title: A scleroderma-like cutaneous syndrome associated with a marked Th2-type immune response occurring after a prosthetic joint implant.
abstract: A scleroderma-like cutaneous syndrome, occurring after implantation of a prosthetic knee joint in an elderly woman, is reported. This case did not seem to typically fit into any of the known scleroderma-like disorders of the skin described to date. The patient was shown to be sensitized to metals contained in the prosthesis and to mount a Th2-type immune response concomitantly with development of skin fibrosis. In particular, eosinophilia, markedly elevated serum IgE levels, in vitro spontaneous production of interleukin (IL)-4 by T lymphocytes, and elevated serum levels of Th2 cytokines (namely, IL-4, IL-5, and IL-13) were observed during the acute phase of illness. Since eosinophils and such Th2 cytokines as IL-13 also have recognized fibrogenic properties, it is speculated that the pathogenesis of skin fibrosis in this case could have been the direct and/or indirect consequence of the coexisting Th2-type immune response.
authors.affiliation: Department of Internal Medicine, Division of Internal Medicine, Allergy and Clinical Immunology, Second University of Naples Polyclinic Hospital, Naples, Italy. ciro.romano@unina2.it
authors.forename: Ciro
authors.initials: C
authors.lastname: Romano
authors.forename: Ausilia
authors.initials: A
authors.lastname: Sellitto
authors.forename: Umberto
authors.initials: U
authors.lastname: De Fanis
authors.forename: Raffaele
authors.initials: R
authors.lastname: Rossiello
authors.forename: Luigi
authors.initials: L
authors.lastname: Rossiello
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giunta
authors.forename: Giacomo
authors.initials: G
authors.lastname: Lucivero
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D003035:Cobalt / Q000276:immunology*; D016207:Cytokines / Q000097:blood; D004802:Eosinophilia / Q000188:drug therapy / Q000209:etiology; D004890:Erythema / Q000209:etiology / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007166:Immunosuppressive Agents; D007720:Knee Prosthesis / Q000009:adverse effects*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011282:Pregnenediones / Q000627:therapeutic use; D045745:Scleroderma, Limited / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D013577:Syndrome
chemical_list: D016207:Cytokines; D007166:Immunosuppressive Agents; D011282:Pregnenediones; D007073:Immunoglobulin E; D003035:Cobalt; D009173:Mycophenolic Acid; C021988:deflazacort