Lymphocytotoxic antibodies in spontaneous cytomegalovirus infection

Optic neuropathy secondary to perhexiline and amiodarone

Bilateral optic disc swelling is an important clinical sign for potentially life-threatening and sight-threatening conditions, with the most common being raised intracranial pressure and pseudopapillitis. Perhexiline-related and amiodarone-related optic disc swellings are diagnoses of exclusion. This report describes the diagnosis of a man with perhexiline-induced and amiodarone-induced optic neuropathy after extensive investigation consisting of full ophthalmic examination, biochemical screen, temporal artery biopsy, CT, MRI, positron emission tomography and lumbar puncture. There was partial to complete resolution of optic neuropathy following cessation of the causative medication. We postulate that the underlying mechanism of perhexiline toxicity could be mitochondrial dysfunction related. Our case demonstrates that patients treated with perhexiline and amiodarone should be monitored closely for ocular side effects.

Renal graft dysfunction during infection with cytomegalovirus: association with IgM lymphocytotoxins and HLA-DR3 and DR7

Of 121 consecutive adult recipients of cadaver renal transplants who were treated with low dose steroids and azathioprine, 23 developed active cytomegalovirus infections. These 23 patients were divided into three groups on the basis of their symptoms related to the infection: five patients had no renal, respiratory, or haematological abnormalities; seven had renal dysfunction; and nine had renal dysfunction plus respiratory or haematological abnormalities. Two patients were regarded as a separate group because their infections occurred two to four weeks after graft nephrectomy. All but three of the patients produced IgM or IgG lymphocytotoxins during their infections. In the patients with mild infections and in control patients without infections, however, these lymphocytotoxins were predominantly IgG antibodies that were not precipitated by 3.5% macrogol (polyethylene glycol). In contrast, 12 of the 16 patients with renal dysfunction during their infections had broadly reactive IgM lymphocytotoxins. These IgM lymphocytotoxins lysed T as well as B lymphocytes at 22 degrees C and were precipitated by 3.5% macrogol, suggesting that they were circulating as immune complexes. Rheumatoid factors were found in sera from nine patients with cytomegalovirus infections, seven of whom developed leukopenia or pneumonia, or both, in addition to renal dysfunction. Some of these immune responses associated with cytomegalovirus infection in transplant recipients may be genetically controlled since 10 of 11 patients positive for HLA-DR3 or DR7 produced IgM lymphocytotoxins.

Two siblings with acute T-cell lymphocytic leukemia

The only two children of clinically healthy parents both developed an acute lymphocytic leukemia of the T-cell type, one with a mediastinal mass, one without. Extensive laboratory studies revealed a combination of the following unusual circumstances. (1) The injection of leukemic bone marrow into BALB/c-nu/nu mice led to an explosive simultaneous development of disseminated lymphomatous tumors with murine karyotype. (2) HLA typing and MLC testing of all four family members revealed sharing of HLA-A,D and DRw determinants between the parents and pointed to the appearance of suppressor cell activity with the outbreak of the acute leukemia of one sibling. (3) Parental lymphocytes gave a low response to mitogen stimulation, suggesting a subclinical cellular immune defect. It is proposed that the siblings inherited from each parent a defective immune response factor, possibly related to HLA-D/DRw antigens, that predisposed to acute T-cell leukemia. The neoplastic process might have been triggered by a transferable agent.

Blood transfusions and antibody response in patients waiting for a kidney transplant

Cold and warm B and T cell antibodies have been investigated following blood transfusion in patients waiting for a kidney transplant. 18 out of 28 patients were sensitized after a single transfusion: half of them presented a B-warm pattern and the other half either a T-warm or a B-cold pattern. Several sera collected after one transfusion were absorbed with pooled platelets. All three T-warm sera have become negative after absorption. Out of 21 B-warm sera, 6 remained B-warm, 3 became B-cold and 12 were negative after absorption. There was no difference in strength between the B-warm sera which were absorbed and those which resisted to absorption. Dilution studies showed that sera followed a similar trend: they convert from T-warm to B-warm and B-cold patterns. Sequential sera from patients receiving systematic transfusions were tested at regular intervals after each transfusion. Most patients produced B-warm antibodies.