[Manifestation of hyper-IgE syndrome in advanced HIV-1 infection].
BACKGROUND
The classical triad of Job's syndrome (Hyper-IgE syndrome), a congenital immunodeficiency disorder, includes recurrent "cold" abscesses, pneumonias and extreme elevations of the serum IgE concentration.


METHODS
A 49-year-old HIV-1 infected patient with a viral load of 268,852 copies/ml plasma and a CD4+ T lymphocyte concentration of 2 cells/microliter blood was admitted to our clinic for antibiotic therapy and incision and drainage of several large abscesses. The patient suffered for approximately 5 years from recurrent pneumonias, abscesses and multiple allergies. The serum IgE level was over 100-fold elevated and, after analysis of archived serum samples, had not been influenced by fluctuations in the plasma viral load or changes in the CD4+ T lymphocyte concentration in previous years. No stigmata of Job's syndrome were present prior to the patient's HIV-1 infection. Observations on other patients with AIDS and recurrent abscesses suggest that in these patients hyperimmunoglobulinemia E is related to a cytokine class switch from a TH1 to a TH2 profile as CD4+ T lymphocytes are depleted.


CONCLUSIONS
Following CD4+ T lymphocyte depletion, it has been rarely documented that HIV-1 infected patients may develop clinical symptoms and a hyperimmunoglobulinemia E, similar to patients with the congenital immunodeficency of Job's syndrome.
Lange
Christoph G
CG
Department of Medicine, Division of Infectious Diseases, Center for AIDS Research, Case Western Reserve University and University Hospitals of Cleveland, OH, USA. cgmlange@hotmail.com
Gripshover
Barbara M
BM
Valdez
Hernan
H
Lederman
Michael M
MM
D000038:Abscess / Q000175:diagnosis / Q000276:immunology; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D007589:Job Syndrome / Q000175:diagnosis* / Q000276:immunology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000276:immunology; D018417:Th1 Cells / Q000276:immunology; D019562:Viral Load