Photosensitivity associated with treatment with triflusal

BACKGROUND: Triflusal is a fluorinated aspirin derivative with antiplatelet properties, which is used in Spain for the management and prevention of thromboembolic disease. CASE REPORT: A 91-year-old female developed a systemic photosensitivity reaction 15 days after beginning triflusal preventive treatment (300 mg/12 h) for prior transient ischaemic attack. Photobiological study showed an abnormal response to light in areas exposed to ultraviolet B and A radiation, with a photopatch test positive to both triflusal and its main metabolite. These observations suggested a causal relation between triflusal and the clinical findings, as described in previous reports. CONCLUSIONS: The few cases reported to date and the clinicopathological features of this case suggested an immunological response as the most likely cause of the reaction.     

糖皮质激素联合免疫球蛋白治疗中毒性表皮坏死松解症15例疗效观察

目的:探讨糖皮质激素联合静脉注射免疫球蛋白(IVIG)治疗中毒性表皮坏死松解症(TEN)的临床疗效、不良反应和转归。方法:回顾性分析15例TEN患者采用糖皮质激素联合免疫球蛋白治疗的临床资料。结果:15例TEN患者均伴有黏膜糜烂,皮损(表皮已剥脱或即将剥脱)面积占体表面积的(19.40±6.51)％;糖皮质激素用量(以泼尼松为标准量):(1.5～2.0)mg/(kg·d);IVIG用量:(0.2～0.4)g/(kg·d),连续用药(6.0±1.3)d。联合用药第(3.0±1.3)天开始起效,痊愈9例,共治疗(23.60±5.49)d;基本痊愈5例,共治疗(16.70±3.14)d;死亡1例。所有患者均可耐受IVIG治疗。结论:糖皮质激素联合IVIG治疗TEN具有协同作用,可明显提高疗效和减少死亡,减少糖皮质激素引起的不良反应。     

Lymphoma with large-plaque parapsoriasis treated with PUVA

We report on a 78-year-old Japanese woman with a 50-year history of large-plaque parapsoriasis that had evolved into cutaneous T-cell lymphoma. Her large-plaque parapsoriasis had been treated with psoralen plus ultraviolet A for 10 years. Subsequently an isolated nodule appeared on her right lower leg. Prior or concurrent patches or plaques were absent. Histology revealed a diffuse nonepidermotropic infiltrate of large lymphocytes in the dermis, which had enlarged nuclei and prominent nucleoli. A diagnosis of CD30- cutaneous large T-cell lymphoma was made. Following systemic chemotherapy, there was clinical improvement. No evidence of recurrence or systemic lymphoma has subsequently been found.     

甲基泼尼松龙联合免疫抑制剂治疗天疱疮

采用甲基泼尼松龙联合环磷酰胺、雷公藤多甙或甲氨喋呤治疗7例天疱疮。除1例91岁患者,治疗前即合并双下肺炎死亡之外,其余6例治疗均获成功。治疗2～11天无新疱出现,16～27天皮疹全部消退。无新疱出现所需皮质类固醇量相当于泼尼松50～120mg/d(平均77.5±27.9mg/d)。皮疹全部消退所需泼尼松相当量为890～6212.5mg(平均2128.8±2045.0mg)。未见严重副作用。结果表明甲基泼尼松龙联合免疫抑制剂治疗天疱疮,见效快,皮质类固醇用量小,皮疹全消时间短,安全性好。     

The Lymphocyte Transformation Test with Sulphadiminidum and with Prealbumin-Sulphadiminidum Complex in Patients with Drug Allergy

Earlier results (the absence or a decreased level of prealbumin [PA] in the serum, a higher proportion of PA-bearing lymphocytes as antigen-binding cells, and the presence of PA in the eluate of lymphocytes in patients with drug allergy) permitted the conclusion that, besides its other relevant functions, PA may also behave as a hapten carrier protein. The lymphocyte transformation test (LTT) involving measurement of ³H-thymidine uptake was therefore carried out with sulphadiminidum (SA) alone, with the PA-SA complex, and with the albumin-SA complex in patients with proven (3 cases) or suspected (63 cases) sensitivity to SA. In all 3 cases with proven drug allergy to SA and in 5 of the 63 suspect cases, the LTT was positive in response to both the drug alone and to the PA-SA complex (The albumin-SA complex gave positivity in only one case). In 5 of the 63 suspect cases, the LTT was positive only in response to the PA-SA complex. It is suggested that the sensitivity of the LTT could be increased if the test could be run with a complex of a protein (hapten carrier?) and a drug.     

43例HIV合并梅毒感染临床及脑脊液分析

目的：分析HIV合并梅毒的临床表现及实验室特征。方法：回顾性分析2014年3月至2017年7月在我院皮肤科进行腰穿的HIV合并梅毒感染的43例患者的人口学特点、临床表现及实验室检查。结果：43例患者中男39例,女4例,中位年龄为31.5岁。有3例（7.0%）符合神经梅毒诊断（脑脊液表现为白细胞≥20/μL并伴有脑脊液RPR阳性）。这3例患者均为二期梅毒,临床表现均为眼部症状,CD4均＜350个/μL,血清RPR均≥1:32。结论：在HIV合并梅毒感染时,神经梅毒尤其好发于血清RPR≥1:32,CD4＜350个/μL的二期梅毒患者。     

Multifocal haemangioma with extracutaneous involvement associated with hypergalactosaemia

Neonatal haemangiomatosis, characterized by multiple haemangiomas, is a rare disease that develops during the neonatal period with or without visceral involvement. We report a 1‐month‐old Japanese boy with multifocal haemangiomas with extracutaneous involvement. A haemangioma on his left lower eyelid, present at birth, increased in size during the first postnatal month and more lesions developed during the same period. Neonatal mass screening showed hypergalactosaemia. Laboratory investigations found raised total bile acid and ammonia. Computed tomography and abdominal ultrasonography studies showed multiple hepatic haemangiomas and intrahepatic portovenous shunts. The child’s cutaneous and hepatic haemangiomas disappeared spontaneously with normalization of laboratory data, and galactose accumulation improved with the feeding of lactose‐free milk. There were no complications and the child has had no recurrence of the symptoms. Our case implies a possible association of multiple haemangioma and hypergalactosaemia, suggesting the necessity for visceral investigation.     

Dermatofibroma with Myxoid Changes in a Patient with Psoriasis

A 38-year-old female with psoriatic arthritis developed a dermatofibroma (DF) on her upper arm. Its position was not exactly on a psoriatic plaque; however, psoriatic lesions were present diffusely around the DF lesion. Histological examination revealed the typical features of DF with myxoid changes in the portion between the tumor nest and the overlying epidermis. The mast cell number was significantly increased over that of solitary DFs without myxomatous lesions. It was suggested that mast cells may play a role in induction of the myxoid changes in the DF lesion in this case.     

Treatment of aphthosis with thalidomide and with colchicine

Thalidomide alone (200-300 mg daily) or associated with colchicine (2-3 mg daily) was given orally to 25 patients with aphthosis: 8 patients with recurrent oral aphthae; 4 patients with recurrent mucocutaneous aphthosis, without visceral involvement, and 13 patients with Beh?et's disease (Touraine's aphthosis). A major improvement was noted in all groups, with a rapid healing of mucous lesions and a rapid reduction of pain and burning as compared to prior spontaneous regressions. No new outbreaks were noted at a dose of 50-100 mg thalidomide and 1 mg colchicine daily. Under oral administration of the drugs, thrombophlebitis was noted in 1 case (third group) only. In the other patients with Beh?et's disease, skin aphthae, ocular symptoms, arthritis, superficial nodular phlebitis quickly disappeared with treatment. The efficiency of the drugs is only temporary, since new lesions usually appeared a few weeks after the end of treatment. Due to the relatively small number of cases studied in each group, no conclusions can be drawn concerning the efficiency of thalidomide alone compared to the association of the two drugs. However, this open trial does support the usefulness of thalidomide, or thalidomide and colchicine, in recurrent mucocutaneous aphthae, aphthosis and Beh?et's disease.