title: Identification of germinal centres in the lymph node of a patient with hyperimmunoglobulin M syndrome associated with congenital rubella.
abstract: BACKGROUND
  The hyper immunoglobulin M syndrome (HIM) associated with congenital rubella infection (rHIM) is an extremely rare disorder, where patients have elevated serum IgM in association with reduced IgG and IgA. We have previously shown that in contrast to X-linked HIM (XHIM), a patient with well-characterised rHIM is able to express functional CD40 ligand, undergo immunoglobulin isotype switching and to generate memory B cells. Here we describe the ultrastructural features of an excised lymph node from this patient.
  
  
  METHODS
  An inguinal lymph node was surgically removed and examined histologically as well as by immunohistochemistry. It was then stained with multiple fluorescent dyes to visualize the cellular interactions within the node. Flow cytometry was undertaken on a cellular suspension from the node.
  
  
  RESULTS
  Our patient has normal lymph node architecture by light microscopy. Immunohistochemistry studies showed the presence of scattered germinal centres. Polychromatic immunofluorescence staining showed disruption of the architecture with mostly abnormal germinal centres. A small number of relatively intact germinal centres were identified. Both IgM and IgG bearing cells were identified in germinal centres.
  
  
  CONCLUSIONS
  In contrast to XHIM where germinal centres are absent, the presence of small numbers of relatively normal germinal centres explain our previous identification of isotype switched memory B cells in rHIM.
authors.affiliation: Departments of Virology and Immunology, LabPlus, Auckland Hospital, Park Rd, Auckland, New Zealand, rohana@adhb.govt.nz.
authors.forename: Rohan
authors.initials: R
authors.lastname: Ameratunga
authors.forename: Chun-Jen J
authors.initials: CJ
authors.lastname: Chen
authors.forename: Wikke
authors.initials: W
authors.lastname: Koopmans
authors.forename: P Rod
authors.initials: PR
authors.lastname: Dunbar
authors.forename: Maia
authors.initials: M
authors.lastname: Brewerton
authors.forename: Richard
authors.initials: R
authors.lastname: Lloydd
authors.forename: Claudia J
authors.initials: CJ
authors.lastname: Mansell
authors.forename: Chris
authors.initials: C
authors.lastname: van Vliet
authors.forename: See-Tarn
authors.initials: ST
authors.lastname: Woon
mesh_terms: D001402:B-Lymphocytes / Q000276:immunology*; D019013:CD40 Antigens / Q000378:metabolism; D018858:Germinal Center / Q000648:ultrastructure*; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications / Q000276:immunology*; D017578:Immunoglobulin Class Switching / Q000235:genetics; D007074:Immunoglobulin G / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007156:Immunologic Memory / Q000235:genetics; D008198:Lymph Nodes / Q000648:ultrastructure*; D008297:Male; D008875:Middle Aged; D012410:Rubella Syndrome, Congenital / Q000150:complications / Q000276:immunology*
chemical_list: D019013:CD40 Antigens; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous
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