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Zack MT, Geissler K. Significance of hypergammaglobulinemia in patients with chronic myelomonocytic leukemia. Wien Med Wochenschr 2023; 173:21-26. [PMID: 36445600 PMCID: PMC9877045 DOI: 10.1007/s10354-022-00983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/15/2022] [Indexed: 12/03/2022]
Abstract
Chronic inflammation is often indicated by a relative increase in the gamma globulin fraction in the serum electrophoresis. In a retrospective study, we analyzed the prevalence of relative hypergammaglobulinemia in 60 patients with chronic myelomonocytic leukemia (CMML), its potential prognostic impact, and potential correlations with laboratory and molecular features. Relative hypergammaglobulinemia (> 20%) was found in 25/60 (42%) patients. The median survival of patients with relative hypergammaglobulinemia was significantly shorter than in patients without hypergammaglobulinemia (10 vs. 24 months, p = 0.018). There was no difference between the groups regarding leukocyte count, hemoglobin value, and platelet count, but a higher prevalence of NRAS mutations and a lower prevalence of ZRSR2 mutations in patients with hypergammaglobulinemia. Our results show that hypergammaglobulinemia is present in a proportion of CMML patients and that this abnormality is associated with poor overall survival. The role of chronic inflammation in the pathophysiology of CMML needs to be further investigated.
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Affiliation(s)
| | - Klaus Geissler
- Medical School, Sigmund Freud University, Vienna, Austria ,Department of Internal Medicine V with Hematology, Oncology and Palliative Care, Hospital Hietzing, Wolkersbergenstr. 1, 1130 Vienna, Austria
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Sassi A. Development of antibodies to the iron-binding proteins transferrin and ferritin in dogs and mice infected with Leishmania parasites. Acta Trop 2022; 232:106522. [PMID: 35597263 DOI: 10.1016/j.actatropica.2022.106522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022]
Abstract
Most microorganisms including Leishmania parasites compete with the innate immune defenses of the infected hosts to acquire iron, an essential nutrient necessary for their growth and replication. In mammals, iron is predominantly bound to protein carriers such as transferrin and ferritin and the strategies adopted by the infected host to restrict its uptake by pathogens are still not elucidated. We compared herein the development of anti-transferrin and anti-ferritin antibodies in hosts that differs by their susceptibility to Leishmania infection. Results showed that Leishmania infantum naturally-infected dogs which have developed canine leishmaniasis (CanL) demonstrated higher titers of IgG antibodies anti-leishmanial antigens and anti-iron binding proteins than those infected without clinical signs. In the experimental mouse model, C57BL/6 mice resisted L. major infection, developed lower titers of Leishmania-specific IgG antibodies than BALB/c susceptible mice but demonstrated also the production of anti-transferrin and anti-ferritin IgG antibodies. Overall, results are in favor that mechanisms, other than the polyclonal activation of B cells associated-hypergammaglobulinemia, a characteristic of susceptible animals, are likely involved and require a replicating parasite for the limitation of iron uptake.
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Atwell JE, Lutz CS, Sparrow EG, Feikin DR. Biological factors that may impair transplacental transfer of RSV antibodies: Implications for maternal immunization policy and research priorities for low- and middle-income countries. Vaccine 2022; 40:4361-4370. [PMID: 35725783 PMCID: PMC9348036 DOI: 10.1016/j.vaccine.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/19/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
Respiratory syncytial virus (RSV) is the leading viral cause of acute lower respiratory tract infection (ALRI), including bronchiolitis and pneumonia, in infants and children worldwide. Protection against RSV is primarily antibody mediated and passively acquired RSV neutralizing antibody can protect infants from RSV ALRI. Maternal immunization is an attractive strategy for the prevention of RSV in early infancy when immune responses to active immunization may be suboptimal and most severe RSV disease and death occur. However, several biologic factors have been shown to potentially attenuate or interfere with the transfer of protective naturally acquired antibodies from mother to fetus and could therefore also reduce vaccine effectiveness through impairment of transfer of vaccine-induced antibodies. Many of these factors are prevalent in low- and middle-income countries (LMIC) which experience the greatest burden of RSV-associated mortality; more data are needed to understand these mechanisms in the context of RSV maternal immunization. This review will focus on what is currently known about biologic conditions that may impair RSV antibody transfer, including preterm delivery, low birthweight, maternal HIV infection, placental malaria, and hypergammaglobulinemia (high levels of maternal total IgG). Key data gaps and priority areas for research are highlighted and include improved understanding of the epidemiology of hypergammaglobulinemia and the mechanisms by which it may impair antibody transfer. Key considerations for ensuring optimal vaccine effectiveness in LMICs are also discussed.
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Affiliation(s)
- Jessica E Atwell
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Disease Epidemiology and Control, Baltimore, MD, USA
| | - Chelsea S Lutz
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Disease Epidemiology and Control, Baltimore, MD, USA
| | - Erin G Sparrow
- The World Health Organization, Department of Immunization, Vaccines and Biologicals, Geneva, Switzerland
| | - Daniel R Feikin
- The World Health Organization, Department of Immunization, Vaccines and Biologicals, Geneva, Switzerland
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Mustika S, Pratama MZ, Lesmana CRA. Diagnostic Challenge in a Patient Presenting with Ascites and Hypergammaglobulinemia. Case Rep Gastroenterol 2021; 15:810-818. [PMID: 34720828 PMCID: PMC8543362 DOI: 10.1159/000518384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Ascites is defined as the accumulation of intra-peritoneal fluid that can be caused by several diseases. We described a 47-year-old female presenting with low serum-ascites albumin gradient (SAAG) and a markedly high level of serum globulin. Serum protein electrophoresis revealed an M spike in the gamma region. Other laboratory results showed a marked increase in aspartate aminotransferase and alanine aminotransferase and predominantly conjugated hyperbilirubinemia without a sign of dilatation of bile ducts from abdominal ultrasonography examination. Furthermore, the follow-up showed a positive result for the anti-nuclear antibody test. The patient was assessed with autoimmune hepatitis, and the cause of ascites was suggested from portal hypertension although the level of SAAG was low. The ascites condition got improved after salt restriction, diuretics treatment, and abdominal paracentesis. However, the patient passed away because of the intracranial hemorrhage as a result of prolonged INR and APTT due to liver failure.
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Affiliation(s)
- Syifa Mustika
- Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia
| | - Mirza Zaka Pratama
- Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia
| | - Cosmas Rinaldi Adithya Lesmana
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Moussiegt A, Müller R, Ebbo M, Grados A, Graveleau J, Ackermann F, Bachmeyer C, Bernit E, Blanche P, Canoui E, Chaix F, Costedoat-Chalumeau N, Groote P, Etienne N, Fior R, Flamarion E, Kennel T, Launay D, Lerolle N, Limal N, Loustau V, Menage E, Moulis G, Papo T, Pouchot J, Quemeneur T, Roumier M, Tchérakian C, Lefèvre G, Rebours V, Kahn JE, Schleinitz N, Groh M; CEREO., French IgG4-RD Study Group. IgG4-related disease and hypereosinophilic syndrome: Overlapping phenotypes. Autoimmun Rev 2021; 20:102889. [PMID: 34237420 DOI: 10.1016/j.autrev.2021.102889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 01/13/2023]
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Affiliation(s)
- Alice R Burton
- Division of Infection & Immunity, University College London, London, UK
| | - Laura J Pallett
- Division of Infection & Immunity, University College London, London, UK.
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Zou L, Chen G, Zhou Y, Ye W, Wen Y, Chen L, Li X. Continuous hypergammaglobulinemia and proteinuria after the recovery of the visceral Leishmaniasis: a case report. BMC Infect Dis 2021; 21:124. [PMID: 33509123 PMCID: PMC7844912 DOI: 10.1186/s12879-021-05819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney involvement of visceral Leishmaniasis is previously reported, but knowledge is limited. Hypergammaglobulinemia is common in visceral leishmaniasis patients. Whether hypergammaglobulinemia after leishmaniasis depletion can cause kidney injury is not well reported yet. CASE PRESENTATION We reported a patient who recovered from visceral Leishmaniasis but showed persistent hypergammaglobulinemia and elevated urinary protein. Kidney biopsy showed glomerular hypertrophy with mild segmental mesangial proliferation without tubulointerstitial involvement in light microscopy. No immune complex deposit was found in the mesangial area by neither immunofluorescent staining nor electronic microscope. Increased lysosomes were observed in proximal tubules by electronic microscope. Valsartan was administered to decrease urinary protein, and no immune-suppressive therapy was added. The urinary protein and serum IgG level gradually dropped, and serum creatinine level remained stable during three- month follow up. CONCLUSIONS Hypergammaglobulinemia is unlikely to cause renal structural or functional damage in the short term. Angiotensin blockade significantly reduced urine protein, with a minor effect on IgG elimination.
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Affiliation(s)
- Linfeng Zou
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Gang Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Yangzhong Zhou
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Ye
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yubin Wen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Fraternale A, Zara C, Di Mambro T, Manuali E, Genovese DA, Galluzzi L, Diotallevi A, Pompa A, De Marchis F, Ambrogini P, Cesarini E, Luchetti F, Smietana M, Green K, Bartoccini F, Magnani M, Crinelli R. I-152, a supplier of N-acetyl-cysteine and cysteamine, inhibits immunoglobulin secretion and plasma cell maturation in LP-BM5 murine leukemia retrovirus-infected mice by affecting the unfolded protein response. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165922. [PMID: 32800945 DOI: 10.1016/j.bbadis.2020.165922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/16/2020] [Accepted: 08/08/2020] [Indexed: 12/27/2022]
Abstract
Excessive production of immunoglobulins (Ig) causes endoplasmic reticulum (ER) stress and triggers the unfolded protein response (UPR). Hypergammaglobulinemia and lymphadenopathy are hallmarks of murine AIDS that develops in mice infected with the LP-BM5 murine leukemia retrovirus complex. In these mice, Th2 polarization and aberrant humoral response have been previously correlated to altered intracellular redox homeostasis. Our goal was to understand the role of the cell's redox state in Ig secretion and plasma cell (PC) maturation. To this aim, LP-BM5-infected mice were treated with I-152, an N-acetyl-cysteine and cysteamine supplier. Intraperitoneal I-152 administration (30 μmol/mouse three times a week for 9 weeks) decreased plasma IgG and increased IgG/Syndecan 1 ratio in the lymph nodes where IgG were in part accumulated within the ER. PC containing cytoplasmic inclusions filled with IgG were present in all animals, with fewer mature PC in those treated with I-152. Infection induced up-regulation of signaling molecules involved in the UPR, i.e. CHAC1, BiP, sXBP-1 and PDI, that were generally unaffected by I-152 treatment except for PDI and sXBP-1, which have a key role in protein folding and PC maturation, respectively. Our data suggest that one of the mechanisms through which I-152 can limit hypergammaglobulinemia in LP-BM5-infected mice is by influencing IgG folding/assembly as well as secretion and affecting PC maturation.
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Mezzanotte JN, Gibbons-Fideler IS, Shilo K, Lustberg M, Devarakonda S. Nodular pulmonary deposition disease in a patient with the acquired immunodeficiency syndrome: a case report. J Med Case Rep 2020; 14:64. [PMID: 32498712 PMCID: PMC7273682 DOI: 10.1186/s13256-020-02394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022] Open
Abstract
Background Pulmonary nodules are a common cause for concern in patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Most commonly, they are the result of an infection, given the patients’ immunocompromised state; however, in some cases, pulmonary nodules in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome can result from cellular or protein deposits. We report a rare case of nodular pulmonary light chain deposition disease in a patient with acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance. Case presentation A 53-year-old African American woman with acquired immunodeficiency syndrome had pulmonary nodules detected incidentally by imaging of her lungs. Pulmonary tuberculosis was high on the differential diagnosis, but she had a negative test result for pulmonary tuberculosis. Imaging also revealed multiple lucent bone lesions, and earlier in the year, serum protein electrophoresis had shown an immunoglobulin G-kappa monoclonal protein (M spike). She was mildly anemic, so there was concern for progression to myeloma; however, the result of her bone marrow biopsy was unremarkable. Lung biopsy revealed finely granular eosinophilic material with negative Congo red staining, consistent with light chain deposition disease. Conclusions The extent of this patient’s light chain deposition disease was thought to be caused by a combination of acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance, and the interval decrease in lung nodule size after restarting antiretroviral therapy confirms this hypothesis and also highlights a potentially unique contribution of the hypergammaglobulinemia to this disease process in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome .
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Affiliation(s)
- Jessica N Mezzanotte
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | | | - Konstantin Shilo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mark Lustberg
- Department of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Srinivas Devarakonda
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Milazzo L, van den Bogaart L, Sollima S, Oreni L, Lai A, Morena V, Bonazzetti C, Ridolfo Anna L, Antinori S. Impact of HCV eradication with direct-acting antiviral agents on serum gamma globulin levels in HCV and HCV/HIV coinfected patients. Eur J Intern Med 2020; 75:50-54. [PMID: 31980330 DOI: 10.1016/j.ejim.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND chronic viral infections by both HCV and HIV may lead to polyclonal activation of B cells resulting in hypergammaglobulinemia. This study retrospectively analyzed the effect of HCV eradication with interferon-free direct-acting antiviral agents (DAAs) on the gamma globulin levels in HCV-infected patients with or without HIV coinfection to identify factors potentially associated with gamma globulins decrease. METHODS The charts of patients treated with DAAs for HCV chronic infection between January 2015-June 2019 were retrospectively reviewed. Gamma globulin levels before treatment and 12 weeks after the end of anti-HCV therapy were evaluated along with liver tests, liver fibrosis stage by elastography, SVR achievement, HIV-coinfection. Multivariate analyses were carried out to assess the factors and the potential confounders related to the changes in gamma globulin levels. RESULTS A significant decrease of gamma globulin concentration was found in both cirrhotic and non-cirrhotic HCV-infected patients after treatment (from mean ± SD of 1.5 ± 0.44 g/dL to 1.31 ± 0.37 g/dL; p = 0.0001). Adjusted linear regression analyses of serum gamma globulin changes from baseline to SVR12 showed a positive significant association with pre-treatment gamma-globulin levels (β-coefficient -0.23; p = 0.0001), Metavir fibrosis score (β-coefficient -0.74; p = 0.008), ALT values and baseline HCV-RNA levels > 800,000. No difference was found between HIV-infected and HIV-uninfected patients. CONCLUSIONS Our study confirms previous preliminary observation of the decrease of serum gamma globulins after HCV eradication either achieved with interferon-based therapy or with DAAs, suggesting a leading role of the virus on the activation of B cell compartment and gamma globulins production.
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Affiliation(s)
- Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy.
| | - Lorena van den Bogaart
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Letizia Oreni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Alessia Lai
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Valentina Morena
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Cecilia Bonazzetti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Lisa Ridolfo Anna
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di, Milano, Italy
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Abstract
Eosinophilic fasciitis is a disease originally proposed as "diffuse fasciitis with eosinophilia" by Shulman in 1974. The patients with this disease often have history of strenuous exercise or labor a few days to 1-2 weeks before the onset. The chief symptoms are symmetrical, full-circumference swelling and plate-like hardness of the distal limbs. This is accompanied by redness and pain in the early stages, with many cases exhibiting systemic symptoms such as fever or generalized fatigue. The lesions have been observed extending to the proximal limbs, though never on the face or fingers. En bloc biopsies from the skin to the fascia show marked fascial thickening and inflammatory cell infiltration by the lymphocytes and plasma cells. Eosinophilic infiltration is useful for the diagnosis but is only seen in the early stages of the disease. Recently, "Diagnostic criteria, severity classification, and clinical guidelines for eosinophilic fasciitis" were published. This review article discusses about eosinophilic faciitis in detail, from its pathophysiology to the treatment.
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Schmutz M, Schaller T, Kubuschok B, Fleischmann C, Hirschbühl K, Dintner S, Häckel T, Märkl B, Trepel M, Claus R. [Periodic fever and pancytopenia in a 35-year-old patient]. Internist (Berl) 2019; 60:1305-1310. [PMID: 31549186 DOI: 10.1007/s00108-019-00679-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
MEDICAL HISTORY AND INITIAL PRESENTATION A 35-year-old patient with a previous history of persistent episodic fever, sore throat, myalgia, and cephalgia presented for evaluation of pancytopenia. He had no recent travel history, except for a stay in Italy 1 year prior to admission and in Spain several years in the past. DIAGNOSTIC WORKUP Laboratory evaluation confirmed pancytopenia, agranulocytosis, and elevated infection parameters without indicative serological results en par with lymphadenitis colli. Computed tomography scanning revealed cervical lymphadenopathy, hepatosplenomegaly, and colitis with occult perforation of the sigmoid colon. Bone marrow biopsy showed an infiltration of polyclonal plasma cells. Lymph node biopsy was compatible with necrotizing lymphadenitis. DIAGNOSIS Polymerase chain reaction analysis of a lymph node specimen confirmed the presence of Leishmania species, thereby enabling the diagnosis of visceral Leishmania. THERAPY COURSE Treatment with liposomal amphotericin B was initiated. Both fever and lymphadenopathy quickly resolved. CONCLUSION VL is a clinically pleiotropic, severe disease with fatal outcome if left untreated. It often presents with distinct similarities to hematologic malignancies. Exacerbation can occasionally occur as fulminant macrophage activation syndrome. Disease incidence is globally increasing and has not peaked as yet. A complex interplay between pathogen and the immune system is the key pathophysiological mechanism.
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Affiliation(s)
- M Schmutz
- 2. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - T Schaller
- Institut für Pathologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - B Kubuschok
- 2. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - C Fleischmann
- 3. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - K Hirschbühl
- 2. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - S Dintner
- Institut für Pathologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - T Häckel
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - B Märkl
- Institut für Pathologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - M Trepel
- 2. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - R Claus
- 2. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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Cushing AC, Ramsay EC, Newman SJ, Hespel AM, Sula MM. HYPERGAMMAGLOBULINEMIA AND MYELOMA IN FIVE TIGERS ( PANTHERA TIGRIS): CLINICOPATHOLOGICAL FINDINGS. J Zoo Wildl Med 2019; 50:219-24. [PMID: 31120681 DOI: 10.1638/2018-0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Five adult tigers (Panthera tigris) presented with a range of clinical signs, including paresis (2/5), lameness (2/5), ataxia (3/5), anorexia (5/5), and lethargy (5/5). Each tiger demonstrated elevated plasma globulin levels (7.8-14.8 g/dl; [reference interval 2-5.1 g/dl]) on routine biochemistry, confirmed as a monoclonal gammopathy using protein electrophoresis. Serum gammaglobulin concentration ranged from 5 to 7.5 g/dl, or 45.1-63.4% of total protein concentration. Azotemia was present in three tigers. Diagnostics and management varied with the presenting signs but included magnetic resonance imaging, radiography, chemotherapy, supportive care, and euthanasia. In each case, necropsy revealed a neoplastic plasma cell proliferation in the bone marrow and one or more extramedullary sites. Lytic lesions in the thoraco-lumbar spine were found in three animals, and one lesion was associated with spinal cord compression. Splenomegaly was present in 4/5 cases. Histopathology confirmed a plasma cell neoplasm in each case, and immunohistochemistry staining with multiple myeloma oncogene 1 (MUM1) was positive in each case. CD20 staining was performed in two cases and was positive in one. CD3 staining was performed in the same two cases, and was negative in each. Based on the clinical, gross, microscopic, and immunohistochemical findings, myeloma was diagnosed in all five tigers.
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Baroncelli S, Maria Galluzzo C, Liotta G, Orlando S, Ciccacci F, Andreotti M, Mpwhere R, Luhanga R, Sagno JB, Amici R, Marazzi MC, Giuliano M. IgG abnormalities in HIV-positive Malawian women initiating antiretroviral therapy during pregnancy persist after 24 months of treatment. Int J Infect Dis 2019; 88:1-7. [PMID: 31499207 DOI: 10.1016/j.ijid.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Hypergammaglobulinemia and anomalies in the IgG subclass distribution are common in HIV-infected individuals and persist even after many years of antiretroviral therapy (ART). The aim of this study was to investigate the IgG profile and dynamics in pregnant HIV-infected Malawian women in the Option B era. METHODS Thirty-seven treatment-naive women received ART from the third trimester of pregnancy to 6 months post delivery (end of the breastfeeding period). ART continuation (group C) or interruption (group I) was then decided on the basis of the CD4+ cell count at enrolment (>350 or ≤350/μl). Total IgG and IgG subclasses were determined in maternal serum using a nephelometric assay at baseline and at 6 and 24 months postpartum. RESULTS At enrolment, 36/37 women had IgG levels >15g/l and there was a predominance of the IgG1 isotype (more than 90%) in parallel with underrepresentation of IgG2 (5.0%). After 6 months of ART, both groups showed a significant median decrease in total IgG (-3.1g/l in group I, -3.5g/l in group C) and in IgG1 (-4.0g/l and -3.6g/l, respectively), but only a modest recovery in IgG2 levels (+0.16 in group I, +0.14g/l in group C). At month 24, hypergammaglobulinemia was still present in 73.7% of women in group C, although a significant reduction was observed in total IgG level and in IgG1 and IgG3 subclasses (p<0.0001 in all cases). IgG2 levels did not show any significant change. In group I at 24 months, total IgG and IgG subclasses had returned to levels comparable to those at baseline. CONCLUSIONS The beneficial effects of 24 months of ART appear to be limited in the B-cell compartment, with an incomplete reduction of total IgG levels and no recovery of IgG2 depletion. A short ART period did not have significant effects on IgG abnormalities in women who interrupted treatment.
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Affiliation(s)
- Silvia Baroncelli
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - Clementina Maria Galluzzo
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Fausto Ciccacci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Mauro Andreotti
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | - Robert Mpwhere
- DREAM Program, Community of S. Egidio, PO Box 30355, Blantyre, Malawi
| | - Richard Luhanga
- DREAM Program, Community of S. Egidio, PO Box 30355, Blantyre, Malawi
| | | | - Roberta Amici
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | | | - Marina Giuliano
- National Centre for Global Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
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15
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Faucher B, Seguier J, Swiader L, Cuquemelle C, Cerutti D, Ebbo M. [Gaucher Disease type 1 mimicking immune thrombocytopenia: Role of hyperferritinemia and hypergammaglobulinemia in the initial evaluation of an isolated thrombopenia]. Rev Med Interne 2019; 40:680-683. [PMID: 31213336 DOI: 10.1016/j.revmed.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Gaucher disease type 1 is a rare genetic disease. It can cause thrombocytopenia. Current guidelines do not support bone marrow examination in front of isolated thrombocytopenia if no evidence suggests malignant hemopathy. This strategy aiming at sparing unnecessary investigations makes such rare diseases more difficult to diagnose. CASE REPORT A 31-year-old woman was diagnosed with immune thrombocytopenia according to current guidelines. She presented later with mild splenomegaly. Bone marrow aspirate smears showed Gaucher cells. Gaucher disease was then confirmed. Looking backward, initial biological clues (hyperferritinemia, hypergammaglobulinemia) should have enabled to consider the diagnosis. CONCLUSION Gaucher disease type 1 can be responsible for apparently isolated thrombocytopenia. The disease must be looked for if the thrombocytopenia is associated with unexplained hypergammaglobulinemia or hyperferritinemia. Diagnosing immune thrombocytopenia without bone marrow sample requires to systematically pay attention to any clinical or biological abnormality, not to ignore rare differential diagnoses.
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Affiliation(s)
- B Faucher
- Département de médecine interne, hôpital de la Timone, Aix-Marseille université, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 05, France.
| | - J Seguier
- Département de médecine interne, hôpital de la Timone, Aix-Marseille université, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 05, France
| | - L Swiader
- Département de médecine interne, hôpital de la Timone, Aix-Marseille université, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 05, France
| | - C Cuquemelle
- Laboratoire de biologie, hôpital Ste-Musse, 83100 Toulon, France
| | - D Cerutti
- Service de médecine interne, hôpital George-Sand, 83500 La Seyne-sur-Mer, France
| | - M Ebbo
- Département de médecine interne, hôpital de la Timone, Aix-Marseille université, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 05, France
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16
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Abstract
Autoimmune hepatitis affects patients of all ages and gender, across all geographic regions. Although still rare, its incidence and prevalence are increasing. Genetic predisposition conveyed by human leucocyte antigen is a strong risk factor for the disease and may be responsible in part for the wide variation in presentation in different geographic regions. Our understanding of the underlying pathogenic mechanisms is evolving and may lead to development of more targeted immunotherapies. Diagnosis is based on elevated levels of serum aminotransferases, gamma globulins, autoantibodies and characteristic findings on histology. Exclusion of other causes of chronic hepatitis is important. Although undiagnosed disease is associated with poor outcomes, it is readily treatable with timely immunosuppressive therapy in the majority of patients. International guidelines are available to guide management but there exists a disparity in the standard treatment regimens. This minireview aims to review the available guidelines and summarize the key recommendations involved in management of this complex autoimmune disease.
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Affiliation(s)
- Dhruv Lowe
- Division of Gastroenterology and Hepatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States
| | - Savio John
- Division of Gastroenterology and Hepatology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States
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17
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Matsuda K, Matsumoto Y, Yoshida M, Shimura K, Kaneko H, Inaba T, Horiike S, Kuroda J, Taniwaki M. Hairy B-Cell Lymphoproliferative Disorder and its Differential Diagnosis: a Case with Long-Term Follow-Up. Mediterr J Hematol Infect Dis 2017; 9:e2017054. [PMID: 28894563 DOI: 10.4084/MJHID.2017.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 11/22/2022] Open
Abstract
Hairy B-cell lymphoproliferative disorder (HBLD) is one of chronic polyclonal B-cell lymphocytosis. We report a 47-year-old female Japanese patient diagnosed as having HBLD based on lymphocytosis with hairy cell appearance and characteristic phenotypes including CD11c+ and without B-cell monoclonality. She was a non-smoker and possessed HLA-DR4. She has been closely followed up without treatment and lymphoma development for over five years. Although this disease is quite rare and has been reported, to our knowledge, in only 13 Japanese cases, an accurate diagnosis, particularly differential diagnosis from persistent polyclonal B-cell lymphocytosis or hairy cell leukemia-Japanese variant is essential for the prevention of unnecessary treatments.
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18
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Okano T, Nishikawa T, Watanabe E, Watanabe T, Takashima T, Yeh TW, Yamashita M, Tanaka-Kubota M, Miyamoto S, Mitsuiki N, Takagi M, Kawano Y, Mochizuki Y, Imai K, Kanegane H, Morio T. Maternal T and B cell engraftment in two cases of X-linked severe combined immunodeficiency with IgG1 gammopathy. Clin Immunol 2017; 183:112-120. [PMID: 28780374 DOI: 10.1016/j.clim.2017.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/21/2017] [Accepted: 08/01/2017] [Indexed: 01/12/2023]
Abstract
X-linked severe combined immunodeficiency (X-SCID), caused by defects in the common gamma chain, is typically characterized by T and NK cell defects with the presence of B cells. T cell dysfunction and impaired class-switch recombination of B cells mean that patients typically have defects in class-switched immunoglobulins (IgG, IgA, and IgE) with detectable IgM. Here, we describe two patients with X-SCID with IgG1 gammopathy, in whom we identified maternal T and B cell engraftment. Exclusively, maternal B cells were found among the IgD-CD27+ class-switched memory B cells, whereas the patients' B cells remained naïve. In vitro stimulation with CD40L+IL-21 revealed that peripheral blood cells from both patients produced only IgG1. Class-switched maternal B cells had restricted receptor repertoires with various constant regions and few somatic hypermutations. In conclusion, engrafted maternal B cells underwent class-switch recombination and produced immunoglobulin, causing hypergammaglobulinemia in patients with X-SCID.
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Affiliation(s)
- Tsubasa Okano
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takuro Nishikawa
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Eri Watanabe
- Laboratory of Diagnostic Medicine, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takashi Watanabe
- Laboratory for Integrative Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Takehiro Takashima
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tzu-Wen Yeh
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Motoi Yamashita
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Mari Tanaka-Kubota
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Satoshi Miyamoto
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Noriko Mitsuiki
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Masatoshi Takagi
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoshifumi Kawano
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshiki Mochizuki
- Laboratory for Integrative Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Kohsuke Imai
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Hirokazu Kanegane
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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19
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Fukunaga M, Harada K, Mae K, Wakamatsu K, Kiriyama N, Tsuboi R, Okubo Y. Erythema Gyratum Repens-Like Purpura in a Patient with Sjögren Syndrome. Case Rep Dermatol 2017; 9:40-43. [PMID: 28690517 PMCID: PMC5498950 DOI: 10.1159/000477375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/05/2017] [Indexed: 11/19/2022] Open
Abstract
The etiology of purpura in Sjögren syndrome (SS) includes cryoglobulinemia, hypergammaglobulinemia, and leukocytoclastic vasculitis (LCV). The clinical symptoms of LCV associated with SS comprise palpable or nonpalpable purpura and urticarial vasculitis. Here, we report a case of LCV presenting as erythema gyratum repens (EGR)-like purpura in a 62-year-old woman with rheumatoid arthritis and SS. EGR-like skin lesions, characterized by annular lesions with expanding concentric pattern and coalescing to form a zebra-like pattern or grain of wood pattern, can appear in various autoimmune conditions; however, EGR-like eruption in SS is extremely rare. On the basis of the expansion pattern, we considered that the EGR-like purpura in this case was elicited by urticarial vasculitis accompanied by SS.
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Affiliation(s)
- Miyuki Fukunaga
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Kenichiro Mae
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Kanae Wakamatsu
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Noriko Kiriyama
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan.,Department of Dermatology, Akishima Hospital, Tokyo, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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20
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Omachi S, Fujii W, Azuma N, Morimoto A, Sanjoba C, Matsumoto Y, Goto Y. B-cell activating factor deficiency suppresses splenomegaly during Leishmania donovani infection. Biochem Biophys Res Commun 2017; 489:528-533. [PMID: 28583852 DOI: 10.1016/j.bbrc.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/01/2017] [Indexed: 11/25/2022]
Abstract
B-cell activating factor (BAFF) is a critical regulator for B-cell development and differentiation. We previously reported elevation of serum BAFF levels in patients with visceral leishmaniasis (VL). In this study, we examined if BAFF is involved in pathologies during infection of Leishmania donovani. BALB/cA mice infected with L. donovani showed significant elevation in serum BAFF and IgG levels as seen in VL patients. In contrast, elevation of serum IgG by L. donovani infection was significantly suppressed in BAFF-deficient mice. The spleen weight of the BAFF-deficient mice after infection was significantly lower than that of the infected wild-type mice, whereas comparable degree of hepatomegaly and anemia were observed in those mice. In the enlarged spleen of L. donovani-infected wild-type mice, increase of CD19+ lymphocytes was more prominent than that of CD3+ cells, suggesting the contribution of B cell increase to splenomegaly during VL. Besides, increase of CD19+ lymphocytes was not found in BAFF-deficient mice after L. donovani infection. Taken together, these results suggest that BAFF is involved in strong B cell activation, which has a pathological role in splenomegaly but not in hepatomegaly or anemia, during VL.
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Affiliation(s)
- Satoko Omachi
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan
| | - Wataru Fujii
- Laboratory of Applied Genetics, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan
| | - Natsuho Azuma
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan
| | - Ayako Morimoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan
| | - Chizu Sanjoba
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan
| | - Yoshitsugu Matsumoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan
| | - Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Japan.
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21
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van de Ven AAJM, Seidl M, Drendel V, Schmitt-Graeff A, Voll RE, Rensing-Ehl A, Speckmann C, Ehl S, Warnatz K, Kollert F. IgG4-related disease in autoimmune lymphoproliferative syndrome. Clin Immunol 2017; 180:97-9. [PMID: 28478106 DOI: 10.1016/j.clim.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/03/2017] [Indexed: 01/13/2023]
Abstract
A patient with autoimmune lymphoproliferative disorder (ALPS) developed IgG4-related disease. In retrospect, he had high levels of serum IgG4 for several years prior to presenting with IgG4-related pancreatitis. These high IgG4 levels were masked by hypergammaglobulinemia, a common feature of ALPS. We next screened 18 ALPS patients; four of them displayed increased levels of IgG4. Hence, IgG4-related disease should be considered in ALPS patients, especially in those manifesting lymphocytic organ infiltration or excessive hypergammaglobulinaemia. Screening of IgG4-related disease patients for ALPS-associated mutations would provide further information on whether this disease could be a late-onset atypical presentation of ALPS.
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22
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Tan Z, Wang L, Wang C, Gao L, Yang Y. Multicentric Castleman's disease with renal amyloidosis and mesangial proliferative glomerulonephritis: a case report. Int J Clin Exp Med 2015; 8:2966-2973. [PMID: 25932265 PMCID: PMC4402912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/06/2015] [Indexed: 06/04/2023]
Abstract
Renal involvement is a significant complication of multicentric Castleman's disease (MCD) and various glomerular involvements have been reported. A 56-year-old Chinese woman presented with proteinuria and skin rash, with lymphadenopathy and hypergammaglobulinemia. Lymph nodes and skin biopsy proven the case was multicentric CD with plasma cell pathological pattern. The renal biopsy was performed and six glomeruli were observed and two of these showed global sclerosis. Moderate increasing of mesangial matrix with mesangial cell proliferation were seen in every glomerulus. In addition, one-segmental sclerosis accompanied by adhesion of the Bowman's capsule was revealed. Two of the glomeruli had crescents formation. Under immunofluorescence microscopy, immunofluorescence for anti-IgA, IgM, C3, C1q and FRA showed coarse and fine granular depositions along capillary walls and sparsely in the mesangium. Staining for anti-IgG was negative. Under electron microscopy revealed indiscriminate amyloidal deposits in glomerular basement membrane. The foot process of glomerular podocytes was fusion. Moderate increasing of mesangial matrix and mesangial cell proliferation were found. Subsequently, she was successfully treated with prednisone combined with cyclophosphamide therapy not only for proteinuria but also for renal function.
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Affiliation(s)
- Zhicheng Tan
- Department of Nephrology, The Second Hospital of Shanxi Medical UniversityTaiyuan 030001, China
| | - Lihua Wang
- Department of Nephrology, The Second Hospital of Shanxi Medical UniversityTaiyuan 030001, China
| | - Chen Wang
- Department of Pathology, The Second Hospital of Shanxi Medical UniversityTaiyuan 030001, China
| | - Lifang Gao
- Department of Pathology, The Second Hospital of Shanxi Medical UniversityTaiyuan 030001, China
| | - Yanrong Yang
- Department of Nephrology, The Second Hospital of Shanxi Medical UniversityTaiyuan 030001, China
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23
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Taubert R, Hardtke-Wolenski M, Noyan F, Wilms A, Baumann AK, Schlue J, Olek S, Falk CS, Manns MP, Jaeckel E. Intrahepatic regulatory T cells in autoimmune hepatitis are associated with treatment response and depleted with current therapies. J Hepatol 2014; 61:1106-14. [PMID: 24882050 DOI: 10.1016/j.jhep.2014.05.034] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease usually requiring life-long immunosuppression. The mechanisms for disease initiation and chronicity are largely unknown. A contribution of deficient regulatory T cells (Tregs) in the blood was controversially discussed recently. So far investigations in the target organ have been limited to single parameter analysis in untreated AIH. METHODS We retrospectively analysed the pattern of liver infiltrating T, B and regulatory T cells quantitatively with simultaneous multicolour immunofluorescence before (n=45) and under (n=31) therapy in adult AIH type 1 (AIH-1) patients. RESULTS Intrahepatic CD4(+) cells dominate over CD8(+) at diagnosis, but with increasing disease activity the CD4(+)/CD8(+) ratio approached one. While there is no change of Tregs in the blood, they are enriched with effector T cells (Teffs) within the liver of patients with untreated AIH-1 with a constant Treg/Teff ratio. Even more importantly, immunosuppression mostly with steroids and azathioprine caused a disproportional loss of intrahepatic Tregs. Patients reaching biochemical remission had higher intrahepatic Treg/Teff and Treg/B cell ratios compared to patients failing to reach remission. In vitro proliferation of Tregs seemed to be more suppressed by prednisolone than expansion of Teffs. Furthermore, intraportal B cells correlated with serum IgG suggesting an autochthonous intrahepatic IgG production. CONCLUSIONS Intrahepatic Tregs are rather enriched than numerically deficient in untreated AIH-1. The disproportional decrease of intrahepatic Tregs during therapy might explain high relapse rates after discontinuation of immunosuppression. Thus, future therapies increasing intrahepatic immunoregulation might be better suited for long-term control of AIH.
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Affiliation(s)
- Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | | | - Fatih Noyan
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Artur Wilms
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Anna K Baumann
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Jerome Schlue
- Department of Pathology, Hannover Medical School, Germany
| | - Sven Olek
- Ivana Türbachová Laboratory for Epigenetics, Epiontis GmbH, Berlin, Germany
| | - Christine S Falk
- Institute of Transplantation Immunology and Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany.
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24
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Taubert R, Hardtke-Wolenski M, Noyan F, Wilms A, Baumann AK, Schlue J, Olek S, Falk CS, Manns MP, Jaeckel E. Intrahepatic regulatory T cells in autoimmune hepatitis are associated with treatment response and depleted with current therapies. J Hepatol 2014; 61:1106-14. [PMID: 24882050 DOI: 10.1016/j.jhep.2014.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/24/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease usually requiring life-long immunosuppression. The mechanisms for disease initiation and chronicity are largely unknown. A contribution of deficient regulatory T cells (Tregs) in the blood was controversially discussed recently. So far investigations in the target organ have been limited to single parameter analysis in untreated AIH. METHODS We retrospectively analysed the pattern of liver infiltrating T, B and regulatory T cells quantitatively with simultaneous multicolour immunofluorescence before (n=45) and under (n=31) therapy in adult AIH type 1 (AIH-1) patients. RESULTS Intrahepatic CD4(+) cells dominate over CD8(+) at diagnosis, but with increasing disease activity the CD4(+)/CD8(+) ratio approached one. While there is no change of Tregs in the blood, they are enriched with effector T cells (Teffs) within the liver of patients with untreated AIH-1 with a constant Treg/Teff ratio. Even more importantly, immunosuppression mostly with steroids and azathioprine caused a disproportional loss of intrahepatic Tregs. Patients reaching biochemical remission had higher intrahepatic Treg/Teff and Treg/B cell ratios compared to patients failing to reach remission. In vitro proliferation of Tregs seemed to be more suppressed by prednisolone than expansion of Teffs. Furthermore, intraportal B cells correlated with serum IgG suggesting an autochthonous intrahepatic IgG production. CONCLUSIONS Intrahepatic Tregs are rather enriched than numerically deficient in untreated AIH-1. The disproportional decrease of intrahepatic Tregs during therapy might explain high relapse rates after discontinuation of immunosuppression. Thus, future therapies increasing intrahepatic immunoregulation might be better suited for long-term control of AIH.
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25
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Wyness SP, Yee MA, La’ulu SL, Tosiello L, Straseski JA. Multiple macroenzymes in a patient with AIDS: diagnosis using ultrafiltration. Am J Clin Pathol 2014; 142:266-8. [PMID: 25015871 DOI: 10.1309/ajcpwa9qhr9whpna] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Multiple immunoglobulin-bound enzymes (macroenzymes) are reported for the first time in an individual with AIDS. Possible causes and suitable methods of detection are addressed. METHODS An asymptomatic man with a history of AIDS with hypergammaglobulinemia and elevated creatine kinase, amylase, and liver enzyme concentrations was evaluated before enrollment in a clinical trial. Macroenzymes were considered a possible source of these elevated concentrations. RESULTS Polyethylene glycol (PEG) precipitation and ultrafiltration (UF) were used to evaluate the presence of seven macroenzymes. PEG results suggested the presence of six of seven macroenzymes tested, while UF revealed three. UF results supported the clinical presentation. CONCLUSIONS A previous report shows that in cases of excess immunoglobulin, PEG coprecipitates monomeric enzymes along with serum globulins, causing false-positive reporting of macroenzymes. This may explain the discrepancy between PEG and UF results in the presence of hypergammaglobulinemia, making UF a better method of detection in these circumstances.
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Affiliation(s)
- Sara P. Wyness
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | | | - Sonia L. La’ulu
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | | | - Joely A. Straseski
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
- Department of Pathology, University of Utah, Salt Lake City
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