Immunologic deficiency, autoimmune disease, and lymphoma: observations, implications, and speculations

Gamma delta cells regulate autoimmunity

Gamma delta cells are attractive candidates for mediators of autoimmune disease. They can expand in germ-free mice, probably through recognition of autoantigens, and gamma delta-cell-deficient mice, unlike mice deficient in alpha beta T cells or B cells, show no severe defects in the immune response to foreign antigen challenge. A capacity of gamma delta cells to effect or regulate tissue damage is also plausible, given their ready localization to tissues, and their myriad of effector functions. Added to this, attempts to reconstruct the physiological course of autoimmune diseases with only autoreactive alpha beta T cells seem invariably to fall short for lack of other unidentified players. Gamma delta cells and their putative ligands have been linked to autoimmune conditions, and recent experiments confirm that gamma delta cells play a significant role in autoimmune disease in vivo.

OPD4-positive T-cell lymphoma of the liver in systemic lupus erythematosus

Primary malignant lymphoma of the liver occupying the right lobe, 14 x 9 x 7 cm in size, developed in a 30-year-old man with a 4-year history of autoimmune hemolytic anemia. The diagnosis of systemic lupus erythematosus (SLE) accompanying thrombocytopenia had been made clinically 10 months earlier. The liver biopsy specimen revealed diffuse proliferation of large lymphoma cells expressing the activated helper/inducer T-cell phenotype (LCA+, UCHL1+, OPD4+, LN3+, MT1-, L26-, MB1-, Leu M1-, Ki-1-, KP1-). The lymphoma was successfully treated by chemotherapy and irradiation. Intractable thrombocytopenia provoked fatal esophageal hemorrhage. At autopsy, no lymphomatous lesion was identified, and the hepatic right lobe contained an encapsulated necrotic lesion without any viable tumor cells. The bone marrow revealed marked hyperplasia of erythroid and megakaryocytic series. Extramedullary hematopoiesis was demonstrated in the liver, spleen and lymph nodes. This is the second case of primary hepatic T-cell lymphoma associated with SLE.

Selective expansion of a CD3+CD4-CD8- subpopulation in clinical groups associated with human immunodeficiency virus infection

T lymphocytes (CD3+) without expression of CD4/CD8 surface antigens have recently been described in the thymus and peripheral lymphoid organs. We have conducted a retrospective analysis of the literature, seeking quantitative variations in this T-cell subset in normal heterosexual controls, and in risk, pre-AIDS, and AIDS groups, by means of the subtraction [CD3-(CD4+CD8]) and the ratio 100 X [CD3-(CD4+CD8])/CD3. Dramatic T lymphocytopaenia in AIDS patients and the progressive decay of CD4+ lymphocytes and increase of CD8+ lymphocytes throughout the clinical spectrum of HIV infection have been confirmed. Furthermore, we hereby demonstrate the selective expansion of CD3+CD4-CD8- lymphocytes, directly related to the clinical state in different clinical groups of infected people when compared with controls (P less than 0.05). The inverse relationship between the CD3+CD4-CD8- cell subset and other mature T-cell subsets, mainly CD4+ (r = -0.49; P less than 0.01), suggests the existence of mutual regulatory interactions. These in vivo results, which are in agreement with those obtained in long-term infected cultures, cannot be explained by direct cytopathic effects of the virus on the very few infected cells. Thus, the implication of the expansion of these functional precursors on the prognosis for infected people, and the paradoxes of the immunodeficiency, such as lymphoproliferation and autoimmune features, are discussed.

Paraneoplastic vasculitis. Unique syndrome of cutaneous angiitis and arthritis associated with myeloproliferative disorders

Six patients are described whose myeloproliferative disorders were complicated by inflammation in small, predominantly cutaneous blood vessels. The clinical manifestations of the vasculitis included palpable purpura, urticaria, maculopapular lesions, and erythema multiforme. Vascular inflammation was confirmed by skin biopsy. Two patients experienced fleeting, asymmetrical nondestructive arthritis. Transient proteinuria complicated one case and was the only suggestion of visceral vasculitis. The clinical features of cutaneous vasculitis antedated bone marrow deterioration in four patients and diminished as bone marrow function worsened in all patients. Oral corticosteroids or chemotherapy for the underlying disorder inconsistently affected the clinical course of the cutaneous vasculitis. Myeloproliferative disorders should be considered among disorders that are complicated by inflammation in small blood vessels.

Genetic factors predisposing to autoimmune diseases. Autoimmune hemolytic anemia, chronic thrombocytopenic purpura, and systemic lupus erythematosus

Genetic factors predisposing to autoimmune diseases were investigated in 10 families having more than one affected member. Seventy relatives and 23 spouses from two large kindreds (one in whom the proband had autoimmune hemolytic anemia and the other immune thrombocytopenic purpura) were examined for immunologically mediated disorders, autoantibodies, immunoglobulin abnormalities, and HLA genotypes. Significant differences between relatives and spouses were found for immune diseases (21 percent versus 0 percent; p = 0.02), antinuclear antibody titer of 1:80 or more (18 percent versus 0 percent; p = 0.04), single-strand DNA antibodies (18 percent versus 0 percent; p = 0.04), high-titer antinuclear antibody or antibodies to single-strand DNA or both (33 percent versus 0 percent; p = 0.001), and the combined frequencies of immune diseases and serologic abnormalities (44 percent versus 4 percent; p = 0.0004). Similar frequencies were found in 41 relatives from eight families in whom the proband had SLE. Segregation analyses using these abnormalities as genetic traits were most compatible with a Mendelian dominant model. Impressive odds (100:1) against linkage to HLA were calculated.

Macroglobulinemia Waldenström complicated by autoimmune hemolytic anemia, meningeal sign and femoral lysis

A necropsied case of macroglobulinemia Waldenström with unusual complications was presented; the patient was found to have autoimmune hemolytic anemia, first. During the course of its treatment, he developed monoclonal immunoglobulin M in serum together with lytic osseous lesion in both femurs, and died of meningeal involvement by tumor cells. Clinically, he had hepatosplenomegaly and generalized lymphadenopathy. The macroglobulin was kappa type of light chain, ultracentrifugation showed sharp spike of 21S in 18.6%, and myelogram revealed increased lymphocytoid series of 29.6%. It was proved that autoantibody causing autoimmune hemolytic anemia was composed of IgG and macroglobulin itself had no activity as an anti-red cell antibody. An emphasis was made that autoimmune hemolytic anemia followed by macroglobulinemia is based on the state of immunodeficiency of this patient.

A case report of primary hepatic carcinoma with prolonged HB virus infection and mono-clonal gammopathy

A case of alpha-feto protein (AFP) positive hepatic cell carcinoma has been presented in which the appearance of a mono-clonal gammopathy can be explained by persistent infection with HB virus (HBV). The patient, a fifty year old male, developed acute jaundice with hepatitis in July, 1952, and died of an hepatic cell carcinoma in December, 1973. The interest of this case lies in the fact that during the seven months prior to be patient's demise, a mono-clonal gammopathy of IgG (L type), together with positive titeres for HBs Ag (adr) and AFP, was demonstrated.

Immunoglobulin levels and autoantibodies in epileptics on long-term anticonvulsant therapy

Serum immunoglobulin (Ig) levels and various autoantibodies have been determined in 53 epileptics treated with anticonvulsant drugs for more than 10 years and in 53 controls matched for age and sex. Aberrations in both IgG, IgA and IgM values were demonstrated. The mean IgG concentration was significantly lower in epileptics (1217 mg/100 ml) than in controls (1364 mg/100 ml) p less than 0.05). The mean IgA value was 161 mg/100 ml in both patients and controls (F-test, p less than 0.01), but abnormally low IgA values were found in 17%, and abnormally high values in 11% of the epileptics. The mean IgM concentration was 157 mg/100 ml in epileptics and 117 mg/100 ml in controls (F-test, p less than 0.01). Autoantibodies were found significantly more often in epileptics (26.4%) than in controls (3.8%) (2p less than 0.002). The occurrence of autoantibodies could not be related to alterations in the Ig levels. Neither was it possible to correlate the occurrence of mitochondrial antibodies, smooth muscle antibodies and antinuclear antibodies to the slightly abnormal biochemical liver parameters found in these patients. Thus, the abnormalities in Ig levels and the autoimmune phenomena observed in epileptics on long-term anticonvulsant therapy are not intimately related.

Familial Sjögren's syndrome with associated primary salivary gland lymphoma

Primary salivary gland lymphoma has been rarely documented in patients with or without Sjögren's syndrome. The association of disseminated lymphoreticular neoplasms with Sjögren's syndrome has been recognized, and the malignancy is usually widespread at the time of diagnosis. Familial occurrence of Sjögren's syndrome is likewise infrequently observed. In the present report we describe a patient with Sjögren's syndrome in whom a primary parotid gland lymphoma subsequently developed. In addition to the propositus, two of four siblings had definite evidence of Sjögren's syndrome and a third had several abnormal studies commonly associated with the disease. This observation suggests that genetic influence alone or in conjunction with other factors may facilitate the development of Sjögren's syndrome.

Vitiligo and dysgammaglobulinemia. A case report and family study

This report concerns an 8 year old female with vitiligo and dysgammaglobulinemia characterized by absent IgA, very low IgG, and normal IgM. The t-cell immune system was intact but other family members had low levels or absence of IgA. The possible relationship of dysgammaglobulinemia and vitiligo is discussed along with the classification and inheritance of the immune cell defects.

Serum immunoglobulin levels in children with acute lymphoblastic leukaemia and their mothers and sibs

Serum immunoglobulins G, A, and M were estimated in 29 children with acute lymphoblastic leukaemia and their first-degree relatives. 6 newborn sibs had high IgM levels in cord blood. IgG and IgM were raised in the mothers' sera and there was a significant decrease in the serum IgG of sibs aged 2 to 10 years. The findings suggest the presence of some antigenic stimulus, possibly a virus, in the intrauterine life of affected sibships. It is postulated that the immunoglobulin abnormalities may be related pathogenetically to the leukaemic process.

An interplay of genetic and environmental factors in familial hepatitis and myasthenia gravis

A family is described in which there occurred two cases of the lupoid type of active chronic hepatitis with cirrhosis, one of chronic persistent hepatitis, and one of myasthenia gravis. The two cases of lupoid hepatitis were in the proposita, a schoolgirl aged 16 years, and her great-aunt aged 69 years whom she had never met. The case of myasthenia gravis was that of the father. The whole family, except the great-aunt, had been exposed to an epidemic of infectious hepatitis five years previously, and the girl and her brother had contracted this disease. The schoolgirl later developed active chronic hepatitis while her brother had chronic persistent hepatitis without immunological concomitants. APART FROM COINCIDENCE, SOME COMBINATION OF THREE PROCESSES WAS REQUIRED TO ACCOUNT FOR THE ILLNESSES IN THIS FAMILY: a genetic predisposition to chronic liver disease in particular, a genetic predisposition to autoimmune reactions in general, and a ;triggering' effect of infection with the hepatitis virus.