Symmetrical Skin Lesions on the Gluteal Region in a Patient with Anti-Laminin-332 Mucous Membrane Pemphigoid

Mucous membrane pemphigoid (MMP), previously called cicatricial pemphigoid, is a rare subepidermal immunobullous disorder that primarily affects the mucous membranes (1,2). MMP is divided into two major subtypes, anti-BP180-type MMP and anti-laminin-332 (previously called laminin 5 or epiligrin) MMP. Anti-laminin-332 MMP is known to be associated with malignant tumors (3), which may cause overexpression of autoantibodies and induce autoimmunity to laminin-332 (4). MMP primarily affects the mucous membranes, and widespread skin lesions are rare. In MMP, circumscribed skin lesions have been previously reported as occurring on the head, neck, and upper trunk (5). We report a case of anti-laminin-332 MMP presenting with symmetrical skin lesions characteristic of MMP on the weightbearing areas of the gluteal regio

Syphilitic Meningitis in a Human Immunodeficiency Virus-Negative Woman

The“ Stop! Syphilis Project” was started in Japan in 2018. A 29-year-old woman was admitted with fever, acute onset of posterior cervical pain, urodynia, and positive signs of meningeal irritation. Three months before admission, her heterosexual partner had been diagnosed with primary symptomatic syphilis with induration, but her initial serological screening tests for syphilis [rapid plasma reagin （RPR） test and Treponema pallidum hemagglutination （TPHA） test] were negative. She presented with a painless genital lesion at 2 months before the current hospitalization and with skin rashes at 1 month before hospitalization； however, these were not recognized as symptomatic for syphilis. Additionally, urodynia appeared at 2 weeks before admission； the patient underwent serological rescreening for syphilis, which tested positive （RPR： 128-fold, TPHA： 640.0 titer unit）, and posterior cervical pain appeared at 10 days before hospitalization. After emergent hospitalization, she was diagnosed with syphilitic meningitis without human immunodeficiency virus infection. Antimicrobial treatment with penicillin G was continued for 2 weeks, after which the fever, posterior cervical pain, urodynia, and rash subsided, and the patient was discharged on hospital day 16. On day 187 after starting treatment, RPR was 8-fold and TPHA was 262.4 titer unit. This case report highlights the fact that for the timely detection and appropriate treatment of syphilis,primary care physicians should recommend a repeated RPR test with incubation period taken into account,even in the absence of symptoms and even if initial screening results are negative.departmental bulletin pape

Oral ulcerations due to drug medications

SummaryUlcers are common symptoms observed in the oral cavity and some ulcerations are induced by drug medications. When ulcers show typical clinical findings differential diagnosis may be easy, but the exact diagnosis is often difficult. We reviewed differential diagnosis of oral ulcerative diseases, clinical characteristics of drug-induced oral ulcerations and drugs inducing oral ulcerations. Many kinds of drugs have been reported to cause oral ulcerations. Among them, non-steroidal anti-inflammatory drugs are popular and well-known. However, several recent reports have described oral ulceration associated with relatively new drugs for the treatment of chronic disorders such as, diabetes, angina pectoris, rheumatoid arthritis, and osteoporosis. We reviewed these new drugs and also reported typical cases of drug-induced oral ulcerations