Persistent neutrophil dysfunction in an adult. Combined defect in chemotaxis, phagocytosis and intracellular killing

Impaired phagocytosis and killing of bacteria by neutrophils were demonstrated repeatedly in a 65 year old man. He had staphylococcal pyarthrosis and osteomyelitis. Phagocytosis and intracellular killing of Staphylococcus aureus by neutrophils of the patient were impaired, but no significant defect was noted when Candida was used as the test organism. Production of ¹⁴CO₂ from glucose-1-¹⁴C, glucose-6-phosphate dehydrogenase levels, nitroblue tetrazolium reduction test and myeloperoxidase levels were all normal in his neutrophils. The monocyte bactericidal capacity for Staph. aureus was normal. Despite normal migration demonstrated by the skin window technic and by the presence of numerous neutrophils in the joint aspirate, studies of neutrophil chemotaxis revealed an impaired response to chemotaxin, and an inhibitor of chemotaxis of normal neutrophils was also found in his serum. However, his serum generated chemotaxin normally. This neutrophil dysfunction appears to differ from that found in chronic granulomatous disease of childhood and other known defects of neutrophil function.