[Donath-Landsteiner antibody of the IgM class with anti-I specificity and possible efficacy of azathioprine therapy in paroxysmal cold hemoglobinuria: a case report].
In October 1988, a 72-year-old man was admitted to Nagasaki Prefectural Shimabara Onsen Hospital because of hemoglobinuria on exposure to cold. On admission, the laboratory data were Hb 9.1 g/dl, LDH 2,337 U/L, and haptoglobin less than 6 mg/dl. The Donath-Landsteiner (DL) test was positive and serological tests for syphilis were negative. Anti-Coxsackie virus type A9 antibody titer was elevated. Accordingly, he was diagnosed as having paroxysmal cold hemoglobinuria (PCH) associated with viral infection. The DL antibody proved to be of the IgM class having anti-I specificity. The patient was treated unsuccessfully with prednisolone, but hemolysis was improved after azathioprine (AZP) therapy. PCH patients with DL antibody of the IgM class exhibiting anti-I specificity are very rare and only two patients including the present case have been reported in Japan. There has been no report on the efficacy of AZP in PCH, but our study suggests that AZP may have a potential therapeutic effect in some PCH patients.
Nakamura
H
H
Department of Internal Medicine, Nagasaki Prefectural Shimabara Onsen Hospital.
Watanabe
T
T
Hayashida
T
T
Ichimaru
M
M
D000368:Aged; D000918:Antibody Specificity; D001323:Autoantibodies / Q000032:analysis* / Q000276:immunology; D001379:Azathioprine / Q000627:therapeutic use*; D003080:Cold Temperature; D006457:Hemoglobinuria, Paroxysmal / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007048:I Blood-Group System / Q000276:immunology*; D007075:Immunoglobulin M / Q000032:analysis* / Q000276:immunology; D008297:Male
D001323:Autoantibodies; D007048:I Blood-Group System; D007075:Immunoglobulin M; D001379:Azathioprine