Case report: distinctive immune abnormalities in a patient with procainamide-induced lupus and serositis.
To gain insight into the immunopathogenesis of drug-induced autoimmune disorders, lymphocyte and immunoglobulin distributions and cytokine levels were monitored in the peripheral blood and pleural fluid of a patient with procainamide-induced lupus and pleural effusion. Approximately 80% of the B cells in both compartments were CD5+ compared to 10% to 25% in normal adults. CD4/CD8 ratio and percentage CD4 were normal in peripheral blood. Serum levels of IgG (particularly IgG2), IL-6, and soluble IL-2R were slightly elevated, and those of IgA were significantly elevated compared to normal controls. Analysis of the pleural effusion revealed an increased CD4/CD8 ratio because of an increased percentage of CD4+CD29+ helper memory T cells, lack of expression of the resting B-cell marker CD21, immune complex deposition and complement consumption, increased relative levels of ANA, abnormally high levels of IL-6 and soluble IL-2R, and detectable levels of IL-1b, IFN-g and TNF-a. These observations provide evidence for the involvement of CD5+ B cells and differential helper T-cell activity in procainamide-induced lupus and for an association between local lymphocyte activation and organ pathology.
Miami Veterans Administration Medical Center, Florida.
N G
NG
Klimas
R
R
Patarca
G
G
Perez
R
R
Garcia-Morales
D
D
Schultz
J
J
Schabel
M A
MA
Fletcher
D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D001327:Autoimmune Diseases / Q000139:chemically induced / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology; D015704:CD4 Antigens / Q000032:analysis; D018956:CD5 Antigens; D016207:Cytokines / Q000032:analysis*; D006801:Humans; D019012:Integrin beta1; D008177:Lupus Vulgaris / Q000139:chemically induced* / Q000276:immunology; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D011342:Procainamide / Q000009:adverse effects*; D015375:Receptors, Interleukin-2 / Q000032:analysis; D012700:Serositis / Q000139:chemically induced* / Q000276:immunology
D015703:Antigens, CD; D015704:CD4 Antigens; D018956:CD5 Antigens; D016207:Cytokines; D019012:Integrin beta1; D015375:Receptors, Interleukin-2; D011342:Procainamide