case_images: PMC9650416_01
case_images: Clinical features. (a-e) Erythematous skin eruptions that first appeared on the right knee and subsequently spread all over the body, except for the upper back and the ends of the extremities, at the first consultation. (f) Clearly demarcated erythema on the right knee only after the intravenous injection (as is) with the mixed agent containing chondroitin sulfate sodium and sodium salicylate. (g) Clearly demarcated erythema on the right knee after intravenous injection with chondroitin sulfate sodium (as is).
case_images: fmed-09-1041492-g001.jpg
case_images: PMC9650416_01_fmed-09-1041492-g001.jpg
case_images: F1
case_images: Additionally, the patient had fever and arthralgia (Figures 1a-e). While intravenous injection (1%; 2 mg of chondroitin sulfate sodium) with the mixed agent elicited a negative response, the intravenous injection (as is; 200 mg of chondroitin sulfate sodium) with the mixed agent led to erythema recurrence without pigmentation in the right knee alone, where marked erythema was initially noted (Figure 1f) after 24 h, and without fever and arthralgia. However, intravenous injection with chondroitin sulfate sodium (as is) caused erythema recurrence without pigmentation in the right knee alone, similar to the response of the mixed agent (as is) (Figure 1g).
case_images: Histopathological features. (a,b) Hematoxylin-eosin staining of a skin biopsy specimen from the right knee at the first consultation showing minimal liquefaction degeneration in the basal layer of the epidermis. Also, lymphocytes and eosinophils are observed around the blood vessels of the dermis [panel (a) x 40, panel (b) x 200]. (c) CD3 staining showing positive results in the cell infiltrations (x 200). (d) CD4 staining showing positive results in the cell infiltrations (x 200). (e) CD8 staining showing positive results in the cell infiltrations (x 200). (f) Melan-A staining showing positive results in melanocytes (x 200). (g) Few melanophages in the dermis with CD68-positive staining (x 200). (h) Fontana-Masson staining showing no increased staining (x 200). (i) Myeloperoxidase staining showing negative results in the cell infiltrations (x 200). (j,k) Hematoxylin-eosin staining of a skin biopsy specimen from the right knee after the challenge test by intravenous injection (as is) with the mixed agent containing chondroitin sulfate sodium and sodium salicylate showing minimal liquefaction degeneration in the basal layer of the epidermis. Also, lymphocytes and eosinophils are observed around the blood vessels of the dermis [panel (j) x 40, panel (k) x 200)]. (l) CD3 staining showing positive results in the cell infiltrations (x 200). (m) CD4 staining showing positive results in the cell infiltrations (x 200). (n) CD8 staining showing positive results in the cell infiltrations (x 200). (o) Melan-A staining showing positive results in melanocytes (x 200). (p) Few melanophages in the dermis with CD68-positive staining (x 200). (q) Fontana-Masson staining showing no increased staining (x 200). (r) Myeloperoxidase staining showing negative results in the cell infiltrations (x 200).
case_images: fmed-09-1041492-g002.jpg
case_images: PMC9650416_01_fmed-09-1041492-g002.jpg
case_images: F2
case_images: In addition, there was minimal liquefaction degeneration in the basal layer of the epidermis and few dermal melanophages (Figures 2a-e). Furthermore, Melan-A staining did not reveal a paucity of melanocytes, and Fontana-Masson staining did not show increased staining (Figures 2f,h). Additionally, myeloperoxidase staining of the cell infiltrations was negative (Figure 2i), and eosinophils were observed around the blood vessels in the dermis (Figures 2a,b). Histopathological examination of the erythematous lesion revealed similar characteristics to those noted previously (Figures 2j-r).