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Treatment of eosinophilic granulomatosis with polyangiitis (EGPA) remains a challenge because currently available therapies, corticosteroids and immunomodulators, do not always control symptoms and are often associated with significant morbidity and relapse. Mepolizumab has been demonstrated to be an effective add-on therapy with steroid-sparing effect in cases of relapsing or refractory EGPA. Intravenous immunoglobulin (IVIG) therapy is effective against mononeuritis multiplex or heart failure in patients with EGPA who do not respond to corticosteroid-cyclophosphamide treatment. We present two cases of EGPA in which earlier add-on administration of adjunct mepolizumab and IVIG led to significant improvement in EGPA symptoms and prevention of flareup of the disease. We suggested that earlier add-on combination administration of IVIG and mepolizumab might be a useful adjunct treatment to induce clinical remission of EGPA and improve the rate of remission, decrease relapse rate, and allow for reduced glucocorticoid use without any serious adverse drug effects.

A 36-year-old female elementary schoolteacher presented with aggregated serous papules surrounded by mild erythema, extending from both nasal wings/nostrils down to the upper lip. No improvement was seen following treatment of the lesions with topical antibiotics for impetigo. Potassium hydroxide（KOH） direct microscopy confirmed the presence of mycelia, and the infection was diagnosed as tinea faciei. The isolate was identified as Trichophyton mentagrophytes using morphological analysis and as Arthroderma benhamiae using genetic analysis. Here we describe that case and summarize the clinical features of other cases of A. benhamiae infection in Japan that have been reported in the literature.

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Dear Editor,We previously established human induced pluripotent stem (iPS) cell-derived melanocytes in large quantities within a short period and induced their differentiation and high melanogenic potency using original iPS cell-derived melanocyte medium (iDMM). 1 We used original iPS cell lines established from T cells in the blood of a healthy 40-year-old Japanese man and a Sendai virus vector. 1 In the present study, we established melanocytes derived from more general iPS cells (1383D6, HPS1006) obtained from the Japanese Center for iPS Cell Research and Application using advanced iDMM (Table S1). The iPS cells were maintained in StemFit medium (AHS, AK02N; Ajinomoto, Tokyo, Japan). We found that many pigmented cells developed from the border of human iPS cell nests within 10 days under advanced iDMM (Fig. 1a). The granules in them were strongly tyrosinase-positive as observed by confocal immunofluorescence laser microscopy, which suggested that they were mature melanocytes (Fig. 1b). Previous approaches to grow and differentiate iPS cells into melanocytes needed first to produce embryoid bodies and then to process them to differentiate into melanocytes, which took approximately 30 days. 2,3 The present approach further improves in production of large quantities within a short period and induces differentiation and high melanogenic potency in vitro. We examined the mRNA expression levels of NANOG, Pax3, MITF, TRP1 and tyrosinase in the human iPS cell-derived melanocytes using quantitative reverse transcription polymerase chain reaction (Table S2, Fig. 1c). Normal human adult epidermal melanocytes were purchased from Invitrogen Gibco (Carlsbad, CA, USA) as controls (Table S3).The mRNA expression level of the pluripotency marker NANOG in these iPS cell-derived melanocytes was significantly lower than in human iPS cells. In contrast, mRNA expression levels of four melanocyte-specific markers (Pax3, MITF, TRP1 and tyrosinase) in the iPS cell-derived melanocytes that we established from a line of human melanocytes were significantly higher than in human iPS cells. The melanocyte-specific marker mRNA expression levels in the iPS cell-derived melanocytes were similar to the levels found in normal human adult epidermal melanocytes (Table S4).