Severe hypersensitivity to mosquito bites (HMB) is characterized by intense local skin reactions and systemic symptoms such as high fever, lymphadenopathy, and hepatosplenomegaly. Patients with HMB often have natural killer (NK) cell lymphocytosis associated with Epstein-Barr virus (EBV) infection. Here we investigated whether mosquito bites have any influence on the oncogenesis of EBV-infected NK cells. We examined six HMB patients with EBV-infected NK cell lymphocytosis. We first demonstrated that CD4+ T cells, but not NK cells, proliferated well in response to mosquito salivary gland extracts (SGE), especially to SGE of Aedes albopictus. When NK cells were cocultured with autologous CD4+ T cells stimulated by mosquito SGE, the expression of viral oncogene latent membrane protein 1 (LMP1) was remarkably enhanced. Next, we stimulated mononuclear cells of the patients with mosquito SGE, and NK cell counts were monitored for 28 d. The counts changed little from initial levels in the culture with mosquito SGE, whereas they decreased steadily in the culture without the extracts. Furthermore, we detected LMP1 mRNA in the skin lesion induced by mosquito SGE. These results suggest that mosquito bites can induce expression of the viral oncogene LMP1 in NK cells via mosquito antigen-specific CD4+ T cells, which is involved in the oncogenesis of NK cells in vivo.
A 62-year-old man was admitted with swelling of the penis caused by long term use of a penis enlarging ring. For the previous 20 years, he had noticed small pruritic nodules on his penis. He had no micturitional or ejaculatory impairment. The penis had a diameter of 6 cm, a length of 10 cm, and was covered with thickened skin. The penis and the scrotal skin were covered with scattered, small, hemispheric nodules and papules ranging in size from 2 mm to 1 cm. Pathologic examination of the biopsied specimen from a nodule revealed enlargement of the lymphatic vessels of the dermis and fibrosis. This was compatible with lymphedema due to chronic strangulation by the ring. Scar resection and full thickness skin grafting was performed to prevent malignant changes in the lesions.
We report a patient undergoing haemodialysis, who developed multiple subcutaneous nodules. Histology showed that the nodules were composed of deposits of crystals in the dermis, with an associated foreign-body reaction. The crystalline deposits were identified as calcium oxalate by histochemical staining, polarizing microscopy, and analytical electron microscopy.
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