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96 Churg Stauss Syndrome: Possible cause of death in asthma
J. ALLERGYCLIN IMMIINOL. JANUARY1391
162 Abstracts
93
94
CORRELATION OF ANTICARDIOLIPIN ANTIBODY LEVELS (ACA) AND PLACENTAL BED VASCULITIS TO POOR OUTCOME OF PREGNANCY. RESPONSE TO PREDNISOLONE AND ASPIRIN. K. Erlendsson, M.D. K.Steinsson, M.D. R.T.Geirsson, M.D. J.H. Johannsson,M.D. Reykjavik Iceland. There seems to be a certain correlation between the presence of ACA, prolonged activated partial thromboblastin time (AFTT) and poor pregnancy outcome, but the mechanism is not clear. We have followed two women with clinically quiescent SLE through their two consecutive pregnancies, and measured the levels of ACA, APTT, examined placental bed biopsies for vasculitis, evaluated pregnancy outcome and correlated with the dose of prednisolone used in each pregnancy. In the first pregnancies there were marked elevation of ACA and signs of anticoagulant present, when treated with IO-lSmg/d of prednisolone and IOOmg of aspirin. In both pregnancies there were a retardation of foetal growth leading to early third trimester delivery and the babies did not SIX\ I \ i/100 < l/300, anti-DNA within normal limits and there were no significant changes in complemenr levels with the treatment. We suggest that the vasculitis was the cause for retarded foetal growth and that the anticardiolipin antibodies played a role in it’s pathogenesis and that treatment with prednisolone in higher doses interferes with the underlying mechanism.
95
PROTEIN S IN CHILIJHOUD COUACEN~IS. Y. EI Gamal, M.D., s. .kkgefhi, YD., NJ. hbd . I.3 wshe& M.D. and H. u asc.,&alro Egypt. The possible role of protein S in the’ hypercoagulability and thro&oembolic complications metwith in childhood collagenosis was assessed in 20 children with systemic lupus erythematosus SLE and juvenile rheumatoid arthritis JRA (10 patients during activity and 10 in remission) as well as in 15 healthy children for control. They were subjected to quantitative estimation of total and free plasma protein S, partial thromboplastin time and platelet count. The total plasma protein S was not significantly decreased in all the patients studied, whether during activity (82.628.1796) or remission (86.85 10.8%), as compared to the control mean (90.2 + 13.6%). Nevertheless, free plasma protein S was sign:ficantly tower in the children with SLE during activity (57.6 + 9.81%) and remission (72.5 ~3.51%) than in the
96
1 PM.
PK CvvLe & R Sidbu, PhD. NJ and Stony Brook, NY. Lyme disease (LD), due to Borrelia is often difficult to buradorferi (Bb), diagnose early as only 50% of the patients have the hallmark sign-erythema Newark,
migrans (EM) -, and Ab tests are often negative for 6 weeks. We previously demonstrated that EM+ seronegative (as and in early as 2-3 weeks certain chronic) cases had complexed, but not. free, anti Bb Ab. The current cane illustrates that detectable KC Ab may be found as early as the time the EM rash might
appear
(7-10
days).
The
patient
lived in an area endemic for LD and presented with a 4 cm erythematous macular lesion which expanded to 12 cm over a 3 day period. Serum and skin biopsy were obtained. Serum IC were isolated by polyethylene glwol t dissociated by O.lM borate pN 10, and analyzed by ELISA and Western blots. IgM and IgG anti Bb and Ab were found against 2 of the major Bb proteins-34 and 41 kD. Bb infection was further confirmed polymerase chain by amplification
of
DNA from
the
skin
using
oligonucleotide primers specific for the outer surface protein encoding region of Bb. In conclusion, though free Ab may not be detected, an early humoral immune can
be detected
by
analysis
of
TC Jib,
aiad 07 asthma CA). hyp&os&philia and systemic vasculitis. This syndrome is potentially lethal,with haif of CSS deaths due to cardiac involvement (Medicine 63:65-81, 1984). Two patients with chronic stable A were recently seen at our institution with unsuspected CSS. Case 1, a 46 year old white woman with 2 year history of (A) was admitted for status asthmaticus, cardiogenic shock ,and EKC changes of acute anterior myocardial infarction. Labs showed CPK (229 II-Uml) with 17% MB fraction and WBC 27,000 with 27% eosinophils (E). Patient was intubated, treated with high dose intravenous corticosteroids (CS) and dobutamine. Emergency cardiac catheterization rove&d normaI coronary arteries and anterior-apical akinesis of the left ventricle (LV). Diagnosis of CSS was made cliiicaliy. After 4 weeks of (CS) therapy serial echocardiography (ECHO) showed normalization of LV function and the eosinophilia resolved. Case 2, a 17 year old white woman with 3 year history of (A) presented with a 6 week history of
painful rash on hands and feet and acute “wheezing” coincident with her apical puk Examinatian showed tender palpable erythematous nodules of fm8ers and toes and a loud pericardial (P) friction rub. Labs showed WBC 12,000 with 38% (E). Skin biopsy showed necrotizing eosinophilic vasculitis and granulomas, typicP of CSS. ECHO revealed LV hypertrophy and small (P) effusion. After 4 we&s of (CS) therapy, skin rash, pcricaniitis and eosinophilia resolved. Recognition of CSS mFgas(A)with(E)may be iifesaving as unheated SS V&I car&ac tnvoivement is often fatal.
162 Abstracts
93
94
CORRELATION OF ANTICARDIOLIPIN ANTIBODY LEVELS (ACA) AND PLACENTAL BED VASCULITIS TO POOR OUTCOME OF PREGNANCY. RESPONSE TO PREDNISOLONE AND ASPIRIN. K. Erlendsson, M.D. K.Steinsson, M.D. R.T.Geirsson, M.D. J.H. Johannsson,M.D. Reykjavik Iceland. There seems to be a certain correlation between the presence of ACA, prolonged activated partial thromboblastin time (AFTT) and poor pregnancy outcome, but the mechanism is not clear. We have followed two women with clinically quiescent SLE through their two consecutive pregnancies, and measured the levels of ACA, APTT, examined placental bed biopsies for vasculitis, evaluated pregnancy outcome and correlated with the dose of prednisolone used in each pregnancy. In the first pregnancies there were marked elevation of ACA and signs of anticoagulant present, when treated with IO-lSmg/d of prednisolone and IOOmg of aspirin. In both pregnancies there were a retardation of foetal growth leading to early third trimester delivery and the babies did not SIX\ I \
95
PROTEIN S IN CHILIJHOUD COUACEN~IS. Y. EI Gamal, M.D., s. .kkgefhi, YD., NJ. hbd . I.3 wshe& M.D. and H. u asc.,&alro Egypt. The possible role of protein S in the’ hypercoagulability and thro&oembolic complications metwith in childhood collagenosis was assessed in 20 children with systemic lupus erythematosus SLE and juvenile rheumatoid arthritis JRA (10 patients during activity and 10 in remission) as well as in 15 healthy children for control. They were subjected to quantitative estimation of total and free plasma protein S, partial thromboplastin time and platelet count. The total plasma protein S was not significantly decreased in all the patients studied, whether during activity (82.628.1796) or remission (86.85 10.8%), as compared to the control mean (90.2 + 13.6%). Nevertheless, free plasma protein S was sign:ficantly tower in the children with SLE during activity (57.6 + 9.81%) and remission (72.5 ~3.51%) than in the
96
1 PM.
PK CvvLe & R Sidbu, PhD. NJ and Stony Brook, NY. Lyme disease (LD), due to Borrelia is often difficult to buradorferi (Bb), diagnose early as only 50% of the patients have the hallmark sign-erythema Newark,
migrans (EM) -, and Ab tests are often negative for 6 weeks. We previously demonstrated that EM+ seronegative (as and in early as 2-3 weeks certain chronic) cases had complexed, but not. free, anti Bb Ab. The current cane illustrates that detectable KC Ab may be found as early as the time the EM rash might
appear
(7-10
days).
The
patient
lived in an area endemic for LD and presented with a 4 cm erythematous macular lesion which expanded to 12 cm over a 3 day period. Serum and skin biopsy were obtained. Serum IC were isolated by polyethylene glwol t dissociated by O.lM borate pN 10, and analyzed by ELISA and Western blots. IgM and IgG anti Bb and Ab were found against 2 of the major Bb proteins-34 and 41 kD. Bb infection was further confirmed polymerase chain by amplification
of
DNA from
the
skin
using
oligonucleotide primers specific for the outer surface protein encoding region of Bb. In conclusion, though free Ab may not be detected, an early humoral immune can
be detected
by
analysis
of
TC Jib,
aiad 07 asthma CA). hyp&os&philia and systemic vasculitis. This syndrome is potentially lethal,with haif of CSS deaths due to cardiac involvement (Medicine 63:65-81, 1984). Two patients with chronic stable A were recently seen at our institution with unsuspected CSS. Case 1, a 46 year old white woman with 2 year history of (A) was admitted for status asthmaticus, cardiogenic shock ,and EKC changes of acute anterior myocardial infarction. Labs showed CPK (229 II-Uml) with 17% MB fraction and WBC 27,000 with 27% eosinophils (E). Patient was intubated, treated with high dose intravenous corticosteroids (CS) and dobutamine. Emergency cardiac catheterization rove&d normaI coronary arteries and anterior-apical akinesis of the left ventricle (LV). Diagnosis of CSS was made cliiicaliy. After 4 weeks of (CS) therapy serial echocardiography (ECHO) showed normalization of LV function and the eosinophilia resolved. Case 2, a 17 year old white woman with 3 year history of (A) presented with a 6 week history of
painful rash on hands and feet and acute “wheezing” coincident with her apical puk Examinatian showed tender palpable erythematous nodules of fm8ers and toes and a loud pericardial (P) friction rub. Labs showed WBC 12,000 with 38% (E). Skin biopsy showed necrotizing eosinophilic vasculitis and granulomas, typicP of CSS. ECHO revealed LV hypertrophy and small (P) effusion. After 4 we&s of (CS) therapy, skin rash, pcricaniitis and eosinophilia resolved. Recognition of CSS mFgas(A)with(E)may be iifesaving as unheated SS V&I car&ac tnvoivement is often fatal.