松永 佳世子

2歳,女児。39℃台の発熱,全身の不定形発疹,頸部リンパ節腫脹,眼球結膜充血,口唇の潮紅を認め川崎病と診断された。アスピリン30mg/kg/day内服,γグロブリン2g/kg/dayにより治療を行い,川崎病は治癒した。その後,掌蹠に皮疹が出現した。膝周囲を中心とした四肢に角化性毛孔一致性の丘疹と掌蹠に落屑を認めた。皮膚生検組織像では,表皮突起の規則的な延長と真皮乳頭層における血管拡張,浮腫を認め,滴状乾癬と診断した。吉草酸酢酸プレドニゾロン含有軟膏を外用し当科初診から2ヵ月後に皮疹は消退した。滴状乾癬と川崎病の共通の病因として細菌感染のスーパー抗原が考えられており,両者の合併は興味深いと考え報告した。(著者抄録)

34歳,男性。職業は競輪選手。5年前より四肢,躯幹に皮下結節が多発していることを自覚していたが放置していた。周囲に指摘されるようになり当科を受診した。当科受診時,両前腕,両大腿,腹部,背部に計11個の皮下結節を認めた。病理組織学的には,結合組織性の被膜に包まれた脂肪塊を認め,内部の脂肪細胞は変性し壊死に陥っており蜂巣状構造を形成していた。以上より結節性嚢胞性脂肪壊死症(Nodular-cystic fat necrosis;NCFN)の中期病変と診断した。本邦では四肢,体幹に多発したNCFNの報告はなく,本例は競輪選手という職業により外傷が多いことが発症要因と考えた。(著者抄録)

We present a case of primary Epstein-Barr virus (EBV) infection with erythema multiforme. A 1-year-old Japanese boy presented with skin eruptions, including typical target lesions and a low-grade fever. Just before the skin biopsy, 95 copies/mu g DNA of EBV genome was detected in peripheral blood mononuclear cells, which subsequently increased to 6,834 copies/mu g DNA. Skin tissue collected from the skin lesion showed the typical pathologic findings of erythema multiforme. EBV-encoded small nuclear RNA signals were not detected in the skin tissue by in situ hybridization.

Obtaining good adherence to acne therapy is a challenge for all dermatologists. We studied 428 acne patients in Japan to determine the likelihood of good adherence and factors associated with medication-taking. This study utilized a simple validated questionnaire to assess risk of poor adherence; information about patient and treatment characteristics was also collected. There was an overall rate of poor adherence in 76% of subjects. Adherence to topical medication was poor in 52% of those treated with a topical agent only (n = 123). Among those taking combination therapies (n = 275), adherence to the topical portion of therapy was poor in 49% of subjects. The likelihood of poor adherence to oral medication was higher, both when administered alone (n = 30, 93% poor adherence) and when given as part of a combination regimen (n = 275, 86%). Factors with an impact on adherence included satisfaction with treatment (p = 0.023) and the experience of side effects (p = 0.027). Patients who felt they had a good understanding of acne and its treatment were more likely to have good adherence. These data suggest that there is significant room for improvement in acne adherence in Japan, as in other areas of the world, and that improved education may enhance adherence. Copyright (C) 2011 S. Karger AG, Basel

A 13-year-old girl who had had pollinosis since the age of eight began to experience itching of the ears and vomiting after eating fresh fruits such as peach, apple and watermelon. This occurred at 10 years of age. The girl displayed positive reactions to six kinds of pollens, eleven kinds of fruits, numerous vegetables and to recombinant: rBet v2 present in specific IgE antibodies. She also reacted positively to several pollens, fruits and rBet v2 in the skin prick test. In the component-resolved diagnosis (CRD) using microarray technology, she also tested positive for profilin, a pan-allergen among plants. It is reported that profilin cross-reacts between pollen, fruits, vegetables and latex. From these results, we concluded that the allergic reactions to multiple kinds of foodstuff and pollens observed in this subject were due to cross-reactivity induced by profilin. Our results demonstrate that CRD by microarray is a reliable test in the diagnosis of PFAS. © 2011 Japanese Society of Allergology.