皮膚病診療 41巻7号 (2019年7月)

  • 文献概要を表示

・キックボクシングの試合にて感染したと考えられた,水疱性膿痂疹と格闘家ヘルペスの合併例を経験した.

・水疱性膿痂疹を思わせる皮膚症状を呈していたが,発熱・リンパ節腫脹といった全身症状を伴っていたこと,小水疱を認めていたことで格闘家ヘルペスと診断することができた.

・抗菌薬投与に加えアシクロビル投与で改善した.

(「症例のポイント」より)

 

A case of herpes gladiatorum with bullous impetigo induced by kickboxing

 

Kimura, Tetsuko1)Hayashi, Hiroaki1)Yamamoto, Takenobu2)Fujimoto, Wataru1)Aoyama, Yumi1) 1)Department of Dermatology, Kawasaki Medical School 2)Department of Dermatology, Kawasaki Medical School General Medical Center

 

16-year-old man presented with erythematous papules on his middle forehead on the day following a kickboxing match. The rash worsened with fever. Systemic antibiotics such as cefcapene pivoxil and vancomycin for bullous impetigo were not effective in fever response. Herpes gladiatorum with bullous impetigo was diagnosed by detection of MSSA with exfoliative toxin-A and HSV-1 in skin lesions. Systemic acyclovir and topical Nadifloxacin reduced fever and induced quick crust formation. Herpes gladiatorum is an infection of HSV occurring among those who engage in combative sports. HSV-1 may have been transmitted from the opponent in the kickboxing match.

  • 文献概要を表示

・手足口病罹患1週間後に全身の多形紅斑を生じた.

・オロパタジンとプレドニゾロンの内服で紅斑は治癒した.

・ウイルス感染に続発した免疫変調により多形紅斑が生じた可能性が示唆された.

(「症例のポイント」より)

 

A case of erythema multiforme developed secondary to hand and foot mouth disease

 

Okazaki, Sari1)Osawa, Risa1)Fujioka, Ai1)Nakajima, Kimiko1)Sano, Shigetoshi1)Kitagawa, Nobuko2) 1)Department of Dermatology, Kochi Medical School, Kochi University 2)Yoshimoto Dermatology Clinic

 

A 33 years old woman, who had been recently suffered from hand and foot mouth disease, presented with bulla on the her hands and feet. About 1 week later the symptoms disappeared, exudative erythema, vesicle appeared on her trunk and limbs. Pathological findings of erythema on the abdomen showed necrotic keratinocytes, liquefaction of the basement membrane and inflammatory cell infiltrate around the small vessels at the upper dermis. Anti coxsackievirus groupA type6-NT antibody (IgG) was elevated. Skin lesions improved with oral administration of predonizolone. We considered the possibility that erythema multiforme developed secondary to hand and foot mouth disease.

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・背部,左踵,両足趾爪からScopulariopsis(S.)brevicaulisが分離されたTrichophyton (T.)rubrumによる汎発性白癬を経験した.

・足趾爪以外の体の皮疹からS. brevicaulisが分離されることはまれである.

・S. brevicaulisが分離された背部の皮疹も含め皮疹は塩酸テルビナフィン内服とルリコナゾール軟膏治療により約2カ月間で消褪した.

(「症例のポイント」より)

 

A case of widespread tinea corporis caused by Trichophyton rubrum possibly complicated with Scopulariopsis

 

Takeda, Kiminobu1)Mochizuki, Hirokazu1)Anzawa, Kazushi1)Mochizuki, Takashi1) 1)Department of Dermatology, Kanazawa Medical University Abstract

 

A 74-year-old man with widespread tinea caused by Trichophyton rubrum presented with multiple annular lesions. Samples obtained from lesions on his back, left heel, and toe nails were cultured. Scopulariopsis brevicaulis was among pathogens isolated from each lesion. His tinea corporis, including back and heel lesions, was successfully treated with oral terbinafine and topical luliconazole. Scopulariopsis, a keratinolytic fungus, is a known causative agent of onychomycosis. Its isolation from other than nail lesions is extremely rare. Whether this species was a contaminant or concomitant pathogen was not confirmed or disproved. The pathogenicity of Scopulariopsis has been discussed.

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・夏場の潮干狩りでVibrio vulnificus(以下V. vulnificus)による壊死性筋膜炎を生じた症例を経験した.死亡率が高いが,救命しえた.

・既往歴にアルコール性肝障害があった.

・早期に皮膚切開とデブリードマンを施行し,empiric therapyとしてメロペネム,クリンダマイシンで抗菌薬投与を開始したところ炎症反応が改善した.

・エンドトキシンによる多臓器不全に対し,エンドトキシン吸着療法(PMX-DHP)を行ったところ,予後が改善された.

(「症例のポイント」より)

 

Necrotizing fasciitis by Vibrio vulnificus infection

 

Hidaka, Yuri1)Mitsuma, Teruyuki1)Murakami, Megumi1)Ueno, Erika1)Mizuta, Miyuki1)Aiyama, Akiteru1) 1)Department of Dermatology, Ichinomiya Municipal Hospital Abstract

 

A 70 years old man with alcoholic liver disease was admitted to our hospital with high fever, depression in blood pressure, general fatigue, and eruption in the lower left leg. He went to get the shellfish on the coast of Aichi prefecture a few days before onset. We took antibiotics immediately, and excised necrotizing tissue in the left leg. Vibrio vulnificus was isolated from a blood culture performed. Then, endotoxin absorption therapy was performed, which successfully saved the patient’s life. In order to prevent this type of fatal infection, it is necessary for medical staffs and patients who have liver disease, diabetes and immune deficiency to make the better understandings of its clinical characteristics.

  • 文献概要を表示

・クラゲは海洋生物による毒被害でもっとも多い原因生物である.

・クラゲ毒による傷害には疼痛や線状発赤,発疹,瘙痒感などの即時型反応と,壊疽や潰瘍形成,血管攣縮,四肢のチアノーゼ,深部静脈血栓症,視力障害,顔面浮腫などの遅延型反応がある.

・自験例はクラゲ毒による遅延型反応で下肢末梢動脈に血管攣縮が生じ,その結果,虚血に伴う足趾末梢循環不全をきたしたと推察した.

(「症例のポイント」より)

 

Jellyfish sting resulting in toes ischaemia

 

Hashimoto, Nana1)Nakata, Kaya1)Watanabe, Kosuke1)Takahashi, Misaki1)Niiyma, Shiro1)Fukuda, Hidetsugu1) 1)Department of Dermatology, Toho University Ohashi Medical Center Abstract

 

A 33-year-old woman visited our department for swelling in her right lower leg and cyanosis in her toes. She was swimming in shallow sea water in the Philippines and stung by a jellyfish 4 days before admission. Vascular spasm is one of the delayed type responses in jellyfish poisoning. We diagnosed the skin disorder as ischemia caused by vasospasm which delayed type response by jellyfish poisoning. The patient was treated with intravenous alprostadil (10μg/day)and heparin sodium (10,000 units/day)and at 12 days after stung by a jellyfish was almost fully recovered.

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・ツツガムシ病のミノサイクリンによる治療経過中に髄膜脳炎を併発した1例を経験した.

・治療開始から4日後に突然の意識障害をきたし,髄液検査で髄膜脳炎が疑われた.

・ツツガムシ病に伴う髄膜炎や髄膜脳炎にミノサイクリン治療が奏効した例は報告があるが,治療開始後に意識障害を認め,同治療継続により改善を認めたことを示した報告はまれである.

(「症例のポイント」より)

 

A case report of scrub typhus complicated with meningoencephalitis under treatment

 

Endo, Ruriko1)Ishizuki, Shoichiro1)Taguchi, Shijima2)Shioya, Ayako3)Ishioka, Haruhiko4) 1)Department of Dermatology, University of Tsukuba Hospital 2)Department of Dermatology, Mito Kyodo General Hospital 3)Department of Neurology, Mito Kyodo General Hospital 4)Department of Infectious diseases, Mito Kyodo General Hospital

 

We report a case with scrub typhus complicated with meningoencephalitis. A 61-year-old man with a tick bite developed fever and black eschar. The blood test revealed a multiorgan failure and atypical lymphocytes. He was clinically diagnosed with scrub typhus. Soon after starting treatment with minocycline, he became stupor. Although brain MRI showed no notable change, the cerebrospinal fluid revealed encephalitis with mild pleocytosis with monocyte domination and mildly high protein level. We continued minocycline treatment as we diagnosed with encephalitis caused by scrub typhus. Finally, he recovered without any complication.

  • 文献概要を表示

・腎不全,呼吸不全を呈したが救命できた重症マムシ咬傷を経験した.

・マムシ抗毒素血清の投与が遅滞した.

・クレアチンキナーゼは15万 IU/l,白血球は2万/μlを超えた.

・ヘパリン投与で血栓形成を抑制することにより腸管壊死の予防を試みた.

(「症例のポイント」より)

 

A patient rescued from severe mamushi bite that induced severe clinical symptoms

 

Okamoto, Osamu1)Hayashi, Tomokazu2)Nakashima, Ryuta2)Hashimoto, Hiroyuki3)Inagaki, Nobuhiro2) 1)Division of Dermatology, Oita City Medical Association’s Almeida Memorial Hospital 2)Division of Critical Care and Emergency Medicine, Oita City Medical Association’s Almeida Memorial Hospital 3)Division of Plastic Surgery, Oita City Medical Association’s Almeida Memorial Hospital

 

We herein report a case of severe mamushi bite that induced severe clinical symptoms. After being bitten, the patient was admitted to another hospital but not given anti-mamushi venom serum. After renal failure appeared the next day, the patient was transferred to our hospital, and the antiserum was given (25 h after the bite). However, the levels of creatine kinase and several hepatic transaminases were severely elevated, and respiratory failure appeared. The patient received hemodialysis, respiratory assist, and heparin administration to prevent intestinal necrosis due to thrombosis. Although the renal failure continued for 20 days, the renal function ultimately recovered, and the patient survived and left the hospital.

  • 文献概要を表示

・アムロジピンによる光線過敏型薬疹を経験した.

・内服照射試験でUVAの最小紅斑量(minimal erythema dose:MED)の低下が認められた.

・アムロジピン内服開始から皮疹出現まで8カ月を要した.アムロジピン中止後,速やかに皮疹が消失し,再投与で皮疹が再燃した.

・内服開始から症状出現まで約8カ月を要していたこと,内服照射試験でUVA1.5 J/cm2以下と少量で紅斑が誘発されたことなどから,

光アレルギー性反応の機序により発生したものと推測された.

(「症例のポイント」より)

 

A case of photosensitive drug eruption caused by amlodipine

 

Matsumoto, Katsura1)Hiramatsu, Kotaro1)Takamatsu, Noriko1)Suzuki, Mao1)Ito, Akiko1)Kambara, Takeshi1) 1)Department of Dermatology,Yokohama City University Medical Center

 

A 74-year-old male developed eczematous eruptions on his face, neck and dorsum of hands 8 months after he was started on treatment with amlodipine. The photo-drug test showed a positive reaction to UVA. The eruption resolved after discontinuation of amlodipine and reappeared when the drug was resumed. Therefore, we concluded that the photosensitive eruption was caused by amlodipine.

  • 文献概要を表示

・日光蕁麻疹は国内外とも女性に好発するが,成人男性に発症した3例を経験した.

・作用波長はわが国でもっとも多い可視光線であった.

・日光蕁麻疹は作用波長によって患者指導が異なるため,光線照射テストで作用波長を同定することは肝要である.

(「症例のポイント」より)

 

Visible light-induced solar urticaria in three adult male cases

 

Nomura, Yuki1)Uetsu, Naoko1)Okamoto, Hiroyuki1) 1)Department of Dermatology, Kansai Medical University

 

Men aged 24, 44 and 46 experienced erythematous skin eruptions on sun-exposed areas immediately after exposure to sunlight. Photoprovocation tests induced erythema in a visible light-irradiated area. Strict avoidance of sunlight, daily use of photoprotective clothing and a broad spectrum sunscreen prevented photosensitivity reactions.

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・symmetrical lividities of the palms and solesの1例を経験した.

・発症の一因として,生活習慣から機械的刺激が考えられた.

・多汗症を基盤とする機序が考えられており,自覚はなかったが多汗症の治療により軽快した.

(「症例のポイント」より)

 

A case of symmetrical lividities of the palms and soles

 

Yamamoto, Yuriko1)Takenaka, Hideya1)Okuzawa, Yasutaro1)Shiomi, Mayu1)Kawai, Keiichi2) 1)Department of Dermatology, Kyoto City Hospital 2)Kawai Keiichi Dermatology Clinic

 

The patient was a 12-year-old girl who had suffered from asymptomatic edematous erythema on the edges of her both soles since about 4 months before. She had belong to a drama club and practiced in barefeet. Both clinical appearance and histological examination indicated symmetrical lividities of the palms and soles. According to the previous reports, this disease is caused by hyperhidrosis and mechanical stimulation. Although local hyperhidrosis was not found in her case, her symptoms were improved with an aluminum chloride lotion.

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・成人になるまで確定診断されなかった骨髄性プロトポルフィリン症(erythropoietic protoporphyria:EPP)の1例を経験した.

・遺伝子解析にて,フェロケラターゼ(ferrochelatase:FECH)における既知の病的変異と多型が同定された.

・長男も赤血球プロトポルフィリンが高値を示し,父親と同様の遺伝子異常が認められ,EPPと診断された.

(「症例のポイント」より)

 

A case of erythropoietic protoporphyria diagnosed in adulthood

 

Kioka, Mana1)Yu, Akitoshi2)Tanizaki, Hideaki2)Kurokawa, Teruo2)Moriwaki, Shinichi2)Nakano, Hajime3) 1)Department of Dermatology, First Towakai Hospital 2)Department of Dermatology, Osaka Medical College 3)Department of Dermatology, Hirosaki University

 

A 33-year-old man occurred cutaneous photosensitivity in childhood. At the first medical examination, cheek and back of the hands were erythematous, pitted scars were seen in cheek and the area around the mouth. His protoporphyrin level in red blood cells was high, but liver function was normal. Genetic analysis determined the missense mutation and polymorphism of FECH. Thus, the patient was diagnosed as erythropoietic protoporphyria (EPP). The patient's eldest son was also diagnosed as EPP from high protoporphyrin level in red blood cells and the same genetic abnormalities as his father although he didn't exhibit photosensitivity.

  • 文献概要を表示

・小児期に発症した膿疱性乾癬患者.経過中,海水浴による日焼けを契機に乾癬が悪化した.

・過去には光線療法で治療効果が得られていた.

(「症例のポイント」より)

 

Pediatric psoriasis showing photo-Köbner phenomenon

 

Hiraiwa, Tomoko1)Yamamoto, Toshiyuki1) 1)Department of Dermatology, Fukushima Medical University

 

A female patient was diagnosed with generalized pustular psoriasis at the age of 4 and was relatively well controlled with topical and PUVA treatments. During the course, the rash was exacerbated after sunburn in the sea at the age of 11 years old, and she was admitted to our hospital. Although ultraviolet (UV)light therapy is an essential treatment for psoriasis, there are rare cases in which psoriasis get worsened by UV light exposure (photosensitivity psoriasis:PP). The mechanism that UV light makes psoriasis better or worse is still unclear but, in our case, it was speculated that UV caused exacerbating psoriasis via activation of innate immunity.

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・日光曝露によって発症した小児全身性エリテマトーデス(SLE)の典型例を経験した.

・日光曝露はSLE発症の重要なメカニズムである.

・小児期発症のSLEは成人発症に比べて急性かつ重篤な経過をたどるため,注意が必要である.

(「症例のポイント」より)

 

Pediatric systemic lupus erythematosus triggered by frequent sun exposure

 

Usui, Toshihiro1)Arai, Satoru1)Yamaguchi, Kenichi2) 1)Department of Dermatology, t. Luke’s International Hospital 2)Immuno-Rheumatology Center, St. Luke’s International Hospital

 

Ultraviolet radiation is thought to precipitate the onset of systemic lupus erythematosus (SLE). We report a case of an 11-year-old boy who presented with a 1-month history of a butterfly rash and discoid lupus erythematosus on his bilateral ears with no systemic symptoms. A diagnosis of SLE was confirmed by blood examination and histopathological findings. Since he was a member of a football team and played football for 3-4 hours twice a week, we suspect that excessive sun exposure was a trigger of SLE in this case.

  • 文献概要を表示

・頸胸部に限局して皮疹が出現した.

・夏季に増悪し,冬季に軽快する.

・母に同症がみられた.

(「症例のポイント」より)

 

A case of Darier’s disease that developed on the neck and breast regions locally and worsens during the summer seasons

 

Suzuki, Nagao1)Kimura, Tetsunori2) 1)Suzuki Dermatology Clinic 2)Sapporo Dermatopathology Institute

 

A 35-year-old woman developed localized and symmetrical copper-colored grouped eruptions from the neck to the breast. These eruptions ameliorates every year in autumn. Histological examination of the eruption revealed that it was Darier’s disease from the findings of corps ronds and grains. Her mother was identified with the same disease. Steps in order to alleviate the exacerbation of these eruptions during the summer season are considered necessary.

  • 文献概要を表示

・第Xa因子阻害薬アピキサバンが著効したリベド様血管症を経験した.

・罹病期間は10年以上の長期にわたっていたが,アピキサバン開始3日目には疼痛が消失し,8週間目には潰瘍がほぼ上皮化した.

(「症例のポイント」より)

 

A case of livedoid vasculopathy successfully treated with factor Xa inhibitor apixaban

 

Yamaguchi, Yasuyuki1)Hirata, Yu2) 1)Department of Dermatology, Hokkaido University Hospital 2)Department of Dermatology, Hakodate General Central Hospital

 

An 83-year-old woman presented with recurrent painful livedoid vasculopathy on her right leg. She was relieved from the severe ischemic pain within 3 days after the initiation of oral factor Xa inhibitor apixaban. Moreover, the skin ulcer was almost epithelialized at 4 weeks. From the viewpoint of safety, the factor Xa inhibitor is superior to warfarin which is widely used for the treatment of livedoid vasculopathy. Our case suggests that the factor Xa inhibitor can be a first-line therapy for livedoid vasculopathy.

editorial

topics

  • 文献概要を表示

好中球の機能亢進が病態に関与している皮膚疾患は多数ある.たとえば,膿疱性乾癬,化膿性汗腺炎,壊疽性膿皮症,Behçet病などでは,病変部に好中球の浸潤がみられるのが特徴である.従来,機能亢進している好中球は通常の細胞の形態を保っていると考えられていたが,必ずしもそうでないということが明らかになってきた.近年,好中球細胞外トラップ(neutrophil extracellulartraps:NETs)という好中球の新たな形態・機能が明らかにされた(図1).NETsは微生物に対する生体防御のみならず,さまざまな疾患の病態に関与していることが注目されている.皮膚疾患も例外でないことも明らかにされてきた.本稿では,NETsと各種皮膚疾患との関係について概説する.(「はじめに」より)

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日本における代表的な陸生の毒ヘビはニホンマムシ,ヤマカガシ,ハブである.ハブは南西諸島に限局して生息しており,本州に生息する毒ヘビはニホンマムシ(以下マムシ)とヤマカガシの2種である1).とくにマムシ咬傷は全国の発生件数は年間1,000~3,000件ともいわれる.致死率は高くないが(年間約10人の死亡者数),重症化すると急性腎不全などをおこすことが知られている1, 2).当院は青森県の県庁所在地に位置するものの市の郊外や近隣市町村は自然豊かな山村地域であり,春から夏の山菜採り,秋のキノコ狩りなど山に親しむ文化も残っているため,ほぼ毎年マムシ咬傷例を経験している.今回われわれは青森市民病院において1998~2018年に経験したマムシ咬傷26例の咬傷発生の背景や症状と治療を後ろ向きに検討し,1症例を供覧する.(「はじめに」より)

the case of the month

  • 文献概要を表示

・甲虫ハネカクシ類の代表種,アオバアリガタハネカクシの体液による接触皮膚炎は線状の紅暈を伴う水疱・膿疱が特徴的とされ「線状皮膚炎」として,あらゆる教本に紹介されている.

・現実の日常臨床上,そのような「線状」の典型例は必ずしも多くなく,微小膿疱散布型や,灰褐色局面を呈するものが多い.

・夏季に忽然と生じた「ムジムジ痒く,チリチリ痛い」急性皮膚炎例では,接触皮膚炎疑いの臨床診断までは行うものの,原因が不明確なまま対応することが多く,線状皮膚炎亜型の可能性を疑うことが大切である.

(「症例のポイント」より)

私の視点

早期体験実習の一場面 森田 栄伸

皮心伝心

全身療法 常深 祐一郎

診察室の四季

夏蒲団 斉藤 隆三

皮膚科のトリビア

第169回

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目次

編集後記・次号予告

基本情報

pd-41-7_cover.jpg
皮膚病診療
41巻7号 (2019年7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27日~8月2日
)