We report two cases of eyebrow granulomas in patients who underwent a permanent eye makeup procedure. A rash was observed 16 months after the procedure in Case 1, and 10 years after the procedure in Case 2. Histopathologically, both patients exhibited noncaseating epithelioid cell granulomas. In Case 1, most of the blackbrown granules of the permanent makeup were not present in the granulomas but were localized in the upper dermis. In contrast, in Case 2, some of the black-brown granules were phagocytized in the granulomas, preferentially within the giant cells.Based on systemic examinations, the patients from Cases 1 and 2 were diagnosed with sarcoidosis and sarcoidal foreign body reaction, respectively. To clarify the pathogenesis of our cases, we performed immunohistochemistry using commercially available monoclonal antibodies specific to Cutibacterium acnes, previously Propionibacterium acnes (PAB), and Mycobacteria (LAM antibody). PAB antibody results were positive in granulomas only in Case 1, and the LAM antibody results were negative in both cases. Immunohistochemical detection of C. acnes in granulomas could provide useful information for differentiating between cutaneous sarcoidosis and sarcoidal foreign body reactions.
A 50-year-old woman presented with a 1-week history of rash on the face and hands and difficulty when rising from a sitting position. She underwent an exploratory laparotomy for ovarian cancer 8 months ago. Three months ago, she underwent total hysterectomy, adnexectomy, and retroperitoneal lymph node dissection. Docetaxel and carboplatin were started and administered twice. Physical examination revealed periorbital edema with a purplish appearance; Erythematous lesions on radiodorsal aspects of the proximal interphalangeal and metacarpophalangeal joints were seen. We diagnosed as dermatomyositis on the basis of clinical findings. Interview demonstrated that such rashes were enhanced 1 week after chemotherapy, and got better through following one week. Cutaneous and muscular symptoms got worse two months after her initial visit. Myotonia was found in electromyography, and high density areas on both femoral regions and lower thighs were observed by MRI of skeletal muscle. Scleroderma-like lesions are known as an adverse effect to taxane. In addition, three cases of dermatomyositis due to taxane were reported in Japan. Since dermatomyositis was regarded as one of paraneoplastic syndrome generally, it was not considered as drug-induced. However, clinical course of our case suggests that docetaxel may play more important role in activity of dermatomyositis than ovarian cancer. Seeing patients treated with taxane, therefore, we have to be careful for symptoms suggestive of autoimmune diseases: not only scleroderma but dermatomyositis.
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