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Pigmentary disorders are recognized adverse effects of the semi-synthetic tetracycline derivative antibiotic, minocycline. Three distinct types of minocycline-induced cutaneous pigmentation have been described. Type I, blue-black pigmentation confined to sites of scarring or inflammation on the face; Type II, blue-grey circumscribed pigmentation of normal skin of the lower legs and forearms; and Type III, diffuse muddy brown pigmentation of normal skin accentuated in sun-exposed areas. We report two patients with acne vulgaris with a fourth type of minocycline-induced cutaneous pigmentation. They presented with circumscribed blue-grey pigmentation within acne scars confined to the back. Histology showed pigment within dendritic cells, and extracellularly throughout the dermis. Histochemistry identified a calcium containing melanin-like substance. Iron was absent. Immunohistochemistry confirmed some pigment-containing cells to be macrophages. Electron microscopy demonstrated electron-dense granules, free and membrane-bound, within macrophages and fibroblast-like cells. Energy-dispersive X-ray analysis confirmed the presence of calcium. Iron was absent. This fourth type of cutaneous minocycline hyperpigmentation may be a variant of Type I, but based on clinical, pathological and microanalytical differences, appears to be a new entity. The pigment may be a drug metabolite-protein complex chelated with calcium, or an insoluble minocycline-melanin complex. We propose a classification of cutaneous minocycline pigmentation based on clinico-pathological criteria.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14723711&dopt=Abstract [PubMed - in process]
Nihon Kokyuki Gakkai Zasshi. 2003 Dec;41(12):868-73.
[Clinical features of Q fever pneumonia]
[Article in Japanese]
Okimoto N, Asaoka N, Osaki K, Kurihara T, Yamato K, Sunagawa T, Fujita K, Ohba H, Nakamura J.
Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kawasaki Hospital, Okayama, Japan.
We report four cases of Q fever pneumonia diagnosed using PanBio Coxilla burnetii ELISA. The patients, a 21-year-old woman, a 53-year-old man, a 74-year-old man and a 87-year-old man, were among 284 with community-acquired pneumonia who were treated as inpatients from March 2001 till March 2003. The frequency of Q fever pneumonia in community-acquired pneumonia was 1.4%. The 21-year-old woman was a typical case of Q fever pneumonia, since her clinical features showed 1. the breeding of cats, 2. development from a fever and non-productive caught in March, 3. multiple soft consolidations in the chest radiograph, 4. normal WBC count, 5. cure by administration of clarithromycin. The pneumonias of the other 3 cases were considered to be mixed infections, with bacteria such as Streptococcus pneumoniae and Haemophilus influenzae. Their clinical features were 1. elderly male patients with underlying diseases, 2. development from fever and cough with purulent sputum in winter, 3. coarse crackle on auscultation, 4. consolidation with pleural effusion in chest radiograph, 5. leukocytosis, elevation of BUN, hyponatremia, 6. a few cases with unfavorable prognoses despite medication with carbapenem and minocycline. These findings suggested that two types of pneumonia exist; one with the usual features of atypical pneumonia, and the other presenting the clinical features of bacterial pneumonia of the elderly due to a mixed infection including C. burnetti.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14727547&dopt=Abstract
J Dermatol. 2004 Jan;31(1):10-5.
A case of anti-epiligrin cicatricial pemphigoid associated with lung carcinoma and severe laryngeal stenosis: review of Japanese cases and evaluation of risk for internal malignancy.
Matsushima S, Horiguchi Y, Honda T, Fujii S, Okano T, Tanabe M, Wakayama T, Hashimoto T, Yancey KB.
Departments of Dermatology, Osaka Red Cross Hospital, Ten'noji-ku, Osaka, Japan.
A 68-year-old Japanese male with a five-year-history of lung carcinoma showed recurrent blisters and erosions on the oral and genital mucosae and the skin. The patient complained of dyspnea due to severe laryngeal stenosis and underwent a tracheostomy. A skin biopsy specimen showed a subepidermal blister and linear deposits of IgG and C3 at the basement membrane zone of the epidermis. Indirect immunofluorescence examination demonstrated circulating IgG anti-basement membrane zone autoantibodies that reacted to epiligrin on immunoblotting. Based on a diagnosis of anti-epiligrin cicatricial pemphigoid, he was treated with prednisolone, minocycline hydrochloride and nicotinamide. Although no new skin lesions appeared, he died of lung carcinoma five months after the tracheostomy. A review of reported cases with anti-epiligrin cicatricial pemphigoid in Japan disclosed that 5 of 16 cases (31.2%) were complicated by internal malignancies.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14739497&dopt=Abstract [PubMed - in process]
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