Comparative study of bone marrow and blood B cells in infantile and acquired agammaglobulinemia. Possible role of circulating anti-IgM in pathogenesis

Case report. Disseminated sporotrichosis presenting as sarcoidosis: electron microscopic and immunologic studies

A 50-year-old black man with constitutional symptoms, cutaneous nodules, and bilateral hilar adenopathy was found to have non-caseating granulomata on bronchial biopsy. He was treated with corticosteroids for sarcoidosis. Within five months he was found to have disseminated sporotrichosis. Electron microscopy revealed mycelial forms of S. schenckii in superficial lesions and yeast forms from deep tissue sites: no novel forms were seen. Blood mononuclear cell studies revealed hyperactive suppressor cells with respect to non-specific T cell targets and the antigen specific target. Examination of the initial biopsy material after digestion with diastase before PAS staining revealed budding yeast consistent with S. schenckii. This case emphasizes the need for careful histopathologic examination of clinical material before a diagnosis of sarcoidosis is made, and reveals an immunologic abnormality which may account for the patient's anergic state and susceptibility to S. schenckii infection.

Myasthenia gravis with a monoclonal gammopathy--report of a case

An elderly man with relapsing myasthenia gravis was found to have hypergammaglobulinaemia, a monoclonal peak of gamma mobility and paraproteinaemia IgG, type K. Bence-Jones proteinuria, type K was present. This is the fourth report of myasthenia gravis associated with a monoclonal gammopathy. Myasthenia gravis is considered to be an autoimmune disease. Recent findings implicate a dysfunction of cellular immunity in the pathogenesis of both immunoproliferative and autoimmune disease. We suggest that the association of myasthenia gravis and monoclonal gammopathy in our patient might have stemmed from a disorder of T lymphocyte function.

Agammaglobulinaemia associated with the occurrence of a monoclonal immunoglobulin

A patient is described with a monoclonal immunoglobulin of the IgG class in the serum and no detectable IgM and IgA. Extensive immunological investigations showed the absence of B-lymphocytes in bone marrow and peripheral blood. Moreover, plasma cells were not present in the bone marrow. The monoclonal IgG was synthesized in the gastrointestinal tract. The cellular immune-status of the patient was synthesized in the gastrointestinal tract. The cellular immune-status of the patient was normal. Clinically the patient suffered from gastrointestinal and severe respiratory tract infections. It was concluded that the findings are consistent with the diagnosis congenital agammaglobulinaemia with concurrence of monoclonal IgG. It was postulated that the cell clone in the gastrointestinal tract resulted from an escape of a pre-B cell clone from the recongized arrest of pre-B cells in congenital agammaglobulinaemia.

Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients

Fifty patients with late-onset idiopathic immunoglobulin deficiency were studied and the frequency of various clinical associations and complications was observed. Men and women were equally affected, although the age at onset in men peaked in the third decade whereas it was more uniformly distributed in women. Sinobronchopulmonary infections were common and were caused by Haemophilus influenzae. Diplococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus: bronchiectasis occurred in 28 per cent. Thirty patients (60 per cent) had diarrhea, which was often associated with steatorrhea, giardiasis, achlorhydria, abnormal Schilling tests and morphologic abnormalities on small bowel biopsy specimens, including nodular lymphoid hyperplasia; three patients had pernicious anemia. In the 20 patients without diarrhea these abnormalities were not observed except for giardiasis in one patient and achlorhydria in two patients. Cholelithiasis occurred in both groups in about a third of the patients tested. A high degree of susceptibility to neoplasia was noted. Thyroid abnormalities, including primary hypothyroidism and Graves' disease, were observed in six patients. Additional occasional findings were vitiligo, keratoconjunctivitis sicca and arthritis. Splenomegaly occurred in 14 (28 per cent) patients. The percentage of B lymphocytes in the blood was determined in 10 patients; it was normal or slightly decreased in eight patients and low in two patients.

Distribution of T and B lymphocytes in lymphoid tissue of infants and children

Normal lymphoid tissue from children undergoing elective surgery was examined for T and B lymphocyte distribution. Although established for peripheral blood and bone marrow, T and B lymphocyte distributions have not been previously reported for lymph nodes, appendix, thymus, and spleen tissues in children. Thymus-dependent T cells were determined by the sheep erythrocyte rosette technique, and thymus-independent B cells were determined by the fluorescent labeling of surface immunoglobulins A (IgA), G (IgG), and M (IgM). Fifty percent of lymph node cells were either T or B cells; 65% of these cells were T lymphocytes, whereas 58% of B cells were of the IgM subclass. Less than half of the appendix cells were either T or B cells; 47% of these were T lymphocytes, and the remainder B lymphocytes had subclass distribution similar to that of lymph nodes but different from peripheral blood and bone marrow where B cells bearing IgG predominate. Thymus tissue contained 43% T cells and less than 1% B cells, but the spleen was composed largely of B cells, predominantly of the IgM type. Lymphoid tissue from nine children with either inflammatory or neoplastic diseases were studied and included for contrast. This paper establishes relative distribution values for T and B lymphocytes in normal lymphoid tissue and points out the potential use of this technique to quantitate deviations from normal in certain inflammatory and neoplastic diseases.

IgA in commercial gamma-globulin preparations

The presence of anti-IgA has been related to adverse reactions to injection or infusion of IgA-containing material. In this study IgA was demonstrated in all of the investigated commercial gamma-globulin preparations. In the material from a few producers it was, however, very low. By immuno-gel filtration it could be shown that the IgA consisted of aggregates as well as a 7S component and fragments. By immunoelectrophoresis-immunofluorescence IgG-IgA complexes could also be detected. The IgA aggregates could be almost completely degraded by reduction-alkylation. It is implied that such changed IgA in gamma-globulin preparations for injection may increase the risk of immunization against IgA.

Acquired agammaglobulinemia after a life-threatening illness with clinical and laboratory features of infectious mononucleosis in three related male children

Three males in one family (two siblings and one maternal cousin) had an illness with cervical adenopathy, hepatosplenomegaly, and a fulminant febrile course. In the two survivors agammaglobulinemia developed. One of them became ill at the age of six months and had an Epstein-Barr-virus antibody titer of 1:10 during illness and convalescence. The white-cell count was 120,000 with 90 per cent lymphocytes, most being atypical and forming increased numbers of sheep erythrocyte rosettes. IgM was elevated, IgA normal and IgG decreased. Subsequently, all immunoglobulins were absent, and the Epstein-Barr-virus antibody titer became negative. Peripheral B-cell number remained normal, but abnormal lymph-node architecture associated with failure to respond to antigenic challenge indicated B-cell dysfunction. The pathogenesis of this entity may involve an abnormal T-cell response to transformation of B cells by Epstein-Barr virus, leading to B-cell dysfunction and agammaglobulinemia.

Human bone marrow lymphocytes. I. Distribution of lymphocyte subpopulations in the bone marrow of normal individuals

This study was undertaken to determine the proportions and in vitro immune capacities of lymphocyte populations in the bone marrows of normal humans. Relatively pure mononuclear cell suspensions were obtained from bone marrow aspirates by linear sucrose gradient centrifugations. Simultaneous peripheral blood and bone marrow specimens from each individual were assayed for lymphocyte surface markers and mitogen responsiveness. Maximal possible contamination of bone marrow aspirates by peripheral blood was determined by performing aspirates on individuals who had received 51chromium-labeled autologous erythrocytes. Rhymus-derived (T) lymphocytes, as determined by the sheep red blood cell (E) rosette assay, comprised 8.6-(plus or minus 1.6)% of the total bone marrow lymphocyte pool. Bone marrow-derived (B) lymphocytes, as determined by the presence of a complement receptor, made up 15.4-(plus or minus 1.9)% of the lymphocyte pool whereas 74.6 (plus or minus 2.4)% of mononuclear cells lacked easily detectable surface markers. These findings could not be explained by contamination with peripheral blood lymphocytes since contamination was corrected for in the calculations. Lymphocyte-enriched suspensions of bone marrow cells responded to stimulation with phytohemagglutinin, concanalin A, and particularly pokeweed mitogen. In vitro incubations of bone marrow and peripheral blood lymphocytes with tritiated thymidine followed by determinations of E and erythrocyte antibody complement (EAC) rosettes were performed. Simultaneous rosetteradioautographs demonstrated that the proliferative potential of bone marrow B lymphocytes was greater than peripheral blood B lymphocytes (P less than 0.01). On the other hand, the proliferative potential of bone marrow T lymphocytes was the same as that of peripheral blood T lymphocytes. These findings demonstrate that in addition to containing B lymphocytes the normal bone marrow contains a small fraction of T lymphocytes similar to the mature T lymphocyte pool found in the peripheral blood. These T cells most probably enter the bone marrow parenchyma as part of the normal recirculating lymphocyte pool.

Membrane-associated immunoglobulin determinants on bone marrow and blood lymphocytes in the pediatric age group and on fetal tissues

Lymphocytes from bone marrow and blood of infants and children and from various tissues of seven fetuses between 13 and 25 weeks of gestational age were studied by immunofluorescence for the presence of membrane-associated immunoglobulins. Cells with mu and delta determinants prevailed, and these immunoglobulins were usually present on the same cell. The bone marrow specimens of all age groups contained more mu-positive cells without delta determinants than did the samples from the peripheral blood. Such mu(+)delta(-) cells were also found in tissues of young fetuses. These cells were postulated to represent the first stage of B cells displaying Ig receptors. Other tests with double staining showed that cells with delta determinants, but without the presence of other H chains, are rare, if they exist at all. This finding supports the idea that the role of IgD could be one of regulation of antibody secretion rather than of antibody activity. The number of cells that displayed alpha determinants was first observed to rise after birth, and only in the bone marrow, where it reached an average maximum of 16%. The relative number of such cells in the blood never exceeded a few percent.