No abstract

A 40-year-old man developed squamous cell carcinoma on a perianal lesion of linear porokeratosis after renal transplantation. The tumor metastasized to the left inguinal lymph node 25 months after the primary tumor was excised. p53 overexpression was observed in the tumor cells, but not in the porokeratotic lesion. Interestingly, continuous subcutaneous infusion of peplomycin for the lymph node metastasis significantly improved the warty lesions of porokeratosis. In this patient, immunosuppressive agents might have accelerated the development of carcinoma on a skin area with malignant potential.

No abstract

We report a case of Churg-Strauss syndrome (CSS) with necrosis of the fingers and toes and liver infarction. A 59-year-old man with asthma suddenly noticed that his fingers and toes felt unusually cold. This condition worsened progressively, and some digits became necrotic within several weeks. Laboratory studies revealed hypereosinophilia and an extremely elevated serum level of IgE. Digital subtraction angiography of the extremities revealed extensive irregular narrowing of small and medium-sized arteries in the extremities. Abdominal computed tomography (CT) revealed an area of low density at the periphery of the right lobe of the liver. Angiography revealed irregular narrowing of small arteries that corresponded to the ischemic area. A nerve conduction study suggested sensory nerve neuropathy. The preceding asthma, acute onset of digital necrosis, liver infarction, neuropathy, and hypereosinophilia strongly suggested a diagnosis of CSS. The patient was treated with 40 mg of prednisolone and 120 micro g of intravenous prostaglandin E1 daily, and all the digits that had turned black and necrotic were amputated. After the amputation, the dose of prednisolone was gradually reduced, and no new lesions appeared on the skin or in the liver. The rare possible complications of CSS, including necrosis of digits and liver infarction, should not be ignored.

A 3-year-old Japanese girl with severe epilepsy had been treated with potassium bromide since August 1999. The dose of potassium bromide was increased from 0.5 g/day to 0.8 g/day in May 2000 because of poor control of epilepsy. She also presented high fever, caused by bacterial pneumonia, in the same period. On June 11, a reddish eruption suddenly appeared on her back. Physical examination revealed grain-size, dark-red, erythematous papules and pustules on the back and face (Fig. 1). Some of the lesions on the back were ovoid to circular with small pustules and necrotic centers. Although some papules seemed to have dell in their centers, showing the appearance of herpes virus infection, Tzanck test was negative. A biopsy specimen obtained from one of the papules revealed a massive infiltration of eosinophils and neutrophils, forming an abscess in the epidermis and dermis (Fig. 2). The serum bromide level, which was 43.7 mEq/L (normal, 0-5 mEq/L) on May 25, increased to 114 mEq/L on June 14. The eruption disappeared within 10 days after the withdrawal of potassium bromide and treatment with topical sulfadiazine silver cream. The serum bromide decreased to 56.8 mEq/L on July 6.