title: Epinephrine test and plasma elastase as diagnostic tools in a patient with CD3+ large granular lymphocyte proliferation.
abstract: Large granular lymphocytes (LGL) proliferation is characterized by expansion of cytotoxic lymphocytes and associated with neutropenia. In a case of CD3+ LGL-proliferation the epinephrine stimulation test (EST) induced a striking elevation of CD3+, CD8+, CD57+ LGL in peripheral blood from 2.7 x 10(9)/l to 20 x 10(9)/l and might be an additional diagnostic tool in patients with normal or low absolute numbers of circulating LGL. After treatment with steroids, plasma elastase--a marker of neutrophil destruction--decreased from 162 to 40 micrograms/l (normal < 47 micrograms/l) which correlated well with a simultaneous increase in peripheral neutrophil counts from 0.14 to 1.0 x 10(9)/l. This finding supports the hypothesis that neutropenia in CD3+ LGL proliferation is due to neutrophil destruction, possibly mediated by LGL.
authors.affiliation: Department of Internal Medicine, University Hospital Zurich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Seebach
authors.forename: B
authors.initials: B
authors.lastname: Schleiffenbaum
authors.forename: R
authors.initials: R
authors.lastname: Rüegg
authors.forename: J
authors.initials: J
authors.lastname: Fehr
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications; D015415:Biomarkers / Q000097:blood; D017252:CD3 Complex / Q000097:blood*; D002455:Cell Division; D004837:Epinephrine; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008218:Lymphocytosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D009503:Neutropenia / Q000209:etiology; D010196:Pancreatic Elastase / Q000097:blood*
chemical_list: D015415:Biomarkers; D017252:CD3 Complex; D005938:Glucocorticoids; D010196:Pancreatic Elastase; D004837:Epinephrine