title: Autoimmune autonomic failure in a patient with myeloma-associated Shy-Drager syndrome.
abstract: We report here the case of a patient with the Shy-Drager syndrome and multiple myeloma who had evidence consistent with a central neural autoimmune basis for sympathetic autonomic failure. Autonomic function testing showed no recordable peroneal skeletal muscle sympathoneural traffic, normal arterial norepinephrine (NE) spillover during supine rest and no increment in NE spillover during exposure to lower body negative pressure. The patient's cerebrospinal fluid and serum contained an immunoglobulin G that bound to rat locus ceruleus (LC) in an in vitro test system. The myeloma protein was of the lambda subtype and bound in the rat LC, without binding in the substantia nigra, as demonstrated with anti-lambda antiserum. Since in this case the monoclonal antibody produced by the myeloma bound specifically to LC cells, the results are consistent with the hypothesis that in this patient the Shy-Drager syndrome may have had an immune-mediated basis.
authors.affiliation: Clinical Neuroscience Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA. daveg@box-d.nih.gov
authors.forename: D S
authors.initials: DS
authors.lastname: Goldstein
authors.forename: A
authors.initials: A
authors.lastname: McRae
authors.forename: C
authors.initials: C
authors.lastname: Holmes
authors.forename: M C
authors.initials: MC
authors.lastname: Dalakas
mesh_terms: D000818:Animals; D001327:Autoimmune Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000134:cerebrospinal fluid; D007146:Immunoglobulin lambda-Chains / Q000097:blood / Q000134:cerebrospinal fluid; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007150:Immunohistochemistry; D008125:Locus Coeruleus / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012791:Shy-Drager Syndrome / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications*
chemical_list: D007074:Immunoglobulin G; D007146:Immunoglobulin lambda-Chains; D016756:Immunoglobulins, Intravenous