118 Letters to the Editor Prostaglandin E2 Increase in Pachydermoperiostosis Without 15-hydroprostaglandin Dehydrogenase Mutations Kyoko Nakahigashi1, Atsushi Otsuka1*, Hiromi Doi1, Satsuki Tanaka2, Yoshiaki Okajima3, Hironori Niizeki4, Asami Hiraki- yama4, Yoshiki Miyachi1 and Kenji Kabashima1* 1Department of Dermatology, Kyoto University, Graduate School of Medicine, 54 Shogoin-Kawara, Sakyo, Kyoto 606-8507, 2Department of Diabetes and Endocrinology, and 3Department of Orthopedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, and 4Department of Dermatology, National Center for Child Health and Development, Tokyo, Japan. *E-mails:
[email protected],
[email protected] Accepted April 10, 2012. Pachydermoperiostosis (PDP), a form of primary hyper head, and marked clubbing of the fingers (Fig. 1a, b). trophic osteoarthropathy (PHO), is a rare hereditary No other remarkable physical findings were observed, disease diagnosed by the presence of the triad of digital and he did not present seborrhoea, acne, folliculitis or clubbing, periostosis, and pachydermia (1, 2). Elevated hyperhidrosis. Family history was non-contributory. prostaglandin E2 (PGE2) levels with cytokinemediated All laboratory tests including serum levels of growth tissue remodelling and vascular stimulation may underlie hormone, insulinlike growth factor1, thyroid fun PHO and is associated with the features such as hyper ction, immunoglobulins, haemoglobin A1c, and bone hidrosis, acroosteolysis, pachydermia, periostosis and mineral metabolism were within normal ranges, which arthritis (3). Homozygous and compound heterozygous ruled out thyroid acropathy and acromegaly. Magnetic germline mutations in the 15hydroxyprostaglandin resonance imaging of the head revealed cutis verticis dehydrogenase (HPGD) gene encoding the major PGE2 gyrate (Fig. 1c). X-ray examination of the knee region catabolizing enzyme have been described in familial PHO revealed periostosis with cortical thickening and ec cases (4).