Journal of Cutaneous Immunology and Allergy最新文献

Autosomal recessive hyper-IgE syndrome (AR-HIES) is a rare primary immunodeficiency disorder characterized by high serum IgE levels, recurrent viral skin infections, severe allergies, and early-onset malignancies, associated with mutations in the gene encoding the dedicator of cytokinesis 8 protein (DOCK8). We report a rare case of AR-HIES with DOCK8 deficiency in a young Japanese male with a past medical history of chronic atopic dermatitis, severe food allergies, and severe herpes simplex virus infection. Treatment was successfully based on infection management, skincare, and dietary elimination. In addition, anti-IgE therapy with omalizumab was the target treatment for this syndrome.

Coronavirus disease 2019 (COVID-19) is related to cutaneous manifestations.¹ Previous reports indicate that pernio-like lesions are cutaneous manifestations of COVID-19.^{1, 2} We report a case of pernio-like lesions related to COVID-19.

A 74-year-old Japanese woman with diabetes and hypertension was diagnosed with COVID-19. She was living with her daughter's family, who had also been diagnosed with COVID-19. On illness day 6, she presented to our emergency department with malaise and worsening shortness of breath (saturation percentage of oxygen in the artery blood 74%). The chest radiograph detected her bilateral interstitial pneumonia, and the treatment of artificial respiration started. Favipiravir, dexamethasone, remdesivir, and empiric antibiotic therapy were administrated because of a positive blood culture (Corynebacterium striatum, Klebsiella species). She was given lactulose, subcutaneous low molecular heparin, and continuous intravenous heparin infusion for prevent COVID-19-related thrombosis. On illness day 13, her breathing became worse. Extracorporeal membrane oxygenation was started. On illness day 25, erythema was seen on her body. On illness day 27, erythema and maculopapular exanthema appeared on her trunk (Figure 1A), legs (Figure 1B), and hands (Figure 1C). A hemorrhagic rash appeared on her hands (Figure 1D). Pernio-like lesions were seen on her fingers (Figure 1E,F) and toes. Laboratory inspection clarified a normal white blood cell count (5860/mm), normal liver and kidney function, decreased hemoglobin (10.1 g/dl; normal range: 10.6–14.4 g/dl), hematocrit (31.5%; normal range: 32.1%–42.7%), platelet count (45,000/mm; normal range: 13,800–309,000/mm), increased C-reactive protein (CRP, 10.56 mg/dl; normal range <0.3 mg/dl), lactate dehydrogenase (LD, 346 U/L; normal range: 119–229 U/L), fibrinogen-fibrin degradation product (FDP, 113.8 μg/ml; normal range <5.0 μg/ml), dimerized plasmin fragment D (D-dimer, 55.5 μg/ml; normal range <1.0 μg/ml), and red blood cell distribution width (RDW, 16.2%; normal range 11.5%–13.8%). Over the following days, gradual spontaneous improvement of skin lesions occurred. However, she became the cerebral infarction and died on illness day 44.

Previous studies found that 318 of 505 (63%) patients with dermatologic symptoms related to COVID-19 had pernio-like lesions.³ Pernio-like lesions were sole symptoms in the 55% of patients.³ Retiform purpura presented entirely in inpatients.¹ Mechanisms of COVID-19 coagulopathy have been proposed. In a hypercoagulable situation, the crosstalk between the inflammatory and hemostatic systems may advance for thrombosis in COVID-19.⁴ Heparin resistance was observed in patients with COVID-19 infectious disease of the serious case.⁴

Elevated RDW is associate

Patch granuloma annulare is a rare type of granuloma annulare. Histopathologically, patch granuloma annulare shows interstitial infiltration of histiocytes. In our case, immunohistochemical analyses demonstrated CD68-negative, CD163-positive M2 macrophages infiltration in an interstitial pattern.

Psoriasiform drug eruption is defined as condition similar to psoriasis triggered by drug administration, including de novo development of psoriasis or exacerbation of pre-existing psoriasis. Herein, we describe a 52-year-old Japanese woman, who developed disseminated psoriasiform lesions following administration of temozolomide, a remedy for glioblastoma, although cutaneous adverse events by this drug was very rare. In addition, we assume that altered inflammatory signals associated with psoriasis, such as activation of signal transducer and activator of transcription 3 (STAT3), might be involved in the underlying pathomechanism of drug eruption caused by temozolomide.

Cerebellar metastasis from malignant melanoma of the inner canthus was resected. The patient was subsequently treated with ipilimumab and has remained disease-free 6 years, however, developed sarcoidosis.

A. Facial swelling during a hereditary angioedema (HAE) attack. B. Computed tomography image of the abdomen with intestinal edema during an HAE attack. C. Histogram of the frequency of monthly HAE attacks during self-administration of icatibant. The asterisk indicates when HAE attacks were treated by on-demand injection of plasma-derived C1 inhibitor at the emergency room.

Erythema annulare centrifugum (EAC) is reportedly related to many factors such as immunological disorders, infections, malignancies, foods, and drugs. Pregnancy-associated EAC is extremely rare, with only six cases reported in the literature.^1-6 To date, there have been no reports of EAC that disappeared and recurred during a single gestation period.

A 34-year-old woman visited our department in the 36th week of her first pregnancy with asymptomatic multiple annular erythematous lesions on the legs. On the examination, the erythematous areas were slightly raised and had slight scales (Figure 1A, B). She reported that the eruption had first appeared in week 10 and spontaneously disappeared within 2 months, then reappeared in week 28 and gradually enlarged centrifugally and increased in number. This was confirmed in serial photographs she had taken. Skin biopsy revealed hyperkeratosis, parakeratosis, mild spongiosis in the epidermis, and a superficial perivascular lymphohistiocytic infiltrate (Figure 1C). She was in good health and had not taken any medication or vaccination during the pregnancy. She had a good pregnancy course except that the fetus was in the breech position. The laboratory test results were normal, including complete blood count, renal and hepatic functions indices, immunoglobulins, antinuclear antibodies, anti-SS-A and anti-SS-B antibodies, and rheumatoid factors. She had no evidence of Sjögren syndrome. She delivered a healthy baby by elective cesarean section in week 38. Although all the erythematous lesions had been increasing in number and enlarging until the delivery, they started to disappear within 2 days after the delivery and wholly resolved within 1 month without any treatment. No recurrence was observed during 4 years of follow-up.

In all six reported cases of pregnancy-associated EAC, including ours, eruptions appeared during the first pregnancy. The onset of the lesions occurred in week 12 in two cases and weeks 26–33 in four.^1-6 The lesions improved in weeks 33–36 in two cases, and at 3 days to 1 month postpartum in four. These findings suggest that the change in maternal hormone levels during pregnancy is a crucial etiological factor.⁵ The major possible causative candidates include estrogen, progesterone, and human chorionic gonadotropin (hCG).⁶ The secretion of hCG differs from that of the other hormones and many other placental proteins. hCG is first detected in maternal serum within 9 days after conception. The hCG levels then rise in a logarithmic fashion, peaking at 8–10 weeks after the last menstrual period, followed by a decline to a nadir at 18 weeks, with subsequent levels remaining constant or slightly increasing in some individuals until delivery.^{7, 8} The concentrations of estrogen and progesterone gradually increase and are maintained at high concentrations until deliv

The coronavirus disease 2019 (COVID-19) vaccine is positively changing the health crises of this pandemic and is currently essential to overcome the COVID-19 pandemic. The vaccine shows high efficacy against the infection and impairs the severity of symptoms. However, this vaccination is associated with concerns, such as vaccine-associated adverse reactions, which are currently highlighted issues for clinicians. We experienced two cases of mild cutaneous adverse reaction following COVID-19 vaccine administration, which was successfully controlled by prior administration of the antihistamine agent fexofenadine 3 days before COVID-19 vaccination for 7 days.