A 43-year-old woman had asymptomatic eruptions on the anterior sides of both legs for 5 years. Biopsy specimens revealed the typical findings of necrobiosis lipoidica. An immunofluorescence study demonstrated no deposits of immunoglobulins, complement, or fibrinogen in vessel walls. Immunohistochemical staining revealed CD4 positive lymphocytes dominating in the lesion and strong expression of ICAM-1 on the endothelial cells, giant cells, lymphocytes and dermal fibroblasts in the lesion. The eruptions resolved remarkably with oral corticosteroid therapy.
Two cases of tsutsugamushi disease misdiagnosed initially as drug eruption were reported. Clinical symptoms of both cases disappeared dramatically after starting minocycline. Statistical examinations were performed on 29 cases of tsutsugamushi disease, including those observed in Mie Prefecture since 1982. Half of them were seen in the last 2 years. The onset was predominantly recorded in November (59%). Presumptive sites of infection were forests (63%) and fields (21%). No patients were infected along river-banks.
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