Murine Schistosomiasis mansoni: anti-schistosomula antibodies and the IgG subclasses involved in the complement- and eosinophilmediated killing of schistosomula in vitro

Summary Protein A-sepharose affinity chromatography was used to isolate IgG subclasses from the serum of CBA mice chronically infected with Schistosoma mansoni. The subclasses were tested for the presence of two antibodies which are responsible for the death of young schistosomula in vitro; 'lethal antibody' (LA), which kills schistosomula in co-operation with complement and 'eosinophil adherence antibody' (EAA) which causes the death of schistosomula by promoting the adherence of eosinophils to the parasite. LA and EAA were detected only in the IgG fraction of the serum. LA was concentrated in the IgG_2a fraction and EAA in the IgG₁ fraction. The development of IgG subclasses specific for schistosomula was followed in mice exposed to twenty cercariae by the fluorescent antibody technique. IgG₁, IgG_2a and IgG_2b antibodies were detected 2 weeks after infection and their titres rose steadily to reach high levels by weeks 12 or 14. IgM antibody was not detected until week 6 and IgA until week 10; both were present at lower concentrations than the IgG₁ antibodies.     

Hypoglycemia due to an insulin binding antibody in a patient with an IgA-kappa myeloma

CONTEXT: Autoantibodies to insulin have been described to cause spontaneous hypoglycemia in nondiabetic subjects. There have been occasional reports of spontaneous hypoglycemia due to monoclonal anti-insulin antibodies. We present the first report of a patient with an IgA-kappa myeloma in whom frequent hypoglycemia resulted from the ability of the monoclonal IgA-kappa to bind insulin. OBJECTIVES: The aim of this study was to describe the occurrence of profound hypoglycemia in a patient with IgA-kappa myeloma, characterize biochemically the nature of the IgA:insulin complex present, and place this case in the context of the published literature on hypoglycemia resulting from autoantibodies to insulin. DESIGN: A case study was performed. PATIENTS: A single case of profound hypoglycemia associated with IgA-kappa myeloma was studied. INTERVENTION: There were no interventions. MAIN OUTCOME MEASURES: A case study was performed. RESULTS: Polyethylene glycol precipitation and gel filtration chromatography were used to demonstrate high-molecular weight insulin immunoreactivity in the patient's plasma. This was characterized as an insulin binding IgA-kappa paraprotein present at 4200 mg/dl (42 g/liter) with a relatively high insulin dissociation constant of 0.32 microm/liter using radiolabelled insulin binding studies. CONCLUSIONS: We present the first case of hypoglycemia due to IgA binding insulin antibodies in a patient with an IgA-kappa paraprotein myeloma. The hypoglycemia was associated with high-plasma insulin levels and relatively low C-peptide levels. A plausible mechanism for the hypoglycemia is the delayed clearance of insulin. This case broadens the spectrum of monoclonal gammopathies that have been associated with anti-insulin reactivity and spontaneous hypoglycemia.     

Chronic scalp wound infection due to Rhodococcus equi in an immunocompetent patient

A case of chronic scalp wound infection due to Rhodococcus equi in an immunocompetent individual following heavily contaminated traumatic injury was successfully treated by combining antibiotics and surgery. The agents used were erythromycin and rifampicin.     

Streptococcal toxic shock syndrome due to noninvasive pharyngitis.

Serious infections due to group A beta-hemolytic streptococcus (GABHS) have been reported with increasing frequency in recent years. We report a case of toxic shock syndrome (TSS) due to GABHS pharyngitis in an otherwise healthy 14-year-old boy. The organism was found to produce toxin A. To our knowledge, this is the second reported case of streptococcal TSS associated with the production of toxin A that is not associated with an invasive disease and the first case associated with a documented rise in the level of antibody to the streptococcal toxin itself. Clinicians must be especially vigilant for this entity in patients who have streptococcal pharyngitis because early recognition and institution of aggressive supportive therapy can be lifesaving.     

Paradoxical embolism of the coronary artery

A case of acute coronary occlusion due to an embolus from an old thrombosis of the femoral vein in the presence of a patent foramen ovale is reported. There were no associated arterial or endocardial changes. The factors in its production are discussed briefly.     

Gastric malignant lymphoma with superimposed amebiasis

A case of primary B, large cell lymphoma of the stomach with superimposed amebiasis due to Entamoeba histolytica is reported. This represents the second recorded case of such an association. A review of the subject and possible mechanisms of infection are discussed.     

Arthritis of the middle ear in ankylosing spondylitis.

A case of ankylosing spondylitis with aortic valve disease and hearing loss is described. A series of radiographic and audiometric investigations showed the hearing loss to be of a conductive type. It seemed most likely that the hearing loss was related to an inflammatory involvement of the ossicular joints due to the primary disease. No other case of conductive hearing loss has previously been reported due to otoarthritis in ankylosing spondylitis. This is important both theoretically and practically.     

Subacute gastric perforation caused by a left ventricular assist device

This case report describes a rare complication of a left ventricular assist device (LVAD). A patient with ischemic cardiomyopathy had an LVAD placed due to intractable congestive heart failure following a large anterior myocardial infarction. The patient developed chronic bacteremia and multiple septic episodes. A gastric endoscopy revealed perforation of the anterior wall of the stomach by the LVAD. Gastric acid related erosions were present on the metallic surface suggesting prolonged exposure. This is the second case report of this rare complication and the first case report of a subacute course.     

Cushing's syndrome with fluctuation due to adrenal adenoma.

A case of fluctuating Cushing's syndrome due to an adrenal adenoma is described. Plasma corticosteroids were frequently low and urinary steroids fluctuated markedly over a 15-month period. Only the response to dexamethasone was consistently abnormal and indicative of Cushings's syndrome.     

Strongyloides stercoralis infection as a cause of acute granulomatous appendicitis in an HIV-positive patient in Athens,Greece

A case of acute granulomatous appendicitis due to Strongyloides stercoralis infection in an HIV-positive patient is described. To our knowledge this is the first case presented in the literature.     

Acute myelomonocytic leukaemia and acquired haemophilia A with severe cutaneous haemorrhage

A case of severe cutaneous haemorrhage due to thrombocytopenia in combination with an acquired haemophilia A is reported. The thrombocytopenia was due to acute myelomonocytic leukaemia (FAB M4). A factor VIII:C specific anticoagulant was also found. Chemotherapy led to complete remission with normal blood counts and coagulation-test results.     

A case of spontaneous perirenal hemorrhage secondary to polyarteritis nodosa

A case report of a patient who develops a spontaneous perinephric hemorrhage secondary to polyarteritis nodosa (PAN) is described. The diagnosis of PAN was delayed in this patient somewhat due to a previously unrecognized relation to a recent perihepatic hemorrhage. Unenhanced CT findings in this case were nonspecific, but follow up angiography demonstrated characteristic subsegmental and interlobular renal artery aneurysms. Spontaneous perinephric hemorrhage is an uncommon complication of PAN however an elevated level of suspicion regarding the diagnosis of a systemic vasculitis should be considered in any case of spontaneous renal, hepatic, or gastrointestinal hemorrhage.     

Group A streptococcus bacteraemia complicated by osteomyelitis in an immunocompetent adult

Osteomyelitis due to group A streptococcus is an unusual complication of varicellae in children. We report the first case of group A streptococcus bacteraemia complicated by multifocal osteomyelitis in an adult.     

Onset of severe refractory thrombocytopenia following surgery in a patient with type 2B von Willebrand disease--a case report

A case of a severe thrombocytopenia occurring in a patient with type 2B von Willebrand disease following an esophagectomy is described. As platelet transfusions were ineffective due to alloimunization, effective hemostasis was achieved only with the factor VIII/von Willebrand factor concentrate Haemate P.     

Congenital long QT syndrome inducing 2:1 atrioventricular block: early detection in fetal life

A case is reported of congenital long QT interval associated with fixed 2:1 atrioventricular block. The bradycardia was detected at 16 weeks of gestational age. The atrioventricular block was due to an extremely delayed ventricular repolarization. Early detection of bradycardia in fetal life and the demonstration of a normal positive correlation between QT duration and ventricular rate suggest that, in this case, the syndrome may be due to an anomaly of the myocardial cells rather than to imbalance of the sympathetic nervous system.     

Listeriosis following shigellosis

In 1987 an outbreak of illness due to Listeria monocytogenes occurred in Philadelphia. In contrast to previously studied outbreaks, no source of infection or vehicle of transmission could be identified, and several listerial strains were found to be involved. A hypothesis that was developed and eventually published suggests that clinical listeriosis may occur when individuals who are asymptomatic for listerial infection but whose gastrointestinal tract has been colonized by Listeria organisms become infected with another pathogen. The case of a farmer who developed a brain stem abscess due to L. monocytogenes following an episode of acute enteritis due to Shigella sonnei lends support to this hypothesis.     

Polyarticular Clostridium perfringens pyoarthritis

A woman with rheumatoid arthritis presented with an abdominal mass and Clostridium perfringens septic arthritis in both wrists and shoulders. We believed this to be the first reported case of polyarticular septic arthritis due to Clostridium perfringens. Apatite, lipid, and cholesterol crystals in the shoulder joint effusions were a potential source of diagnostic confusion.     

Two-stage repair for aortic regurgitation complicated by severe coarctation of the thoracoabdominal aorta due to Takayasu's arteritis

Takayasu's arteritis is a rare inflammatory aortoarteritis of unknown etiology and causes stenoocclusive disease of the aorta and its branches as well as aortic regurgitation. A surgical case of Takayasu's arteritis is presented. A 56-year-old female exhibited aortic regurgitation complicated by severe coarctation of the thoracoabdominal aorta due to Takayasu's arteritis. In this case, a 2-staged repair, consisting of an axillofemoral bypass and an aortic valve replacement, was successfully performed.     

Liver abscess due to Salmonella enteritidis in a returned traveler with HIV infection: case report and review of the literature

Bacteremia due to non-typhi Salmonella is more frequent in patients infected with the human immunodeficiency virus (HIV). However, focal complications have been rarely described. We report a case of liver abscess due to Salmonella enteritidis in an HIV-infected patient who recently returned to Sao Paulo, Brazil, from a trip in the Caribbean. A good clinical and radiological response was seen with both percutaneous catheter drainage and antibiotic treatment. To our knowledge, this is the first culture proven case of non-typhi Salmonellaliver abscess in an HIV-infected patient in Brazil.     

Pseudo-retrograde conduction in complete A-V heart block due to ectopic His bundle activity.

A case with complete A-V heart block in whom retrograde P- waves following some of the ventricular complexes were due to an ectopic junctional activity with the characteristics of parasystole is reported. His bundle electrogram showed an infrahisian block. After administration of 1 mg atropine intravenously the retrograde P- waves were detached from the ventricular automatic complexes and an H' deflection preceded each inverted P- wave with an H'-A' interval of 40 msec.