Acute chylothorax in children: selective retention of memory T cells and natural killer cells.
OBJECTIVE
To assess for immunodeficiency in patients with hypogammaglobulinemia in the setting of draining acute chylothorax.


METHODS
Humoral and cellular immunity was evaluated in 8 patients with chylothorax. Chylous fluid was also analyzed to document cellular losses. Data regarding clinical course and immunologic characteristics were reviewed retrospectively.


RESULTS
All patients had hypogammaglobulinemia (IgG=179+/-35 mg/dL) as well as lymphopenia (985+/-636 cells/mm(3)). T cells were decreased and natural killer cells increased in peripheral blood. The converse was found in chylous fluid. The ratio of CD3+/CD45RA+ naive: CD3+/CD45RO+ memory T cells was greater in chyle than in peripheral blood. In vitro proliferative responses to antigens and mitogens were similar to control subjects, and previously immunized patients maintained evidence of protective vaccine-specific humoral immunity. To treat hypogammaglobulinemia, patients received intravenous immunoglobulin (IVIG) to maintain IgG within normal range; 6 of 8 patients had serious infections before receiving IVIG compared with 4 of 8 patients during the period of IVIG administration.


CONCLUSIONS
Draining chylothorax resulted in IgG and lymphocyte depletion with preferential retention of memory T cells and natural killer cells in the circulation. Overall, protective-specific antibody levels and T cell function were maintained. IVIG administration did not lead to discernible protection from infectious complications in this small group of patients.
Orange
Jordan S
JS
Division of Immunology, Children's Hospital, Enders Building, 300 Longwood Avenue, Boston, MA 02115, USA.
Geha
Raif S
RS
Bonilla
Francisco A
FA
D000208:Acute Disease; D000361:Agammaglobulinemia / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002675:Child, Preschool; D002913:Chyle / Q000276:immunology; D002916:Chylothorax / Q000276:immunology*; D005260:Female; D006801:Humans; D007156:Immunologic Memory / Q000276:immunology*; D007223:Infant; D007231:Infant, Newborn; D007694:Killer Cells, Natural / Q000276:immunology*; D017493:Leukocyte Common Antigens / Q000276:immunology*; D008231:Lymphopenia / Q000276:immunology; D008297:Male; D012189:Retrospective Studies
D017493:Leukocyte Common Antigens