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We experienced a rare case of papulonecrotic tuberculide (PT). A twenty-four year old female was referred to our hospital because she had had an eruption for the last for four years. Her chest X-ray revealed no abnormal shadow three years ago when her eruption had already appeared. This time, the skin biopsy and repeated chest X-ray were investigated. These results showed pulmonary tuberculosis accompanied with PT. Both rifampin and isoniazid were administered and apparent improvement was achieved after six months-of treatment. Pt also showed improvement. Her skin involvement was preceded by pulmonary tuberculosis. Nowadays, PT is a rare disease but physicians should be on the alert for this disease as a sign of tuberculosis.

The clinical utility of two serum Candida mannan antigen detection kits with ELISA, UNIMEDI Candida and PLATERIA Candida Ag, was investigated. Thirty-four serum samples from 12 cases with candidemia diagnosed at Kawasaki Medical School Hospital in 1999 and 15 samples from 15 healthy volunteer were examined. The sensitivities and specificities of the two kits were 82.1% and 40.0%, 100% and 100% respectively. This sensitivity was higher than that achieved with the conventional methods. However, it was realized that the discrepancy between the sensitivity of these two kits was quite significant. This may have been caused by a difference in the reactivities of the respective kits against different species of Candida. A combined application of these methods and other supportive diagnostic methods, such as serum (1-->3)-beta-D-glucan detection, will improve their utility. A larger number of cases should be evaluated to clarify the characteristics of these new kits.

The in-vitro activity of moxifloxacin, a new fluoroquinolone, against Chlamydia species was investigated. The minimal inhibitory concentration of moxifloxacin for 10 standard strains of different Chlamydia species and 15 wild-type strains of Chlamydia pneumoniae isolated in Japan, which were morphologically different from clinical isolates from the United States, ranged from 0.031 to 0.125 microg/ml. The activity of moxifloxacin was almost the same as those of sparfloxacin, and it was 16, 8, 2, and 2 times more active than ciprofloxacin, levofloxacin, grepafloxacin, and tosufloxacin, respectively. The minimal chlamydiacidal concentration of moxifloxacin ranged from 0.031 to 0.125 microg/ml. These results suggest that moxifloxacin has potential effects against Chlamydia species.

A 63-year-old man was admitted to our hospital because of a large, firm tumor in the upper region of the anterior chest wall. The tumor measured 8 x 10 cm in diameter. A diagnosis of chondrosarcoma of the sternum was made cytologically from a percutaneous fine needle aspiration biopsy. The primary tumor was completely resected, but the sternum, ribs and clavicles were only partially resected. Another tumor was detected five months after resection and metastasis to the brain was recognized in December 2000. The patient, now suffering headaches and vomiting due to the intracranial hemorrhage around the metastatic lesion in the brain, was readmitted. Although temporary improvement of his general condition was achieved by conservative treatment, he suddenly died of respiratory failure because of multiple tumor emboli in the pulmonary artery. This was a very interesting case in that the chondrosarcoma was of sternal origin and was complicated by tumor emboli in the pulmonary artery.

Two cases of recurrent pneumonia due to Chlamydia pneumoniae are described. C. pneumoniae was continuously detected from the nasopharynx in both patients by the polymerase chain reaction and/or culture even with appropriate antibiotic therapy during the first episode. After eradication of C. pneumoniae with long-term macrolide therapy, the respiratory symptoms of both patients completely disappeared and no relapse was observed. These data indicate that new treatment strategies may be necessary to eradicate the organism in patients prone to persistent infection.