Primary deficiencies in humoral immunity

Anaphylactic transfusion reaction associated with a possible anti-A2m(1)

A 42-year-old leukaemic black male developed shortness of breath, itching, hot flushes, substernal pain, marked hypotension, and cardiorespiratory arrest after the infusion of 50 ml of pooled platelet concentrates. The patient had had one previous and uneventful red blood cell transfusion. Serologic studies of this patient's post-transfusion serum showed the presence of an antibody against one denatured IgA2 protein with the phenotype A2m(1 + 2-). All of the platelet donors were A2m(1) positive. The patient was successfully transfused with platelets from donors with the phenotype A2m(1 - 2+). Although 35.8% of Blacks and 30.0% of Chinese are A2m(1) negative, this is the first reported transfusion reaction associated solely with the occurrence of a possible anti-A2m(1) in an individual of the type A2m(1 - 2+).

An X-linked syndrome of diarrhea, polyendocrinopathy, and fatal infection in infancy

We have studied a patient from a family in which 17 male infants died in the first years of life. The clinical characteristics of this disorder were established from information from eight patients. The features included diarrhea, diabetes mellitus, hemolytic anemia, eczematoid rashes, and exaggerated responses to viral illnesses, combined with pathologic evidence of autodestruction of endocrine glands, insulitis, and thyroiditis with thyroid autoantibodies in one patient. When tested, B-lymphocyte cell function, T cell numbers, polymorphonuclear leukocyte chemotaxis, and complement concentrations were normal. Lymphocyte stimulation with phytohemagglutinin was low in one to two affected males and delayed skin test anergy was noted in another, raising the question of a T-lymphocyte cell abnormality. The basic genetic mechanism is unknown, but involvement of an immune response locus on the X chromosome, dysfunction of which is responsible for overactivity of the autoimmune system, is postulated.

Cutaneous infections and disorders of inflammation

In 1908, the Nobel Prize in Physiology and Medicine was shared by Elie Metchnikoff and Paul Ehrlich. Their joint commendation acknowledged the vigorous debate which then existed and, in a sense, paved the way for our modern recognition that both cellular and humoral mechanisms might participate in immunity. Of Ehrlich's and Metchnikoff's many accomplishments, those concerning the basic nature of the inflammatory reaction suggested a clinical potential that has been realized only in the last decade. Central to their theories was the implication that normal inflammatory processes were of benefit to the host and that disordered inflammation was likely to lead to disease. Over the past decade or so, we have recognized an extensive set of diseases associated with primary or acquired deficiencies of inflammation, thus beginning to catch up to the genius of Ehrlich and Metchnikoff. Most, if not all, of these disorders demonstrate major cutaneous involvement in their clinical and biologic presentations. It is thus of essential importance that the dermatologist be familiar with this fascinating spectrum of disease, and it is to this end that this review is directed.