Cases reported "Autoimmune Diseases"

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1/14. Autoimmune and pregnancy complications in the daughter of a kidney transplant patient.

    BACKGROUND: immunosuppressive agents taken by pregnant organ transplant recipients readily cross the placenta during development of the fetal immune system. There are few data on the long-term implications for the progeny, but evidence from animal studies suggest that second and third generations of organ transplant patients may be at risk for autoimmune disorders and reproductive problems. methods: We present the 23-year-old daughter of a renal allograft recipient exposed to azathioprine 75 mg/day and prednisone 5 mg/day throughout her mother's pregnancy. RESULTS: During the daughter's first pregnancy, she developed multiple autoantibodies, Raynaud's phenomenon, and fetal death occurred at 20 weeks gestation. The second pregnancy was complicated by systemic lupus erythematosus, preeclampsia, and the birth of a preterm male infant. CONCLUSIONS: It is uncertain whether the autoimmune manifestations and obstetric complications in this patient were related to fetal exposure to immunosuppressive drugs. Nevertheless, further studies on the health and pregnancies of adult offspring of transplant patients are warranted.
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2/14. Resolution of immune-mediated diseases following allogeneic bone marrow transplantation for leukaemia.

    Experimental work in animal models suggests that the course of systemic and organ-specific autoimmune disorders can be modified by allogeneic bone marrow transplantation (BMT). We describe two patients, each with a long history of psoriasis and ulcerative colitis, who received an allogeneic BMT for leukaemia. Four years post-BMT, they remain in full remission of psoriasis and ulcerative colitis, and of their leukaemia. We review the evidence for support of the concept that both psoriasis and ulcerative colitis are immune-mediated disorders and speculate on the possible role of allogeneic BMT in treating life-threatening autoimmune disorders.
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3/14. Cytotoxic T lymphocyte-associated antigen 4 blockade in patients with metastatic melanoma: a new cause of uveitis.

    Cytotoxic T Lymphocyte-associated antigen 4 (CTLA-4) is an important costimultory receptor expressed on activated T cells. CTLA-4 blockade using a monoclonal antibody (mAb) in conjunction with tumor vaccines has improved tumor responses in animal models and enhanced numerous models of T cell-associated autoimmune diseases. Two patients with stage IV metastatic melanoma vaccinated with the gp 100 melanocyte/melanoma differentiation antigen either before or during anti-CTLA-4 mAb therapy developed uveitis. This is the first report of autoimmune disease involving the eye in patients treated with anti-CTLA-4 mAb. This suggests that CTLA-4 is an important regulatory molecule for maintenance of tolerance to melanosomal antigens and prevention of uveitis.
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4/14. Acupuncture for immune-mediated disorders. literature review and clinical applications.

    Acupuncture activates the defense systems. It influences specific and nonspecific cellular and humoral immunities; activates cell proliferation, including blood, reticuloendothelial, and traumatized cells; and activates leucocytosis, microbicidal activity, antibodies, globulin, complement, and interferon. It modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle, and local and general thermoregulation. Immunostimulant points include LI-4, LI-11, ST-36, GB-39, SP-6, GV-14, BL-11, BL-20, BL-23, BL-24, BL-25, BL-26, BL-27, BL-28, and CV-12. Some, such as BL-47, are immunosuppressive. Antifebrile points include GV-14 and ST-36. Reactive reflex SHU points, MU points, and earpoints are useful in organic diseases. In immunomediated diseases, some or all of these points can be used with other points, especially local points and points of the major symptoms or points of the affected body part, area, function, or organ. Applications of acupuncture include treatment of inflammation and trauma; stimulation of tissue healing in burns, ulcers, indolent wounds, ischemia, necrosis, and gangrene; infections; postinfection sequelae; fever; autoimmune disease; allergies; anaphylaxis and shock; and treatment or prevention of side effects from cytotoxic chemotherapy and ionizing radiation. acupuncture therapy may inhibit neoplastic cells. Examples of acupuncture use in immunomediated conditions in small animals are given.
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5/14. Inner ear autoantibodies in patients with rapidly progressive sensorineural hearing loss.

    Recognition of immune-mediated sensorineural deafness that responds to immunosuppressive therapy has led to a search for a diagnostic assay to identify inner ear autoantibodies. Without a confirmed diagnosis of autoimmune disease, many patients have undergone inappropriate immunosuppressive treatment or developed irreversible inner ear damage. serum from patients with progressive sensorineural hearing loss (n = 54), ulcerative colitis (N = 5), normal controls (N = 14), and animals with experimental autoimmune sensorineural hearing loss (EASNHL) were analyzed by Western blot against fresh bovine inner ear antigen preparations. The hearing loss group (19 [35%]) showed a single-or double-band migrating at 68,000 molecular weight (MW), differing from the normal group (1 of 14 [7%]) which showed a similar band (P = .031). Upon analysis by two-dimensional gel electrophoresis both the EASNHL guinea pigs and a patient reacted against identical components of inner ear antigen. These results suggest an autoimmune basis for disease in patients reacting against the 68,000 MW antigen.
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6/14. Immunoreactive myelin basic protein in tumor cells associated with carcinomatous neuropathy.

    Tumors from two patients with carcinomatous neuropathy were studied with an immunohistochemical method using anti-myelin basic protein (anti-MBP) sera. In both cases, immunoreactive MBP was clearly demonstrated in some of the tumor cells, which were widely distributed either singly or, more often, in clusters. The staining intensity varied from cell to cell. An autoimmune mechanism to nervous elements has been suggested in the pathogenesis of carcinomatous neuropathy. MBP is known to be a highly specific and potent antigen that can induce allergic neuritis in animals. In one patient the progressively worsening neurologic condition rapidly improved after gastrectomy removed the carcinoma. It is possible that immunoreactive MBP in tumor cells may function as an "antigen" in the development of carcinomatous neuropathy.
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7/14. Minimal change nephropathy and pemphigus vulgaris associated with penicillamine treatment of rheumatoid arthritis.

    A 51-year-old man developed pemphigus vulgaris, minimal change nephropathy and acute tubular necrosis after 11 months of treatment with penicillamine for rheumatoid arthritis associated with features of Reiter's syndrome. penicillamine is a polyclonal B lymphocyte activator in animals and precipitates a variety of autoimmune reactions in man. The pathogenesis of minimal change nephropathy is obscure, but our observations support the possibility that autoimmune mechanisms play a role.
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8/14. Membranous nephropathy associated with primary biliary cirrhosis and bullous pemphigoid.

    Membranous nephropathy has been shown to be an immune-mediated lesion in both human and experimental animal models. Primary biliary cirrhosis and bullous pemphigoid are also diseases of probable autoimmune origin. In this brief report, a woman with all three disease entities is described and an interrelationship among the three is discussed.
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9/14. thalidomide for autoimmune disease.

    The therapeutic efficacy of thalidomide in erythema nodosum leprosum suggests that thalidomide might play a useful therapeutic role in other human immune-complex diseases. thalidomide has shown anti-inflammatory or immunosuppressive actions in several animal models. Current evidence suggests that its rapid activity in ENL may result from suppression of neutrophil chemotaxis and phagocytosis. Scattered anecdotal clinical reports of apparent response to thalidomide in various autoimmune diseases are hardly conclusive, but underline the desirability of appropriate pilot trials of thalidomide in autoimmune diseases, particularly those in which immune complex deposition plays a prominent role. Provided that a contraindication in fertile women is strictly observed, thalidomide therapy appears to be quite safe.
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10/14. Bovine collagen induced systemic symptoms: antibody formation against bovine and human collagen.

    We describe the first case of systemic symptoms after injection of bovine collagen and silicone polymers associated with antibodies to both native type I and II bovine and human collagen that varied with clinical features. Joint inflammation, edema at the injection site of bovine collagen implant and fever appeared 6 months after injection. Our patients history raises the question of whether the injection of animal derived collagen, particularly combined with silicone, induces or exacerbates autoimmune disease.
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