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Mitoxantrone is a synthetic antineoplastic anthracenedione used to treat hormone-refractory prostate cancer and acute leukemias. In addition, mitoxantrone is indicated for worsening relapsing and secondary progressive multiple sclerosis (MS). 1 The dose-limiting factor of mitoxantrone is cardiac toxicity, but therapy-related leukemia has been reported. 2 Reported cases of therapy-related leukemia following the use of mitoxantrone for MS have been myeloid forms. We report acute lymphoblastic leukemia following mitoxantrone therapy for MS.Case report. A 40-year-old African American woman with obesity and adult-onset diabetes presented with episodes of numbness, weakness, and ataxia over the past two decades. She also reported fatigue during warm weather and urinary urgency. She had normal mental status and cranial nerves, full strength in her arms and mild weakness in the legs, brisk reflexes in all extremities, and patchy areas of sensory loss in the legs. Her finger tapping was slow, and she had a broad-based gait. Brain MRI showed multiple periventricular T2/fluidattenuated inversion recovery hyperintensities consistent with demyelination, and CSF revealed two oligoclonal bands with elevated myelin basic protein and IgG synthesis index. Based on history, examination, imaging, and CSF analysis, the patient was diagnosed with relapsing-remitting MS and treated with interferon 1b.Her condition stabilized for 3 months, but she then began to experience frequent relapses and became wheelchair dependent. Repeat MRI demonstrated 11 new gadolinium-enhancing lesions; thus, mitoxantrone (12 mg/m 2 every 3 months) was added for worsening relapsing-remitting MS. Within 6 months of starting mitoxantrone, her condition improved, and she was able to ambulate with a walker. This represented a decrease in her Kurtzke Expanded Disability Status Scale (EDSS) score from 7.0 to 6.5.She continued on mitoxantrone and interferon 1b for 3 years, and her disease remained stable. However, 3 years after starting mitoxantrone, she had a myocardial infarction. An evaluation at that

The histiocytic disorders are uncommon, have a wide spectrum, and are poorly understood. We describe seven cases developing in infancy, seen during a period of 9 years at Asan Medical Center, Seoul, Korea. Clinically the patients had multiple papules over the face, trunk, and extremities that developed at birth or during infancy. Histopathologic examinations revealed an infiltrate of many histiocytic cells in the upper dermis with or without epidermotropism. Four cases were classified as congenital self-healing reticulohistiocytosis in that the histiocytes were identified as Langerhans cells by positive immunohistochemical staining for S-100 protein, ultrastructural studies showing many Birbeck granules, and spontaneous regression of the lesions within 1-4 months. One infant with a solitary lesion on the forehead was diagnosed as solitary, congenital, indeterminate cell histiocytoma because the histiocytic cells were S-100 protein positive, but meticulous ultrastructural studies did not detect Birbeck granules. The lesion was removed by shave excision. Two cases were classified as generalized eruptive histiocytoma. The histiocytic cells were S-100 protein negative and ultrastructurally Birbeck granules were absent. In one patient, eyeball- or popcornlike lysosomal structures were seen. The lesions regressed completely.

: The Q-switched alexandrite laser is a safe and highly effective modality for removing freckles without scarring or permanent pigmentary changes in Asian skin.

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The common clinical presentations of herpes simplex virus (HSV) and molluscum contagiosum (MC) are well known to dermatologists. However, folliculitis due to these viruses is an infrequently reported entity and might be considered a sign of immunosuppression [such as infection with human immunodeficiency virus, (HIV)], especially in cases of folliculitis due to MC. The purpose of this study was to describe the clinical and histopathological characteristics of viral folliculitis due to HSV and MC. We retrospectively collected all our cases with histologically proven folliculitis due to HSV and MC between 1994 and 1999. A total of seven patients aged 7-54 years was identified. Prior to establishment of the diagnosis of folliculitis due to HSV and MC, they were treated with topical antibiotics or topical steroids, without improvement. Tentative diagnoses were bacterial folliculitis, syringoma, perifollicular fibrosis, contact dermatitis or pseudolymphoma. Biopsy of the lesions revealed multiple molluscum bodies in the follicular epithelium with sparing of the epidermis in four patients, and ballooning degeneration and intranuclear viral inclusions in the follicular epithelium in the other three. Three patients had evidence of underlying immune suppression, such as pregnancy, chronic viral hepatitis B and nasopharyngeal carcinoma. One patient had suffered from epilepsy for 4 years. Testing for HIV by enzyme-linked immunosorbent assay was negative in the four patients in whom this was performed, and T-cell subsets were normal in the three patients in whom these were quantified. In cases of molluscum folliculitis treated with simple curettage, the lesions cleared without scarring or recurrence. In cases of herpetic folliculitis, the lesions improved with antihistamines or acyclovir. MC or HSV should be considered in cases that present with folliculitis-like dermatoses but which are refractory to anti-infective and anti-inflammatory treatment.

We suggest that HHV-8 may not involve in a pathogenetic role in ALHE and Kimura's disease and the failure to demonstrate clonality may be consistent with the reactive nature of these diseases and lack of malignant transformation. In addition, heteroduplex-PCR can be applied to confirm doubtful cases of lymphoma in that heteroduplex-PCR is more specific than PCR as seen in our study.