CD8+ T lymphocytes infiltrate predominantly in the inflammatory foci of MPO-ANCA-positive thoracic hypertrophic pachymeningitis in a patient with HLA-A24.
Hypertrophic pachymeningitis (HP) is extremely rare and an inflammatory process that thickens the dura mater. A 59-year-old Japanese woman developed backache, became paraplegic, and magnetic resonance imaging revealed diffuse thickening of the thoracic dura mater encompassing the spinal cord. Although a test for myeloperoxidase antineutrophil cytoplasmic autoantibody (MPO-ANCA) was shown to be positive, vasculitis was not found and CD8(+) T lymphocytes that predominated in the inflammatory foci. Both interleukin (IL)-2 and IL-6 were markedly elevated in not only sera but also cerebrospinal fluids, very much higher in the latter. Human leukocyte antigen (HLA) typing revealed A24 positivity, suggesting this molecule was interacting with CD8(+) T lymphocytes. It was suggested that immunological disharmony and autoimmunity would play a pivotal role in the development of HP under genetic background of HLA-A24, and HP would be one feature of multiple organ involvement in ANCA-associated diseases.
Nakamura
Tadashi
T
Section of Internal Medicine and Rheumatology, Kumamoto Center for Arthritis and Rheumatology, 1-15-7 Kuhonji, Kumamoto 862-0976, Japan. naktrkme@koh.marutakai.or.jp
Hirakawa
Kei
K
Higashi
Syu-ichi
S
Tomoda
Kunihiko
K
Tsukano
Michishi
M
Iyama
Ken-ichi
K
Sakae
Terumi
T
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000187:drug effects / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D015234:HLA-A Antigens; D059871:HLA-A24 Antigen; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007796:Laminectomy; D008297:Male; D008582:Meningitis, Aseptic / Q000188:drug therapy / Q000276:immunology*; D008875:Middle Aged; D009195:Peroxidase / Q000187:drug effects / Q000276:immunology*; D011859:Radiography; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
D000305:Adrenal Cortex Hormones; D019268:Antibodies, Antineutrophil Cytoplasmic; D015234:HLA-A Antigens; D059871:HLA-A24 Antigen; D007166:Immunosuppressive Agents; D009195:Peroxidase