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Tambe S, Jangid K, Shinde G, Jadhav S, Mahobia S, Lala M, Gabhale Y. Drug-induced systemic lupus erythematosus in a child living with HIV. Indian J Sex Transm Dis AIDS 2024; 45:59-61. [PMID: 38989068 PMCID: PMC11233042 DOI: 10.4103/ijstd.ijstd_69_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/26/2023] [Accepted: 12/13/2023] [Indexed: 07/12/2024] Open
Abstract
Pediatric systemic lupus erythematosus (SLE) constitutes approximately 10% of SLE cases. The diagnosis and management of this condition remains to be a challenge in the pediatric population. The distinguishing clinical features are less pronounced male-to-female ratio, more organ damage, and higher disease activity compared to adult-onset disease. Drug-induced lupus erythematosus is rare in children. We report a case of drug-induced SLE in a child on antiretroviral therapy.
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Affiliation(s)
- Swagata Tambe
- Department of Dermatology, Seth V.C. Gandhi and M.A. Vora Municipal General Hospital, Mumbai, Maharashtra, India
| | - Kirti Jangid
- Department of Dermatology, Seth V.C. Gandhi and M.A. Vora Municipal General Hospital, Mumbai, Maharashtra, India
| | - Geeta Shinde
- Department of Dermatology, Seth V.C. Gandhi and M.A. Vora Municipal General Hospital, Mumbai, Maharashtra, India
| | - Shubhada Jadhav
- Department of Dermatology, Seth V.C. Gandhi and M.A. Vora Municipal General Hospital, Mumbai, Maharashtra, India
| | - Shraddha Mahobia
- Department of Dermatology, Seth V.C. Gandhi and M.A. Vora Municipal General Hospital, Mumbai, Maharashtra, India
| | - Mamatha Lala
- Department of Pediatrics, Khurshitji Beharamji Bhabha Mun.Gen.Hospital, Bandra, Mumbai, Maharashtra, India
| | - Yashwant Gabhale
- Programme Director of Pediatric Centre of Excellence for HIV Care, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Nakamura H, Tsukamoto M, Nagasawa Y, Kitamura N, Shimizu T, Kawakami A, Nagata K, Takei M. Does HTLV-1 Infection Show Phenotypes Found in Sjögren's Syndrome? Viruses 2022; 14:v14010100. [PMID: 35062304 PMCID: PMC8780498 DOI: 10.3390/v14010100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/17/2022] Open
Abstract
Viruses are a possible cause for Sjögren’s syndrome (SS) as an environmental factor related to SS onset, which exhibits exocrine gland dysfunction and the emergence of autoantibodies. Although retroviruses may exhibit lymphocytic infiltration into exocrine glands, human T-cell leukemia virus type 1 (HTLV-1) has been postulated to be a causative agent for SS. Transgenic mice with HTLV-1 genes showed sialadenitis resembling SS, but their phenotypic symptoms differed based on the adopted region of HTLV-1 genes. The dominance of tax gene differed in labial salivary glands (LSGs) of SS patients with HTLV 1-associated myelopathy (HAM) and adult T-cell leukemia. Although HTLV-1 was transmitted to salivary gland epithelial cells (SGECs) by a biofilm-like structure, no viral synapse formation was observed. After infection to SGECs derived from SS patients, adhesion molecules and migration factors were time-dependently released from infected SGECs. The frequency of the appearance of autoantibodies including anti-Ro/SS-A, La/SS-B antibodies in SS patients complicated with HAM is unknown; the observation of less frequent ectopic germinal center formation in HTLV-1-seropositive SS patients was a breakthrough. In addition, HTLV-1 infected cells inhibited B-lymphocyte activating factor or C-X-C motif chemokine 13 through direct contact with established follicular dendritic cell-like cells. These findings show that HTLV-1 is directly involved in the pathogenesis of SS.
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Affiliation(s)
- Hideki Nakamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; (M.T.); (Y.N.); (N.K.); (K.N.); (M.T.)
- Correspondence: ; Tel.: +81-3-3972-8111 (ext. 2400); Fax: +81-3-3972-2893
| | - Masako Tsukamoto
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; (M.T.); (Y.N.); (N.K.); (K.N.); (M.T.)
| | - Yosuke Nagasawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; (M.T.); (Y.N.); (N.K.); (K.N.); (M.T.)
| | - Noboru Kitamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; (M.T.); (Y.N.); (N.K.); (K.N.); (M.T.)
| | - Toshimasa Shimizu
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan; (T.S.); (A.K.)
| | - Atsushi Kawakami
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan; (T.S.); (A.K.)
| | - Kinya Nagata
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; (M.T.); (Y.N.); (N.K.); (K.N.); (M.T.)
| | - Masami Takei
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan; (M.T.); (Y.N.); (N.K.); (K.N.); (M.T.)
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Liu Z, Chu A. Sjögren's Syndrome and Viral Infections. Rheumatol Ther 2021; 8:1051-1059. [PMID: 34227038 PMCID: PMC8380615 DOI: 10.1007/s40744-021-00334-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease, characterized by lymphocytic infiltration of the secretory glands. This leads to dryness of the main mucosal surfaces such as the mouth, eyes, nose, larynx, pharynx, and vagina. Although there is little morbidity data at the initial diagnosis, SS may be a serious disease, with extra mortality caused by hematological cancer. The cause of SS is unknown, but factors postulated to play a role include genetic and environmental factors, hormonal abnormality, and viral infection. Under the influence of these factors, the immune system becomes abnormal and the tissue is damaged. In this study, we summarize recent developments in our understanding of the relationship between SS and viral infections, including Epstein-Barr virus (EBV), hepatitis C virus (HCV), human T cell lymphotropic virus type 1 (HTLV-1), cytomegalovirus (CMV), and human immunodeficiency virus (HIV).
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Affiliation(s)
- Zhiyong Liu
- Department of Rheumatism Immunity, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuchang, Wuhan, 430060, China
| | - Aichun Chu
- Department of Rheumatism Immunity, Wuhan University, Renmin Hospital, 238 Jiefang Road, Wuchang, Wuhan, 430060, China.
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Liao HY, Tao CM, Su J. Concomitant systemic lupus erythematosus and HIV infection: A rare case report and literature review. Medicine (Baltimore) 2017; 96:e9337. [PMID: 29390513 PMCID: PMC5758215 DOI: 10.1097/md.0000000000009337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Coexisting systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection cases are rare worldwide. Great challenges are posed on the diagnosis and treatment of such concurrent cases. PATIENT CONCERN We report the case of a 44-year-old Chinese man with edema, hematuria, and fever who presented at West China Hospital, Sichuan University, Chengdu, Sichuan, China, in 2013. DIAGNOSES An initial diagnosis of SLE was made from the clinical manifestations and laboratory findings based on the Systemic Lupus International Collaborating Clinics classification criteria. Immunosuppressant therapy relieved him of the edema and hematuria, but he regained the symptoms after a cold. Workup, including electrochemiluminescence immunoassay, western blot, and polymerase chain reaction analysis, revealed that he was concurrently infected with HIV after hospitalization. INTERVENTIONS The treatment plan included methylprednisolone and cyclophosphamide, with gastroprotective and hepatoprotective agents, simultaneously aiming to reduce urinary protein. After HIV infection confirmed, cyclophosphamide was stopped. He was referred to the local Centers for Disease Control and Prevention for combination antiretroviral therapy (ART). He was suggested to continue monitoring CD4 T-cell count for an appropriate dose of immunosuppressive drugs. OUTCOMES In the last follow-up in May 2017, he had been stable in terms of both SLE and HIV infection. LESSONS The case highlights the presence of concurrent SLE and HIV infection. Laboratory technicians and clinicians should be cautious on diagnosis, especially in eliminating the false-positive results. Attention should be paid to the dose of immunosuppressants and the ART procedure.
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Kaleidoscope of autoimmune diseases in HIV infection. Rheumatol Int 2016; 36:1481-1491. [DOI: 10.1007/s00296-016-3555-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/13/2016] [Indexed: 12/23/2022]
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Meng Z, Du L, Hu N, Byrd D, Amet T, Desai M, Shepherd N, Lan J, Han R, Yu Q. Antiretroviral Therapy Normalizes Autoantibody Profile of HIV Patients by Decreasing CD33⁺CD11b⁺HLA-DR⁺ Cells: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3285. [PMID: 27082567 PMCID: PMC4839811 DOI: 10.1097/md.0000000000003285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Autoimmune manifestations are common in human immunodeficiency virus (HIV) patients. However, the autoantibody spectrum associated with HIV infection and the impact of antiretroviral therapy (ART) remains to be determined. The plasma autoantibody spectrum for HIV patients was characterized by protein microarrays containing 83 autoantigens and confirmed by enzyme-linked immunosorbent assay (ELISA). Regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs) were analyzed by flow cytometry and their effects on autoantibodies production were determined by B cell ELISpot. Higher levels of autoantibody and higher prevalence of elevated autoantibodies were observed in ART-naive HIV patients compared to healthy subjects and HIV patients on ART. The highest frequency of CD33(+)CD11b(+)HLA-DR(+) cells was observed in ART-naive HIV patients and was associated with the quantity of elevated autoantibodies. In addition, CD33(+)CD11b(+)HLA-DR(+) cells other than Tregs or MDSCs boost the B cell response in a dose-dependent manner by in vitro assay. In summary, HIV infection leads to elevation of autoantibodies while ART suppresses the autoimmune manifestation by decreasing CD33(+)CD11b(+)HLA-DR(+) cells in vivo.The roles of CD33(+)CD11b(+)HLA-DR(+) cells on disease progression in HIV patients needs further assessment.
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Affiliation(s)
- Zhefeng Meng
- From the Oncology Bioinformatics Center, Minhang Hospital, Fudan University (ZM, LD); Shanghai, China; Department of Microbiology and Immunology and Center for AIDS Research, Indiana University School of Medicine, Indianapolis, Indiana, USA (ZM, DB, TA, NS, JL, QY); Zhejiang Provincial Key Laboratory for Technology and Application of Model Organisms, Wenzhou Medical University, University Park, Wenzhou, China (NH); Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN (MD, SG, QY); and Department of Surgery, Davis Heart and Lung Research Institute, Biomedical Sciences Graduate Program, Biophysics Graduate Program, The Ohio State University Wexner Medical Center, Columbus, OH, USA (RH)
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Mody GM, Patel N, Budhoo A, Dubula T. Concomitant systemic lupus erythematosus and HIV: Case series and literature review. Semin Arthritis Rheum 2014; 44:186-94. [DOI: 10.1016/j.semarthrit.2014.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/10/2014] [Accepted: 05/05/2014] [Indexed: 01/10/2023]
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Ramos-Casals M, Font J, Ingelmo M. [Prevalence and clinical significance of hepatitis C virus infection in systemic autoimmune diseases]. Med Clin (Barc) 2001; 116:701-9. [PMID: 11412684 DOI: 10.1016/s0025-7753(01)71958-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- M Ramos-Casals
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínic, Barcelona, Spain
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Kawano C, Muroi K, Akioka T, Izumi T, Kodera Y, Ozawa K. Cytomegalovirus pneumonitis, activated prothrombin time prolongation and subacute thyroiditis after unrelated allogeneic bone marrow transplantation. Bone Marrow Transplant 2000; 26:1347-9. [PMID: 11223977 DOI: 10.1038/sj.bmt.1702711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 22-year-old female with acute myeloid leukemia (AML) in complete remission received a conditioning regimen containing antithymocyte globulin for an unrelated bone marrow transplant (BMT). After BMT, the patient suffered from cytomegalovirus (CMV) pneumonitis with markedly high levels of CMV antigenemia, activated prothrombin time (APTT) prolongation, and subacute thyroiditis. Recovery of CD4+ cells was delayed as long as 1 year after BMT. An association between these three episodes and viral infection due to the delayed recovery of CD4+ cells is suggested.
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Affiliation(s)
- C Kawano
- Division of Cell Transplantation and Transfusion, Jichi Medical School, Minamikawachi, Japan
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Wen L, Hayday AC. Gamma delta T-cell help in responses to pathogens and in the development of systemic autoimmunity. Immunol Res 1997; 16:229-41. [PMID: 9379074 DOI: 10.1007/bf02786392] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mice rendered deficient in alpha beta T-cells by single-gene knockout mutation show enhanced levels of autoantibody formation and even some symptoms of autoimmune disease. This is remarkable given that most experimental studies heretofore have indicated that the development of autoimmune disease is highly multigenic, requiring the complementary actions of multiple loci. The basis of the phenomenon in alpha beta T-cell-deficient mice appears to be the provision of help to B-cells by other cells, including gamma delta T-cells. Perhaps surprisingly, gamma delta T-cell help seems quite efficacious, particularly after infection, when it can culminate in the formation of germinal centers. Furthermore, two independent sets of studies reviewed here indicate that significant levels of self-reactive IgG can also be provoked by gamma delta T-cells independent of germinal center formation. The task ahead is to integrate this pathway into the physiologic immune responses to healthy individuals, immunocompromised individuals, and newborns.
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Affiliation(s)
- L Wen
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
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