PMC4717627_01
Changes in serum human chorionic gonadotropin (hCG) levels, urinary 8-carboxyl porphyrin (URO) and urinary 4-carboxyl porphyrin (COPRO) during treatment. ACT-D actinomycin D, ATH abdominal total hysterectomy, D&C dilatation and curettage, MTX methotrexate
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Fig1
One month after D&C, our patient presented with an elevated serum human chorionic gonadotropin (hCG) level (Fig. 1). No changes in our patient's urinary coproporphyrin or uroporphyrin levels were observed despite the appearance of skin lesions (Fig. 1). ACT-D was not implicated as either porphyrinogenic or nonporphyrinogenic, our patient received intravenous ACT-D at a dose of 1.5 mg/day on days 1-5 of every 2-week period, starting on day 70 of her clinical course. As shown in Fig. 1, her serum hCG level effectively decreased, and the lung metastasis disappeared without any porphyric attacks. After five cycles of ACT-D, her serum hCG level stabilized at 3.2 mIU/mL. Although other chemotherapeutic drugs were considered, a negative serum hCG level was achieved and maintained for the following 3 years.
Progress of eruption. On day 6, erythema with infiltration appeared on the trunk (upper panel); blisters containing bloody serum developed on our patient's hands (middle panel), and erosive lesions and a furred tongue were observed in her mouth (lower panel). On day 8, the erythema became brown (upper panel); bullous lesions were observed on her hands (middle panel), and mucosal erosion of her mouth continued (lower panel). On day 18, the erythema improved, leaving only pigmentation (upper panel); the bullous rash was epithelialized with scaling (middle panel), and some erosive lesions became blood-filled blisters (lower panel)
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Fig2
On day 5, the eruptions expanded over her whole body and worsened, with ulcers developing on the oral mucosa (Fig. 2).
Abdominal skin biopsy. Microabscesses formed under the stratum corneum, with neutrophilic and eosinophilic invasion, and neutrophilic exocytosis was observed in the epidermis (hematoxylin and eosin staining, x20 and x40 magnification)
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Fig3
Liquefaction was also observed between the epidermis and dermis, and eosinophilic, neutrophilic, and lymphocytic invasion from the layer between the epidermis and dermis to the superficial layer of the dermis was noted (Fig. 3).