title: Autoimmune hemolytic anemia in allergic granulomatous angitis (Churg-Strauss syndrome).
abstract: We describe a patient with allergic granulomatous angitis who developed autoimmune hemolytic anemia (AIHA). A 44-year-old male had been suffering from bronchial asthma. On admission, laboratory tests revealed the presence of severe eosinophilia (21,500/microliters), elevation of total immunoglobulin E (IgE), high lactic dehydrogenase (LDH) and low haptoglobin levels, in addition to moderate reticulocytosis. During admission, the patient showed almost simultaneous occurrence of vasculitis in the extremities, severe hemolysis and exacerbation of asthma in relation to the progression of eosinophilia. Both IgM and IgG autoantibodies were considered to be responsible for hemolysis. Interestingly, serum levels of interleukin-4 (IL-4) and IL-5 were increased in association with eosinophilia and increased IgE production. These findings suggest that the AIHA in this patient is mediated or enhanced at least partly by high IL-4 and IL-5 production. Although AIHA in this syndrome is very rare, it should be considered as a clinical manifestation.
authors.affiliation: Second Department of Internal Medicine, Okayama University Medical School, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kojima
authors.forename: E
authors.initials: E
authors.lastname: Omoto
authors.forename: Y
authors.initials: Y
authors.lastname: Katayama
authors.forename: M
authors.initials: M
authors.lastname: Uno
authors.forename: I
authors.initials: I
authors.lastname: Takada
authors.forename: G
authors.initials: G
authors.lastname: Kimura
authors.forename: A
authors.initials: A
authors.lastname: Kanehiro
authors.forename: S
authors.initials: S
authors.lastname: Tada
authors.forename: K
authors.initials: K
authors.lastname: Hayashi
authors.forename: I
authors.initials: I
authors.lastname: Kimura
authors.forename: H
authors.initials: H
authors.lastname: Sanada
authors.forename: M
authors.initials: M
authors.lastname: Harada
mesh_terms: D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000209:etiology*; D001798:Blood Proteins / Q000378:metabolism; D015267:Churg-Strauss Syndrome / Q000150:complications*; D047091:Eosinophil Granule Proteins; D006801:Humans; D015847:Interleukin-4 / Q000097:blood; D015848:Interleukin-5 / Q000097:blood; D008297:Male; D012260:Ribonucleases
chemical_list: D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D015848:Interleukin-5; D015847:Interleukin-4; D012260:Ribonucleases