Purpose: To evaluate the efficacy and toxicities of skin-directed radiotherapy (RT) in primary cutaneous T-cell lymphoma (CTCL). Materials and Methods: We retrospectively analyzed 57 CTCL lesions treated with skin-directed RT between January 2000 and December 2022. Lesions were categorized into three distinct groups: early-stage disease treated with local RT, advanced-stage disease treated with local RT, and advanced-stage disease treated with total skin electron beam therapy (TSEBT). Treatment outcomes, including response rates, recurrence patterns, and local progression probability, were assessed for each group. Results: Mycosis fungoides (MF) constituted 90.9% of the advanced-stage pathologies, while CD4+ primary cutaneous small/medium T-cell lymphoproliferative disorder was common in the early stage lesions (55%). Median RT doses were 30.6 Gy, 27 Gy, and 32 Gy for the local RT with early stage, the local RT with advanced stage, and TSEBT with advanced stage, respectively. The complete response rates were high across the groups: 95.5%, 70.8%, and 90.9%, respectively. Seven local recurrences (29.2%) occurred in the local RT group with advanced stage, while seven patients (63.6%) in the TSEBT group experienced local failure. All recurrences were observed in lesions and patients with MF. Acute toxicities were mainly grade 1 or 2, with no grade 3 or higher events. No significant association between RT dose and local progression rates in MF lesions was found. Conclusion Skin-directed RT in CTCL is effective for local control and well-tolerated with less toxicity.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Purpose: To evaluate the efficacy and toxicities of skin-directed radiotherapy (RT) in primary cutaneous T-cell lymphoma (CTCL). Materials and Methods: We retrospectively analyzed 57 CTCL lesions treated with skin-directed RT between January 2000 and December 2022. Lesions were categorized into three distinct groups: early-stage disease treated with local RT, advanced-stage disease treated with local RT, and advanced-stage disease treated with total skin electron beam therapy (TSEBT). Treatment outcomes, including response rates, recurrence patterns, and local progression probability, were assessed for each group. Results: Mycosis fungoides (MF) constituted 90.9% of the advanced-stage pathologies, while CD4+ primary cutaneous small/medium T-cell lymphoproliferative disorder was common in the early stage lesions (55%). Median RT doses were 30.6 Gy, 27 Gy, and 32 Gy for the local RT with early stage, the local RT with advanced stage, and TSEBT with advanced stage, respectively. The complete response rates were high across the groups: 95.5%, 70.8%, and 90.9%, respectively. Seven local recurrences (29.2%) occurred in the local RT group with advanced stage, while seven patients (63.6%) in the TSEBT group experienced local failure. All recurrences were observed in lesions and patients with MF. Acute toxicities were mainly grade 1 or 2, with no grade 3 or higher events. No significant association between RT dose and local progression rates in MF lesions was found. Conclusion Skin-directed RT in CTCL is effective for local control and well-tolerated with less toxicity.

Purpose: To evaluate the efficacy and toxicities of skin-directed radiotherapy (RT) in primary cutaneous T-cell lymphoma (CTCL). Materials and Methods: We retrospectively analyzed 57 CTCL lesions treated with skin-directed RT between January 2000 and December 2022. Lesions were categorized into three distinct groups: early-stage disease treated with local RT, advanced-stage disease treated with local RT, and advanced-stage disease treated with total skin electron beam therapy (TSEBT). Treatment outcomes, including response rates, recurrence patterns, and local progression probability, were assessed for each group. Results: Mycosis fungoides (MF) constituted 90.9% of the advanced-stage pathologies, while CD4+ primary cutaneous small/medium T-cell lymphoproliferative disorder was common in the early stage lesions (55%). Median RT doses were 30.6 Gy, 27 Gy, and 32 Gy for the local RT with early stage, the local RT with advanced stage, and TSEBT with advanced stage, respectively. The complete response rates were high across the groups: 95.5%, 70.8%, and 90.9%, respectively. Seven local recurrences (29.2%) occurred in the local RT group with advanced stage, while seven patients (63.6%) in the TSEBT group experienced local failure. All recurrences were observed in lesions and patients with MF. Acute toxicities were mainly grade 1 or 2, with no grade 3 or higher events. No significant association between RT dose and local progression rates in MF lesions was found. Conclusion Skin-directed RT in CTCL is effective for local control and well-tolerated with less toxicity.

Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Afferent loop syndrome (ALS) is a rare complication of gastrectomies and gastrointestinal reconstruction. This can predispose patients to fatal conditions, such as cholangitis, pancreatitis, and duodenal perforation with peritonitis. Therefore, emergency decompression is necessary to prevent these complications. Herein, we report two cases in which transcholecystic duodenal drainage, an alternative decompression treatment, was performed in ALS patients without bile duct dilatation. Two patients who underwent distal gastrectomy with Billroth II anastomosis sought consultation in an emergency department for epigastric pain and vomiting. On CT, ALS with acute pancreatitis was diagnosed. However, biliary access could not be achieved because of the absence of bile duct dilatation. To overcome this problem, a duodenal drainage catheter was placed to decompress the afferent loop after traversing the cystic duct via a transcholecystic approach. The patients were discharged without additional surgical treatment 2 weeks and 1 month after drainage.

Purpose: To evaluate the efficacy and toxicities of skin-directed radiotherapy (RT) in primary cutaneous T-cell lymphoma (CTCL). Materials and Methods: We retrospectively analyzed 57 CTCL lesions treated with skin-directed RT between January 2000 and December 2022. Lesions were categorized into three distinct groups: early-stage disease treated with local RT, advanced-stage disease treated with local RT, and advanced-stage disease treated with total skin electron beam therapy (TSEBT). Treatment outcomes, including response rates, recurrence patterns, and local progression probability, were assessed for each group. Results: Mycosis fungoides (MF) constituted 90.9% of the advanced-stage pathologies, while CD4+ primary cutaneous small/medium T-cell lymphoproliferative disorder was common in the early stage lesions (55%). Median RT doses were 30.6 Gy, 27 Gy, and 32 Gy for the local RT with early stage, the local RT with advanced stage, and TSEBT with advanced stage, respectively. The complete response rates were high across the groups: 95.5%, 70.8%, and 90.9%, respectively. Seven local recurrences (29.2%) occurred in the local RT group with advanced stage, while seven patients (63.6%) in the TSEBT group experienced local failure. All recurrences were observed in lesions and patients with MF. Acute toxicities were mainly grade 1 or 2, with no grade 3 or higher events. No significant association between RT dose and local progression rates in MF lesions was found. Conclusion Skin-directed RT in CTCL is effective for local control and well-tolerated with less toxicity.

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient’s clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.