confirmed cases may endanger international society. According to current epidemiological statistics, the high frequency of human-to-human transmission might lead to more epidemics, particularly among males who have sex with men. Despite some therapeutic effects of presently used medications in the clinic, the development of antiviral treatments and vaccines against the monkeypox virus is urgent.","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"39 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74163490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.37191/mapsci-2582-6549-4(1)-040
R. Maes
The WHO was created in 1950 with the prime assignment to fight tuberculosis. To this end, it was granted immunity against any prosecution. The French state immediately exploited this advantage to impose the BCG vaccine developed by the Pasteur institute, although this vaccine was known, by both the Pasteur institute and the WHO, to be deficient. It was poorly attenuated and some of its strains favor the spread of TB. The BCG also favors the spread of leprosy. The WHO knew this and nevertheless supported this fraud. It banned serological tests and imposed an expensive antigen- detection test, the Xpert/Rif test, in 2011. This test was rapidly demonstrated to be peppered with severe deficiencies, which were ignored by the treatment action group (TAG) and the WHO. Both insisted on its use while systematically denigrating the serological tests that this antigen-test was supposed to replace. The result of the use of this ill-functioning test was the spread of multi-drug resistant strains of TB. Serological tests monitor the immune status of infected patients: it allows the detection of those patients prone to convert as well as the immune status of patients under therapy. Those who do not respond to current treatment are therewith detected. A shameful demand of financial contribution by those countries that suffered most from the mismanagement of TB by well–endowed nations is currently underway.
{"title":"The Herculean Task of Tedros","authors":"R. Maes","doi":"10.37191/mapsci-2582-6549-4(1)-040","DOIUrl":"https://doi.org/10.37191/mapsci-2582-6549-4(1)-040","url":null,"abstract":"The WHO was created in 1950 with the prime assignment to fight tuberculosis. To this end, it was granted immunity against any prosecution. The French state immediately exploited this advantage to impose the BCG vaccine developed by the Pasteur institute, although this vaccine was known, by both the Pasteur institute and the WHO, to be deficient. It was poorly attenuated and some of its strains favor the spread of TB. The BCG also favors the spread of leprosy. The WHO knew this and nevertheless supported this fraud. It banned serological tests and imposed an expensive antigen- detection test, the Xpert/Rif test, in 2011. This test was rapidly demonstrated to be peppered with severe deficiencies, which were ignored by the treatment action group (TAG) and the WHO. Both insisted on its use while systematically denigrating the serological tests that this antigen-test was supposed to replace. The result of the use of this ill-functioning test was the spread of multi-drug resistant strains of TB. Serological tests monitor the immune status of infected patients: it allows the detection of those patients prone to convert as well as the immune status of patients under therapy. Those who do not respond to current treatment are therewith detected. A shameful demand of financial contribution by those countries that suffered most from the mismanagement of TB by well–endowed nations is currently underway.","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"4 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73364601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>A 29-year-old Japanese woman presented with a 6-month history of pustular eruptions on the palms and soles. She also suffered from pain and stiffness in the anterior chest and the lumbar spine for 3 months, which were treated with loxoprofen. Although she had no history of rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, she was diagnosed with endometrial uterine cancer 3 years before. After treatment with surgery and chemotherapy, she experienced no recurrence of the tumor. She had neither focal infection nor history of smoking. At presentation, the patient had erythema with scales and pustules on the palms and soles. Palmoplantar pustulosis (PPP) area and severity index (PPPASI) was 16.8. Serologically, C-reactive protein and rheumatoid factor were negative. Lumbar magnetic resonance imaging (MRI) revealed bone marrow edema in L4 and L5 under T2-weighted condition, corroborating the presence of spondylitis (Figure 1A). <sup>99m</sup>Tc bone scintigraphy showed increased uptakes in the right clavicle and sternoclavicular joint and the lumbar spines (Figure 1B). A diagnosis of PPP with pustulotic arthro-osteitis (PAO) was made. Three-month treatment with topical betamethasone butyrate propionate and maxacalcitol resulted in partial improvement of skin symptoms, and PPPASI decreased to 7.9 (Figure 1C). On the other hand, pain in the back and anterior chest was persistent. Her Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) remained as high as 4.8. Because of insufficient improvement of skin symptoms and intractable back pain, treatment with anti-interleukin-23p19 subunit monoclonal antibody guselkumab was initiated. After 6-month guselkumab therapy, back pain visual analogue scale improved to 3 compared to 6 at the initiation of the treatment. In addition, BASDAI decreased to 4. Follow-up lumbar MRI demonstrated remarkable reduction of bone marrow edema in the vertebral bodies of L4 and L5 using short TI inversion recovery image (Figure 1D). Bone scintigraphy also confirmed decreased uptakes in the lumbar spines and the right clavicular region (Figure 1E). On the other hand, her anterior chest pain did not ameliorate even after the treatment. During the 6-month treatment, skin symptoms completely disappeared (Figure 1F).</p><p>The efficacy of guselkumab for PPP has been established,<span><sup>1, 2</sup></span> and it is approved for PPP in Japan. However, very limited information is available on the efficacy of this drug for PAO.<span><sup>3</sup></span> In particular, its effectiveness for spondylitis in PAO is largely unknown. We have recently reported that guselkumab improves joint pain of PAO patients as a whole.<span><sup>4</sup></span> In a PPP clinical trial, 52-week guselkumab treatment showed beneficial outcomes for MRI scores as well as EQ-5D pain/discomfort scores in PPP patients with PAO, in which the spine, sacroiliac joint, and peripheral joints were considered together.<span><sup>3</sup></span> It
{"title":"Clinically and radiologically successful treatment of spondylitis by guselkumab in a patient with pustulotic arthro-osteitis","authors":"Natsumi Ikumi MD, Hideki Fujita MD, PhD","doi":"10.1002/cia2.12299","DOIUrl":"10.1002/cia2.12299","url":null,"abstract":"<p>A 29-year-old Japanese woman presented with a 6-month history of pustular eruptions on the palms and soles. She also suffered from pain and stiffness in the anterior chest and the lumbar spine for 3 months, which were treated with loxoprofen. Although she had no history of rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, she was diagnosed with endometrial uterine cancer 3 years before. After treatment with surgery and chemotherapy, she experienced no recurrence of the tumor. She had neither focal infection nor history of smoking. At presentation, the patient had erythema with scales and pustules on the palms and soles. Palmoplantar pustulosis (PPP) area and severity index (PPPASI) was 16.8. Serologically, C-reactive protein and rheumatoid factor were negative. Lumbar magnetic resonance imaging (MRI) revealed bone marrow edema in L4 and L5 under T2-weighted condition, corroborating the presence of spondylitis (Figure 1A). <sup>99m</sup>Tc bone scintigraphy showed increased uptakes in the right clavicle and sternoclavicular joint and the lumbar spines (Figure 1B). A diagnosis of PPP with pustulotic arthro-osteitis (PAO) was made. Three-month treatment with topical betamethasone butyrate propionate and maxacalcitol resulted in partial improvement of skin symptoms, and PPPASI decreased to 7.9 (Figure 1C). On the other hand, pain in the back and anterior chest was persistent. Her Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) remained as high as 4.8. Because of insufficient improvement of skin symptoms and intractable back pain, treatment with anti-interleukin-23p19 subunit monoclonal antibody guselkumab was initiated. After 6-month guselkumab therapy, back pain visual analogue scale improved to 3 compared to 6 at the initiation of the treatment. In addition, BASDAI decreased to 4. Follow-up lumbar MRI demonstrated remarkable reduction of bone marrow edema in the vertebral bodies of L4 and L5 using short TI inversion recovery image (Figure 1D). Bone scintigraphy also confirmed decreased uptakes in the lumbar spines and the right clavicular region (Figure 1E). On the other hand, her anterior chest pain did not ameliorate even after the treatment. During the 6-month treatment, skin symptoms completely disappeared (Figure 1F).</p><p>The efficacy of guselkumab for PPP has been established,<span><sup>1, 2</sup></span> and it is approved for PPP in Japan. However, very limited information is available on the efficacy of this drug for PAO.<span><sup>3</sup></span> In particular, its effectiveness for spondylitis in PAO is largely unknown. We have recently reported that guselkumab improves joint pain of PAO patients as a whole.<span><sup>4</sup></span> In a PPP clinical trial, 52-week guselkumab treatment showed beneficial outcomes for MRI scores as well as EQ-5D pain/discomfort scores in PPP patients with PAO, in which the spine, sacroiliac joint, and peripheral joints were considered together.<span><sup>3</sup></span> It","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 4","pages":"136-138"},"PeriodicalIF":1.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47479592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kimura's disease is refractory and sometimes has prurigo as a comorbidity. This report shows a case of Kimura's disease accompanied by prurigo and successfully treated both with dupilumab. Dupilumab might be considered for Kimura's disease with prurigo, which is resistant to conventional treatments.
，
{"title":"Refractory Kimura's disease accompanied with prurigo responding to dupilumab administration: A case report","authors":"Fumie Fukami MD, Yuta Koike MD, PhD, Hiroyuki Murota MD, PhD","doi":"10.1002/cia2.12298","DOIUrl":"10.1002/cia2.12298","url":null,"abstract":"<p>Kimura's disease is refractory and sometimes has prurigo as a comorbidity. This report shows a case of Kimura's disease accompanied by prurigo and successfully treated both with dupilumab. Dupilumab might be considered for Kimura's disease with prurigo, which is resistant to conventional treatments.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 4","pages":"134-135"},"PeriodicalIF":1.0,"publicationDate":"2023-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45073471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inborn errors of immunity (IEIs) are monogenic diseases of the immune system. Despite the increasing genetic advancements, the diagnosis of IEIs still lean on clinical diagnosis. Dermatological manifestations are observed in a large number of IEI patients and can lead to proper approach and prompt intervention.
Methods
This cross-sectional study was carried out between 2018 and 2020 on IEIs at a Children's tertiary care center in Tehran, Iran. Demographic details and age at onset of symptoms of IEI were recorded.
Results
Overall, 212 patients were included. Cutaneous findings were reported in 95 (44.8%) patients, and 61 of 95 (64.2%) reported skin lesions as the first clinical presentation. Skin infection (69, 72.6%) was the most frequent cutaneous manifestation, followed by eczematous rash (24, 25%).
Conclusions
Skin manifestations are a common feature in IEI patients and are readily recognizable by healthcare providers. This study tried to provide information on prognostic consequences.
{"title":"Skin manifestations in children with inborn errors of immunity in a tertiary care hospital in Iran","authors":"Zahra Salehi Shahrbabaki MD, Zahra Chavoshzadeh MD, Fahimeh Abdollahimajd MD, Samin sharafian MD, Mahnaz Jamee MD, Anastasia Bondarenko MD, Tolue Mahdavi MD","doi":"10.1002/cia2.12296","DOIUrl":"10.1002/cia2.12296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Inborn errors of immunity (IEIs) are monogenic diseases of the immune system. Despite the increasing genetic advancements, the diagnosis of IEIs still lean on clinical diagnosis. Dermatological manifestations are observed in a large number of IEI patients and can lead to proper approach and prompt intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study was carried out between 2018 and 2020 on IEIs at a Children's tertiary care center in Tehran, Iran. Demographic details and age at onset of symptoms of IEI were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 212 patients were included. Cutaneous findings were reported in 95 (44.8%) patients, and 61 of 95 (64.2%) reported skin lesions as the first clinical presentation. Skin infection (69, 72.6%) was the most frequent cutaneous manifestation, followed by eczematous rash (24, 25%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Skin manifestations are a common feature in IEI patients and are readily recognizable by healthcare providers. This study tried to provide information on prognostic consequences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 3","pages":"72-77"},"PeriodicalIF":1.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44693107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Treatment of eosinophilic granulomatosis with polyangiitis (EGPA) remains a challenge because currently available therapies, corticosteroids, and immunomodulators, do not always control symptoms and are often associated with significant morbidity and relapse. We previously proposed that the initial cutaneous clinical and histopathologic findings based on skin biopsy and peripheral blood findings, as hallmark manifestations of EGPA, could prompt dermatologists to consider this diagnosis at an earlier stage.<span><sup>1</sup></span> Based on these cutaneous findings, we also reported that earlier adjunct administration of mepolizumab and intravenous immunoglobulin therapy (IVIG) led to significant improvement in EGPA symptoms.<span><sup>2</sup></span> Since those initial reports, we have been able to maintain good control of the disease, allowing us to taper their prednisolone dosage without any negative impact on the improvement of these symptoms or any significant adverse effects related to the drugs during a 3-year follow-up.</p><p>A 55-year-old man presented with erythematous nodules and livedo racemosa with purpura on his leg edema. There were clinical signs of mononeuritis multiplex as evidence of peripheral neurologic involvement. Microscopic examination of the indurated nodules revealed necrotizing vasculitis in the lower dermis and subcutaneous fat. There was a predominance of eosinophil infiltration into the dermis around the vascular walls and nerve fiber. He had been treated with oral prednisolone and intravenous cyclophosphamide pulse therapy (IVCY). The therapy did not resolve his symptoms, including the associated multiple mononeuritis. We administered IVIG, 400 mg/kg for 5 days, and mepolizumab 300 mg subcutaneously every 4 weeks to address concerns of exacerbation of complications such as peripheral neuropathy. The symptoms gradually improved, with resolution of the peripheral eosinophilia and normalized IgE levels. Azathioprine was additionally administered from the 6th month as prednisolone was tapered smoothly. To date, he has not developed any additional vasculitis symptoms during the 3-year follow-up (Figure 1A).</p><p>A 30-year-old woman presented with slightly purpuric skin lesions on her lower extremities. Nerve conduction tests revealed a mononeuritis multiplex on her lower extremities. Microscopic examination of skin biopsy specimens obtained from the purpura revealed leukocytoclastic vasculitis. There was a predominance of eosinophils infiltrating the dermis around the nerve fiber. We applied an adjunct combination therapy of IVIG and mepolizumab. After two courses of this adjunct therapy, the cutaneous manifestations, as well as the arthritis and mononeuritis multiplex had been completely resolved along with the normalization of peripheral eosinophilia, without any remarkable adverse effects related to prednisone such as opportunistic infections. Prednisolone was subsequently tapered smoothly. After 3 years, there ha
治疗嗜酸性肉芽肿病合并多血管炎(EGPA)仍然是一个挑战，因为目前可用的治疗方法，皮质类固醇和免疫调节剂，并不总能控制症状，往往与显著的发病率和复发有关。我们之前提出，基于皮肤活检和外周血结果的最初皮肤临床和组织病理学发现，作为EGPA的标志性表现，可以促使皮肤科医生在早期阶段考虑这种诊断基于这些皮肤发现，我们也报道了早期辅助给予mepolizumab和静脉免疫球蛋白治疗(IVIG)可显著改善EGPA症状自这些初步报告以来，我们已经能够保持对疾病的良好控制，使我们能够逐渐减少泼尼松龙的剂量，而不会对这些症状的改善产生任何负面影响，也不会在3年的随访中出现与药物相关的任何重大不良反应。一个55岁的男人提出了红斑结节和活的总状斑紫癜在他的腿水肿。多发性单神经炎的临床表现为周围神经受累的证据。显微镜检查硬化结节显示坏死性血管炎在下真皮和皮下脂肪。血管壁及神经纤维周围真皮以嗜酸性细胞浸润为主。他接受口服强的松龙和静脉环磷酰胺脉冲治疗(IVCY)。治疗没有解决他的症状，包括相关的多发性单神经炎。我们给予IVIG, 400mg /kg，持续5天，mepolizumab每4周皮下注射300mg，以解决并发症恶化的问题，如周围神经病变。随着外周血嗜酸性粒细胞增多和IgE水平正常化，症状逐渐改善。从第6个月开始，随着泼尼松龙逐渐逐渐减少，我们开始额外使用硫唑嘌呤。到目前为止，在3年的随访中，他没有出现任何额外的血管炎症状(图1A)。一名30岁女性下肢出现轻微紫癜性皮肤病变。神经传导测试显示她的下肢有多发性单神经炎紫癜患者皮肤活检标本的显微检查显示白细胞分裂性血管炎。神经纤维周围真皮以嗜酸性粒细胞浸润为主。我们采用了IVIG和mepolizumab的辅助联合治疗。经过两个疗程的辅助治疗，皮肤表现以及关节炎和多发性单神经炎已完全消失，周围嗜酸性粒细胞正常化，未出现与强的松相关的明显不良反应，如机会性感染。强的松龙随后逐渐逐渐减少。3年后，没有临床复发或全身性皮质类固醇不良反应的证据(图1B)。EGPA治疗的最重要目标是诱导长期缓解，减轻全身糖皮质激素和免疫抑制治疗的负担。一些研究报道了mepolizumab诱导缓解、预防复发和减少糖皮质激素剂量的能力。3-5我们建议早期持续给予mepolizumab可能有助于控制复发和难治性疾病，并可以减少对不太理想的治疗方案(如长期皮质类固醇)的需求。作者声明无利益冲突。研究方案的批准:是的。N / A ?知情同意:是的。注册处及注册编号: N / A。动物研究:无。
{"title":"Earlier continuous administration of mepolizumab for eosinophilic granulomatosis with polyangiitis based on cutaneous findings","authors":"Takaharu Ikeda MD, PhD, Toshiro Komatsu MD, Kae Yokoyama MD, Tamihiro Kawakami MD, PhD","doi":"10.1002/cia2.12295","DOIUrl":"10.1002/cia2.12295","url":null,"abstract":"<p>Treatment of eosinophilic granulomatosis with polyangiitis (EGPA) remains a challenge because currently available therapies, corticosteroids, and immunomodulators, do not always control symptoms and are often associated with significant morbidity and relapse. We previously proposed that the initial cutaneous clinical and histopathologic findings based on skin biopsy and peripheral blood findings, as hallmark manifestations of EGPA, could prompt dermatologists to consider this diagnosis at an earlier stage.<span><sup>1</sup></span> Based on these cutaneous findings, we also reported that earlier adjunct administration of mepolizumab and intravenous immunoglobulin therapy (IVIG) led to significant improvement in EGPA symptoms.<span><sup>2</sup></span> Since those initial reports, we have been able to maintain good control of the disease, allowing us to taper their prednisolone dosage without any negative impact on the improvement of these symptoms or any significant adverse effects related to the drugs during a 3-year follow-up.</p><p>A 55-year-old man presented with erythematous nodules and livedo racemosa with purpura on his leg edema. There were clinical signs of mononeuritis multiplex as evidence of peripheral neurologic involvement. Microscopic examination of the indurated nodules revealed necrotizing vasculitis in the lower dermis and subcutaneous fat. There was a predominance of eosinophil infiltration into the dermis around the vascular walls and nerve fiber. He had been treated with oral prednisolone and intravenous cyclophosphamide pulse therapy (IVCY). The therapy did not resolve his symptoms, including the associated multiple mononeuritis. We administered IVIG, 400 mg/kg for 5 days, and mepolizumab 300 mg subcutaneously every 4 weeks to address concerns of exacerbation of complications such as peripheral neuropathy. The symptoms gradually improved, with resolution of the peripheral eosinophilia and normalized IgE levels. Azathioprine was additionally administered from the 6th month as prednisolone was tapered smoothly. To date, he has not developed any additional vasculitis symptoms during the 3-year follow-up (Figure 1A).</p><p>A 30-year-old woman presented with slightly purpuric skin lesions on her lower extremities. Nerve conduction tests revealed a mononeuritis multiplex on her lower extremities. Microscopic examination of skin biopsy specimens obtained from the purpura revealed leukocytoclastic vasculitis. There was a predominance of eosinophils infiltrating the dermis around the nerve fiber. We applied an adjunct combination therapy of IVIG and mepolizumab. After two courses of this adjunct therapy, the cutaneous manifestations, as well as the arthritis and mononeuritis multiplex had been completely resolved along with the normalization of peripheral eosinophilia, without any remarkable adverse effects related to prednisone such as opportunistic infections. Prednisolone was subsequently tapered smoothly. After 3 years, there ha","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 4","pages":"132-133"},"PeriodicalIF":1.0,"publicationDate":"2023-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48273876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dermatofibrosarcoma protuberans with fibrosarcomatous transformation (DFSP-FS) is a rare variant, with higher rates of recurrence and metastasis than DFSP. Detection of the collagen type I alpha 1 (COL1A1)–platelet-derived growth factor beta chain (PDGFB) fusion gene is useful for the diagnosis of DFSP. In this letter, we report a case of DFSP-FS, focusing on the expression of the COL1A1-PDGFB fusion gene in the lesions. Increased expression of the COL1A1-PDGFB fusion gene may be associated with fibrosarcomatous changes during the pathogenesis of DFSP.
{"title":"Possible role of the collagen type I alpha 1–platelet-derived growth factor beta chain fusion gene in the development of dermatofibrosarcoma protuberans with fibrosarcomatous transformation","authors":"Fuminori Katsumata MD, Koji Kamiya MD, PhD, Hitomi Miyauchi BEng, Hirofumi Okada MD, Atsuko Sato MD, PhD, Takeo Maekawa MD, PhD, Mayumi Komine MD, PhD, Mamitaro Ohtsuki MD, PhD","doi":"10.1002/cia2.12297","DOIUrl":"10.1002/cia2.12297","url":null,"abstract":"<p>Dermatofibrosarcoma protuberans with fibrosarcomatous transformation (DFSP-FS) is a rare variant, with higher rates of recurrence and metastasis than DFSP. Detection of the collagen type I alpha 1 (COL1A1)–platelet-derived growth factor beta chain (PDGFB) fusion gene is useful for the diagnosis of DFSP. In this letter, we report a case of DFSP-FS, focusing on the expression of the COL1A1-PDGFB fusion gene in the lesions. Increased expression of the COL1A1-PDGFB fusion gene may be associated with fibrosarcomatous changes during the pathogenesis of DFSP.</p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 4","pages":"129-131"},"PeriodicalIF":1.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43550088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cases of skin infections caused by Panton–Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA), particularly USA300 clone, have been increasing in Japan. We report that clinical findings of 5 patients with PVL-positive MRSA and compared to those of four patients with PVL-negative MRSA. Severities of patients with PVL-positive MRSA were significantly higher than those of patients with PVL-negative MRSA. Average durations of antimicrobial therapy for patients with PVL-positive MRSA were 3.4-fold longer than those for patients with PVL-negative MRSA. Our data suggest that PVL-positive MRSA should be deal with a causative agent for intractable skin infections in Japan likewise other countries.
{"title":"Severity and intractableness of skin infections caused by Panton–Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus","authors":"Tamihiro Kawakami MD, PhD, Kae Yokoyama MD, Takaharu Ikeda MD, PhD, Hiroshi Kaneko MD, PhD, Yuji Watanabe PhD, Hidemasa Nakaminami MD, PhD","doi":"10.1002/cia2.12294","DOIUrl":"10.1002/cia2.12294","url":null,"abstract":"<p>Cases of skin infections caused by Panton–Valentine leukocidin (PVL)-positive methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), particularly USA300 clone, have been increasing in Japan. We report that clinical findings of 5 patients with PVL-positive MRSA and compared to those of four patients with PVL-negative MRSA. Severities of patients with PVL-positive MRSA were significantly higher than those of patients with PVL-negative MRSA. Average durations of antimicrobial therapy for patients with PVL-positive MRSA were 3.4-fold longer than those for patients with PVL-negative MRSA. Our data suggest that PVL-positive MRSA should be deal with a causative agent for intractable skin infections in Japan likewise other countries.</p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 3","pages":"94-97"},"PeriodicalIF":1.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41820687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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