Our results indicate that overestimation of the PV-ICG can occur in septic patients and, further, suggest that simultaneous measurement of the two distribution volumes would help predict generalized capillary protein leakage in septic patients without repeated measurement.

No abstract

Generalized pustular psoriasis (GPP) is characterized by sudden fever and extensive erythema with pustules and occurs in patients with or without preceding psoriasis vulgaris. We report an 83-year-old man showing irregularly shaped erythema with pustules on the trunk and extremities. He initially had no fever and came to our clinic a few days after the onset of the skin lesions because of high fever and general malaise. We found an extension and new development of erythema and pustules on the whole body. The patient also manifested night delirium. Histological examination revealed neutrophil infiltration into the upper epidermis, which formed a spongiform pustule of Kogoj. Pustular fluid cultures were negative for bacteria. We diagnosed GPP without preceding psoriasis vulgaris. Mutation analysis revealed no significant mutations in IL36RN and CARD14. Previous reports indicated that onset of GPP at the age of 83 years is definitely rare. In older individuals, general disease characteristics include an atypical clinical course, an especially slow appearance and cure, and mental disorder. Our case also revealed such characteristics. Thus, it is necessary to be aware of the clinical course and mental problems in elderly patients with GPP.

The results suggest that the Vd-ICG/IDVG ratio and the IDVG are useful in evaluating the magnitude of the leakage and hypovolaemia.

Juvenile temporal arteritis with eosinophilia associated with systemic sclerosis Dear Editor, Juvenile temporal arteritis with eosinophilia (JTAE) is a rare disease, manifesting as an asymptomatic nodule in the temporal artery area in young adults. Despite an increasing number of reports, the etiology of JTAE is yet unknown. We report a case of JTAE in a patient with systemic sclerosis (SSc).A 39-year-old Japanese man had started treatment for bronchial asthma 10 years prior. Around the same time, he developed scleredema of the extremities and Raynaud's phenomenon. He was diagnosed with SSc based on clinical and histopathological findings and had been treated with daily 5 mg oral prednisolone until presentation. Two months before his initial examination, he noticed nodular thickening along the left temporal artery. The nodule became gradually larger, and he visited our clinic. Physical examination showed a non-tender cord-like induration measuring more than 5 cm in size on the superficial temporal left artery. Laboratory tests revealed a white blood cell count of 12 610/mm 3 with a total eosinophil count of 2520/mm 3 (20%), and antinuclear antibody (homogeneous and speckled pattern) test was positive. C-reactive protein test was negative, and the erythrocyte sedimentation rate was 10 mm/h. Total immunoglobulin E, interleukin (IL)-5 and eosinophil cationic protein (ECP) levels were normal, although the IL-4 level was elevated at 12.3 pg/mL (normal, <6.0). Ultrasonography of the left temporal artery showed hypoechoic vessel wall-thickening and vessel lumen occlusion, described as a halo sign. He underwent a 4-cm long left temporal artery biopsy. Histopathology revealed non-granulomatous panarteritis with lymphocytes and eosinophils, but giant cells were not found. Arteritis, occlusive fibrous intimal proliferation and disruption of the internal elastic lamina were present (Fig. 1). He was diagnosed with JTAE, but we decided to monitor the clinical course without any treatment. Shortly after biopsy, the nodule on the temporal artery became flattened, but hypereosinophilia did not resolve.