皮膚病診療 41巻4号 (2019年4月)

  • 文献概要を表示

・菌状息肉症に皮膚アミロイドーシスが続発した症例を経験した.

・臨床的にポイキロデルマ,乾癬様,結節など多彩な皮膚所見を認めた.

・真皮に沈着したアミロイドは抗ケラチン染色が陽性であり,皮膚アミロイドーシスと診断した.

・ナローバンドUVB(NBUVB)療法で紅斑の消褪傾向と結節部の平坦化がみられ,効果的であった.

(「症例のポイント」より)

 

Secondary cutaneous amyloidosis in a patient with mycosis fungoides

 

Tsukahara, Rieko1)Umemoto, Naoka1)Yamada Tomoko2)Kawase, Masaaki2)Demitsu, Toshio2) 1)Department of Dermatology, Sashiogi Hospital 2)Department of Dermatology, Jichi Medical University Saitama Medical Center

 

A 53-year-old woman had received topical steroid for her eruption as atopic dermatitis for 20 years. She had had diffuse poikiloderma on the trunk and extremities. A nodule on the knee and well-delineated erythematous plaque with a silvery-white scale on her buttocks and her thigh also existed. A biopsy specimen revealed an atypical lymphocyte infiltration from the epidermis to the dermis and necrosis of the keratinocytes. In addition, amorphous eosinophilic deposits were present in the papillary dermis. We diagnosed this case as secondary cutaneous amyloidosis associated with mycosis fungoides.

  • 文献概要を表示

・自験例はAL(免グロブリン性)アミロイドーシスにみられる典型的な「アライグマの眼サイン(raccoon eyes sign)」を呈した.

・皮膚生検組織のCongo red染色においては,アミロイドの染色性が薄く,典型的な染色所見は得られなかったが,心筋生検組織にて明瞭なアミロイド沈着が証明され,病理組織学的にも全身性アミロイドーシスと確定診断した.

(「症例のポイント」より)

 

Systemic amyloidosis with monoclonal gammopathy of undetermined significance (MGUS)

 

Ueda, Takashi1)Utsumi, Yuri1)Watanabe, Masahiro2)Shirai, Kyomi1) 1)Department of Dermatology, National Hospital Organization Yokohama Medical Center 2)Department of Cardiology, National Hospital Organization Yokohama Medical Center

 

An 83-year-old Japanese man presented with an approximately 1-year history of purpura in the eyelids (raccoon eyes sign). The purpura, which develops with minor trauma, gradually extended to the neck and trunk. Skin biopsy from an eyelid showed pink, acellular, eosinophilic, homogeneous material in the dermis on hematoxylin and eosin staining. This pink eosinophilic material displayed apple-green birefringence under polarized light on congo red staining. Bone marrow biopsy showed 10% plasma cells. Systemic amyloidosis was diagnosed based on the clinical presentation and histopathology. Six months after first presentation, he fainted twice. A biopsy of cardiac muscle showed amyloid deposits resembling those from skin biopsy. The patient declined further treatment and died of heart failure after 1 year.

  • 文献概要を表示

・水疱を形成した反応性AAアミロイドーシスを経験した.

・水疱・血疱を伴ったアミロイドーシスに抗AA抗体陽性を伴った例は本邦,海外ともに少なく,今後の症例の集積が待たれる.

(「症例のポイント」より)

 

A case of AA amyloidosis with bullous formation

 

Miyake, Atsushi1)Hayashi, Yoshio1)Takimoto, Sonoko1)Takahashi, Koji1)Saito, Ikuo2)Ohmatsu, Hanako1) 1)Department of Dermatology, National Hospital Organization Sagamihara National Hospital 2)Department of Diagnostic Pathology, National Hospital Organization Sagamihara National Hospital

 

An 87-year-old female presented with hemorrhagic bullous skin lesions with purpura and scratch marks affecting the neck, chest, and axilla. She had a history of chronic heart failure, chronic renal failure, and dementia, but had not undergone dialysis. Biopsy specimen from purpura revealed amorphous, eosinophilic masses in the dermis and subcutaneous tissue. The direct fast scarlet stain revealed amyloid deposition. The amyloid was permanganate-sensitive, positive for anti-AA antibody, but negative for anti-TTR antibody; the observation qualified for a diagnosis of AA amyloidosis. She had no collagen diseases, including rheumatoid arthritis or systemic vasculitis. Bence-Jones protein was not detected. However, high titer of CA125, fecal occult blood, and IgG-λ type M-proteinemia were observed. Computed tomography showed thickened rectal wall. The evaluation ended, as she desired. There are only few reports of AA amyloidosis with blister formation in current literature.

  • 文献概要を表示

・腹部の無疹部より皮膚生検し,病理組織学的所見でアミロイドの沈着を認め,全身性アミロイドーシスの確定診断の一助となった.

・皮膚生検は他臓器の生検と比べ侵襲が少なく,容易であり,アミロイドーシスの診断に積極的に取り入れるべきと考える.

(「症例のポイント」より)

 

A case of systemic amyloidosis that diagnosis was aided by a biopsy from the normal skin

 

Kamei, Chisato1)Tohda, Rie1)Shimizu, Nami1)Okabayashi, Aya1)Nakagawa, Koichi1) 1)Department of Dermatology, Saiseikai Tondabayashi Hospital

 

An 80-year-old male diagnosed with lower edema and diarrhea was admitted to the department of cardiovascular internal medicine in our hospital. As doctors detected full circumferential wall thickening by an echocardiogram, they suspected the patient was suffering from cardiac amyloidosis. Therefore, they requested us to perform a skin biopsy on the abdomen without abnormal eruption. Histopathology of the specimen revealed an amyloid deposit around the blood vessels in the adipose tissue. These findings aided the diagnosis of systemic amyloidosis. We emphasized such a skin biopsy is very safe and useful for the diagnosis of systemic amyloidosis.

  • 文献概要を表示

・水疱を形成した反応性AAアミロイドーシスを経験した.

・画像検査にて肺野に結節影が多発しており,アミロイド病変の可能性が示唆される.他臓器へのアミロイド沈着に関して慎重な経過観察が必要である.

(「症例のポイント」より)

 

Secondary cutaneous AA amyloidosis in a patient with Sjögren’s syndrome

 

Yamashita, Chigusa1)Tanaka, Aya1)Shirai, Hirohiko1)Sonobe, Syoko2) 1)Department of Dermatology, Sakai City Medical Center 2)Department of Respiratory disease, National Hospital Organization Kinki-chuo Chest Medical Center

 

A 70-year-old female complained of xerostomia and xerophthalmia and was diagnosed as primary Sjögren’s syndrome. At the same time, she had skin nodule on left lower leg. Skin biopsy specimen from the left lower leg revealed amyloid A protein deposition in the dermis. Furthermore, her chest X-ray and CT scan showed multiple nodular shadows in the lungs and the lesions were also supposed to be AA amyloidosis.

  • 文献概要を表示

・当科で経験した脛骨前粘液水腫(pretibia-lmyxedema,以下PTM)の2例のうち,1例はBasedow病,1例は橋本病患者であった.

・PTMはBasedow病のまれな合併症であるが,橋本病にも極めてまれに合併する.

・PTMにはTSH受容体抗体の関連が示唆されており,当科で経験した2例でも抗体価が上昇していた.

(「症例のポイント」より)

 

Pretibial myxedema associated with thyroid abnormalities : of two case reports

 

Takazawa, Maya1)Umemoto, Naoka1)Yamada, Tomoko1)Kawase, Masaaki1)Demitsu Toshio1) 1)Department of Dermatology, Jichi Medical University Saitama Medical Center

 

Two reports presents a rare case of pretibial myxedema(PTM)occurring in a 70-year-old man with Basedow’s disease and a very rare case of PTM occurring in a 60-year-old man with Hashimoto's disease. Histopathological findings confirmed the presence of PTM in two patients who underwent pretibial skin biopsy. Laboratory tests of both cases showed normal thyroid stimulating hormone (TSH)and serum free T3 and T4 levels. The TSH receptor antibody titer was elevated. The mechanism of PTM is unknown,but most likely that is increase of the score of TSH receptor antibody. Both cases responded well to topical steroid treatment.

  • 文献概要を表示

・当科で経験した脛骨前粘液水腫(pretibia-lmyxedema,以下PTM)の2例のうち,1例はBasedow病,1例は橋本病患者であった.

・関節リウマチ(rheumatoid arthritis;以下,RA)に合併した左手関節部屈側のself-healing papular mucinosis(以下,SHPM)を経験した.

・生検施行後,病変の退縮傾向を認め,生検半年後に完全に消褪した.

・成人型のSHPMは12例の報告があり,そのうち自験例は最高齢である.

・長期にわたるRA罹患歴がSHPM発症になんらかの影響を及ぼす可能性が推測された.

(「症例のポイント」より)

 

A case of self-healing papular mucinosis of a Japanese female associated with rheumatoid arthritis

 

Tohda, Rie1)Kamei, Chisato1)Shimizu, Nami1)Okabayashi, Aya1)Nakagawa, Koichi1) 1)Department of Dermatology, Saiseikai Tondabayashi Hospital

 

A 75-year-old Japanese woman presented with a month history of asymptomatic slightly reddish papules on the front of left wrist. The papules ranged from 2 to 5 mm in diameter. She had been suffering from rheumatoid arthritis for 17 years. Histological examination revealed mucin deposit in the upper and mid dermis with proliferation of fibroblasts and perivascular infiltrate of inflammatory cells. Six months after the skin biopsy, the lesions resolved spontaneously without treatment. It was guessed that the long history of rheumatoid arthritis might participate in the occurrence of this disorder.

  • 文献概要を表示

・右上眼瞼の打撲部位に生じた結節性黄色腫を経験した.

・部分生検後に自然消褪をきたした.

・自験例は打撲を契機に短期間で急性に発症しており,過去に同様の報告はなくまれな症例である.

(「症例のポイント」より)

 

A case of tuberous xanthoma triggered by blunt trauma

 

Kataoka, Yukiko1)Asai, Jun1)Katoh, Norito1) 1)Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science

 

An 82-years-old man was referred to our hospital for a nodule on the upper right eyelid. He gave a history of bruising his upper right eyelid two weeks earlier. Histopathologically, the lesion was characterized by the presence of foamycells in the dermis and subcutis. We diagnosed the nodule as a tuberous xanthoma. The nodule disappeared spontaneously within three months.

  • 文献概要を表示

・Ⅳ型脂質異常症に伴い発症した発疹性黄色腫を経験した.

・食事療法と運動療法のみで高トリグリセライド血症および皮疹は改善した.

・脂質異常症を背景とする発疹性黄色腫の治療では,安易に薬物療法を選択せず,まず食事療法と運動療法による改善を試みる必要がある.

(「症例のポイント」より)

 

A case of eruptive xanthoma improved by exercise and diet therapy

 

Miyagawa, Hidemi1)Hayakawa, Jun1)Ohni, Mitsuo2)Ohyama, Manabu1) 1)Department of Dermatology, Kyorin University School of Medicine 2)Department of Genontology, Kyorin University School of Medicine

 

A 36-year-old female visited our institute with 2-week history of asymptomatic eruptions on the whole body. On physical examination, yellowish papules predominantly distributed on the trunk and the extremities were observed. In histology, perivascular collection of foam cells in the superficial layer of the dermis was noted. The diagnosis of eruptive xanthoma was made. Laboratory examination revealed dyslipidemia. Hypertriglyceridemia started to improve 4 weeks after the initiation of exercise and diet therapy. This case reports clearly indicated the importance of dietary and lifestyle guidance over drug therapy in the management of dyslipidemia-associated eruptive xanthoma.

  • 文献概要を表示

・播種状黄色腫はまれな疾患であるが,アトピー性皮膚炎と同様に間擦部に対称性に皮疹が出現するという特徴がある.しかしその病理組織学的所見は肉芽腫で特異的である.

・発症機序は不明で,海外では抗IL-1受容体抗体が奏効した症例が報告されているが,本邦では適応がなく,承認されている有効な全身療法はない.

・自験例はCO2レーザーとルビーレーザーを用いて整容的な改善を得ることができた.対症療法的な治療であるが患者の満足度は比較的高い.

(「症例のポイント」より)

 

Xanthoma disseminatum in a young adult female : A case cosmetically ameliorated by laser therapy

 

Kogame, Toshiaki1)Shibuya, Mami1)Okamoto, Natsuko1)Kumakiri, Masanori2)Arata, Jun2)Toichi, Eiko1) 1)Department of Dermatology, National Hospital Organization Kyoto Medical Center 2)Department of Plastic Surgery, National Hospital Organization Kyoto Medical Center

 

A woman in the third decade suffered from diabetes insipidus and yellow-brown, granulomatous papules. The papules symmetrically appeared on the intertriginous areas such as the axillary fossa, the upper eye lids and the neck. Histopathological analysis revealed that the granulomas were composed of CD68+/CD1a−/S100− cells, which suggested the non-Langerhans cell origin. Coupled with the unique distribution of the skin lesions, the diagnosis was finally concluded as xanthoma disseminatum. Application of a CO2 laser and a ruby laser cosmetically ameliorated her cutaneous symptoms.

  • 文献概要を表示

・口蓋に生じた異物沈着による色素斑を経験した.

・X線微量点分析では,主としてチタンが検出された.

(「症例のポイント」より)

 

Oral pigmented lesion caused by the deposition of titanium

 

Urano, Shoko1)Kimu, Taishi2)Ohta, Isao3) 1)Department of Dermatology, Enshu General Hospital 2)Department of Plastic Surgery, Enshu General Hospital 3)Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine

 

A 61-year-old female was pointed out an asymptomatic pigmented lesion by a dentist. After 4 days, she visited our hospital for the evaluation of the lesion. Physical examination revealed a 3×2 mm blue-grey macule on the palate. With the main differential diagnosis of malignant melanoma, the lesion was completely excised. Histological examination showed numerous granular and irregular dark brown deposits being distributed among collagen fibers, which extends through the entire dermis to subcutaneous fat. An X-ray microanalysis revealed that the depositions consisted mainly of titanium.

  • 文献概要を表示

・両側下腿前面に青黒色斑が出現し,ミノサイクリン塩酸塩による色素沈着Ⅱ型と考えられた1例を報告した.

・内服は中止とし,中止後10カ月後に消褪した.

・ミノサイクリンは抗菌作用だけではなく,抗炎症作用があるため,慢性炎症性疾患に対して長期にわたって用いられる薬剤ではあるが,色素沈着については忘れてはならない副作用として広く認識する必要がある.

(「症例のポイント」より)

 

A case of minocycline-induced pigmentation of lower legs

 

Nojiri, Yuka1)Kato, Hiroshi1)Horio, Ai1)Morita, Akimichi1) 1)Department of Dermatology, Nagoya City University School of Medicine

 

A 25-year-old woman visited to our hospital complaining with 10-month history of blue-black pigmentation on her lower legs. She had a history of acne vulgaris and had taken minocycline hydrochloride for 11 months. Clinical feature exhibited blue-black pigmentation on her both lower legs. Histological findings showed brown pigment granules in macrophages clustered around vessels in the reticular dermis, which was positive with the Prussian blue method for iron. Based on these findings, we diagnosed her with minocycline-induced pigmentation. After withdrawal of the minocycline, the pigmentation gradually disappeared. Since minocycline is a medicine that is often used for chronic inflammatory diseases for a long time, pigmentation should be widely recognized as an important side effect.

  • 文献概要を表示

・皮膚沈着症(calcinosis cutis)は,基礎疾患により3つに分類されている.

・その中でも,カルシウム,リン代謝異常,膠原病などの基礎疾患や腫瘍,外傷などの誘因がないものをidiopathic typeといい,自験例のtumoral calcinosisはこの中に属する.

・tumoral calcinosisは本邦において20例しか過去に報告がなく,比較的まれな疾患といえる.

(「症例のポイント」より)

 

A case of tumoral calcinosis

 

Hoshiyama, Yasuko1)Yanagihara, Shigeto2)Oiso, Naoki2)Kawada, Akira2) 1)Department of Dermatology, JCHO Osaka Hospital 2)Department of Dermatology, Kindai University Faculty of Medicine

 

We report a 78-year-old Japanese female patient with 3 years history of a subepidermal nodule on the right lumbar. Physical examination revealed a slightly raised, firm and painful nodule of 25*30 mm in size. Blood tests were not unusual. This nodular skin lesion was evaluated with computed tomography, indicating a high concentration region in the subcutaneous fat. Histopathological findings showed in the subcutaneous tissue masses of calcium deposition surrounded by fibrous tissue. This patient had neither hypercalcemia nor hyperphosphatemia and showed no underlying diseases. So, we diagnosed as tumoral calcinosis. Tumoral calcinosis is classified into the idiopathic calcinosis cutis. The mechanism of the calcification is still unclear. 6 months have passed after excision, but it does not recur. Because tumoral calcinosis is known to be prone to recurrence, we should continue with the follow-up observations have to a regular observation.

  • 文献概要を表示

・腎不全に併発した転移性皮膚石灰沈着症(metastatic calcinosis cutis)の1例を経験した.

・自験例はビタミンD製剤,カルシウムサプリメントの長期摂取が腎不全の増悪ならびに石灰沈着症の誘因と考えられた.

・石灰沈着症の診断においては,基礎疾患の有無,血液検査ならびに薬剤,サプリメントなどの摂取歴を聴取する必要がある.

(「症例のポイント」より)

 

A case of metastatic calcinosis cutis associated with renal failure

 

Watabe, Daisuke1)Akasaka, Toshihide2)Kan, keiko3)Amano, Hiroo1) 1)Department of Dermatology, Iwate Medical University School of Medicine 2)Division of Dermatology, Kitakami Saiseikai Hospital 3)Kan Orthopedics and Dermatology Clinic

 

A 61-year-old woman presented with a cutaneous nodule on the left knee that had been present for 5 years. Physical examination revealed multiple, hard, yellow-whitish nodules in the periarticular regions. X-ray examination of the left hand demonstrated calcified nodules on the periarticular tissues. Histologically, nodular calcified masses were evident in the dermis and subcutaneous tissue. Laboratory examinations revealed elevated levels of serum calcium and phosphate at 12.1 mg/dl and 5.2 mg/dl, respectively. The level of intact PTH was normal. These findings were consistent with metastatic calcification associated with renal failure and hypercalcemia due to chronic ingestion of vitamin D and calcium supplement. After improvement of renal function, the skin nodules resolved gradually.

  • 文献概要を表示

・過去報告例と比較して巨大なインスリンボールを経験した.

・全切除および病理組織学的所見よりインスリンボールと診断した.

・インスリンボールの発生予防には注射部位のローテーション指導が重要である.

(「症例のポイント」より)

 

A case of giant insulin ball

 

Kitano, Tasuku1)Oishi,Naoto1)Sugishita, Kazuyuki2)Takazakura, Eisuke3) 1)Department of Dermatology, Kurobe City Hospital 2)Department of Plastic Surgery, Kurobe City Hospital 3)Department of Internal Medicine, Takazakura Internal medicine Clinic

 

The patient was a 55-year-old female who was diagnosed with type 2 diabetes and treated with insulin. A skin tumor appeared on her left abdomen and grew bigger over time, leading her to visit the hospital. She underwent resection surgery to remove the tumor under general anesthesia. Histologically, her tumor samples showed amyloid deposits and an increased density of collagen fibers in the dermis. The tumor was thus diagnosed as insulin injection-induced local amyloid deposition. Her blood insulin levels were markedly lower when insulin was injected into the region containing amyloid deposits than when it was injected into healthy skin.

  • 文献概要を表示

・右第Ⅱ趾に生じた痛風結節.

・初診直前まで,痛風発作がなく,患部に気づかなかった.

・生検時に治療への貢献も兼ねてデブリードマンをすると白色チョーク様物質が排出された.

(「症例のポイント」より)

 

A case of tophus without suffering painful attacks

 

Suzuki, Nagao1)Seo, Kazumi2)Anami, Takashi3) 1)Suzuki Dermatology Clinic 2)Twin Orthopedics Clinic 3)Sapporo Dermatopathology Institute

 

A 75-year-old man developed whitish subcutaneous nodule on the dorsal side of the second distal interphalangeal joint. He has never experienced any kind of pain in the affected area. Histological examination of the nodule revealed gouty tophus. During the biopsy, the tophus was removed through débridement. I think that development of tophus may have been brought about by stagnation of the bloodstream around the second distal interphalangeal joint. The Grecian foot deformity of the pharanx bones or additional trauma may have possibly caused stagnation of bloodstream.

editorial

  • 文献概要を表示

医療倫理とは,生命倫理学の一分野であり,医 療やヘルスケアに関連した倫理的問題を扱う学問 分野である.医療倫理は,主に研究倫理と臨床倫 理という2つの柱からなる.研究倫理は,倫理的な 研究のあり方を問うものである一方,臨床倫理は, 「臨床現場で生じた倫理的問題を同定分析し,解 決を試みることにより,患者ケアの質を向上させ る」「ある特定の患者の具体的な臨床場面で,より よい倫理的意思決定を模索する」ことを目的とし た,倫理的な取り組み,倫理実践である.つまり, 日常診療における医療倫理とは,すなわち臨床倫 理を指すものといえよう.(冒頭より)

  • 文献概要を表示

医学研究においては,ヒト由来の情報を用いる ことが必要不可欠である.その多くの場合では, 特定の個人を識別することができる情報を取り扱 うこととなり,その特定の個人の健康状態などそ の取り扱いに特別な配慮が必要である.さらに観 察研究では,研究対象者から研究についてのイン フォームド・コンセントを受ける代わりに,オプ トアウト(通知または公開と拒否権の保障)が同意 手続きとして実施されることもしばしばである.  2017年に「個人情報の保護に関する法律」(個人 情報保護法:以下,個情法)が改正施行された際に, 医学研究に関する倫理指針も改正され,医学研究 における個人情報の取り扱いや同意手続きが改め て注目された.本稿では,法令や行政指針を遵守 し社会に受容されるかたちで研究を実施するため に必要な,医学研究における個人情報の保護と利 活用についての基本的な枠組みを解説する.(「はじめに」より)

蝶の博物詩

生態46 西山 茂夫

皮心伝心

診察室の四季

夕桜 斉藤 隆三

皮膚科のトリビア

第166回 浅井 俊弥

「結核接触者健康診断」の話

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目次

編集後記・次号予告

基本情報

pd-41-4_cover.jpg
皮膚病診療
41巻4号 (2019年4月)
電子版ISSN:2434-0340 印刷版ISSN:0387-7531 協和企画

文献閲覧数ランキング(
7月6日~7月12日
)