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Selective IgA deficiency and circulating immune complexes containing bovine proteins in a child with chronic graft versus host disease
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A nine year old boy with severe diabetic ketoacidosis was successfully treated with intravenous fluids, bicarbonate and insulin. Potassium supplementation was given only as the phosphate salt, in accordance with some current recommendations. Marked hypocalcemia, hypomagnesemia and hyperphosphatemia resulted. We caution physicians of this iatrogenic sequela to such potassium phosphate therapy. We recommend that judicious phosphate administration be accompanied by close monitoring of serum calcium, magnesium and phosphorus when it is employed in the therapy for diabetic ketoacidosis.
1979.
B-896,1979.
A fatal case of disseminated granulomatous infection with a skin lesion and focal encephalitis due to Acanthamoeba astronyxis is reported. Indirect fluorescent antibody tests of both patient tissue and patient serum established the diagnosis. Amphotericin B therapy is ineffective in vitro and has not been effective in vivo. It is recommended that corticosteroid therapy be avoided because ii may aggravate the disease. Physicians caring for patients with diseases caused by free-living ameba may call the CDC Parasitic Drug Service.
Winter RJ, Harris CJ. Phillips LS. Green OC: Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am J Med 67:897-900,
Hyperphosphatemia
Hypocalcemia
Gulleti J. Mills J, Hadley K. Podemski B, Pitts L. Gelber R: Disseminated granulomatous Acanthamoeba infection presenting as an unusual skin lesion. Am J Med 67:
Meningoencephalitis
Potassium phosphate therapy
Diabetic ketoacidosis Hypomagnesemia
Acanthamoeba
Disseminated granulomatous infection Skin lesions
We report here that high levels of circulating immune complexes were found in the serum of a child who had been treated for severe combined immunodeficiency by bone marrow transplantation, but in whom the IgA-producing cells subsequently failed. As increasing amounts of complexes appeared over a two year period, the child had a parallel progression of chronic graft versus host disease with features of sclercderma. Chemical studies showed that the majority of the circulating complexes contained bovine milk proteins and that deposits of bovine casein were found in the child’s dermis. After milk exclusion, the level of circulating complexes fell 77 per cent.
I
Bovine milk proteins Chronic graft versus host disease
A 51 year old man presenting with amyloidosis involving the lungs, the testes, the skin and the stomach has been followed for eight years. Serial pulmonary functions revealed StOwty progressive physiologic deterioration. The various clinical features and the lengths of survival in the previously reported cases of diffuse interstitial pulmonary amyloidosis are reviewed. The unusually long survival of this patient and its implications are discussed.
lmmunoglobulin A deficiency
Circulating immune complexes
Cunningham-Rundles C, Brandeis WF. Safai 8, D’Reilly R, Day NK, Good HA. Selective IgA deficiency and circulating immune complexes containing bovine proteins in a child with chronic graft versus host disease. Am J Med 67: 883 890. 1979.
Interstitial lung disease
Kanada DJ, Sharma OP: Long-term survival with diffuse interstitial pulmonary amyloidosis. Am J Med 67:879-882, 1979.
Pulmonary functions
Pulmonary amyloidosis
-.
__--__
A nine year old boy with severe diabetic ketoacidosis was successfully treated with intravenous fluids, bicarbonate and insulin. Potassium supplementation was given only as the phosphate salt, in accordance with some current recommendations. Marked hypocalcemia, hypomagnesemia and hyperphosphatemia resulted. We caution physicians of this iatrogenic sequela to such potassium phosphate therapy. We recommend that judicious phosphate administration be accompanied by close monitoring of serum calcium, magnesium and phosphorus when it is employed in the therapy for diabetic ketoacidosis.
1979.
B-896,1979.
A fatal case of disseminated granulomatous infection with a skin lesion and focal encephalitis due to Acanthamoeba astronyxis is reported. Indirect fluorescent antibody tests of both patient tissue and patient serum established the diagnosis. Amphotericin B therapy is ineffective in vitro and has not been effective in vivo. It is recommended that corticosteroid therapy be avoided because ii may aggravate the disease. Physicians caring for patients with diseases caused by free-living ameba may call the CDC Parasitic Drug Service.
Winter RJ, Harris CJ. Phillips LS. Green OC: Diabetic ketoacidosis. Induction of hypocalcemia and hypomagnesemia by phosphate therapy. Am J Med 67:897-900,
Hyperphosphatemia
Hypocalcemia
Gulleti J. Mills J, Hadley K. Podemski B, Pitts L. Gelber R: Disseminated granulomatous Acanthamoeba infection presenting as an unusual skin lesion. Am J Med 67:
Meningoencephalitis
Potassium phosphate therapy
Diabetic ketoacidosis Hypomagnesemia
Acanthamoeba
Disseminated granulomatous infection Skin lesions
We report here that high levels of circulating immune complexes were found in the serum of a child who had been treated for severe combined immunodeficiency by bone marrow transplantation, but in whom the IgA-producing cells subsequently failed. As increasing amounts of complexes appeared over a two year period, the child had a parallel progression of chronic graft versus host disease with features of sclercderma. Chemical studies showed that the majority of the circulating complexes contained bovine milk proteins and that deposits of bovine casein were found in the child’s dermis. After milk exclusion, the level of circulating complexes fell 77 per cent.
I
Bovine milk proteins Chronic graft versus host disease
A 51 year old man presenting with amyloidosis involving the lungs, the testes, the skin and the stomach has been followed for eight years. Serial pulmonary functions revealed StOwty progressive physiologic deterioration. The various clinical features and the lengths of survival in the previously reported cases of diffuse interstitial pulmonary amyloidosis are reviewed. The unusually long survival of this patient and its implications are discussed.
lmmunoglobulin A deficiency
Circulating immune complexes
Cunningham-Rundles C, Brandeis WF. Safai 8, D’Reilly R, Day NK, Good HA. Selective IgA deficiency and circulating immune complexes containing bovine proteins in a child with chronic graft versus host disease. Am J Med 67: 883 890. 1979.
Interstitial lung disease
Kanada DJ, Sharma OP: Long-term survival with diffuse interstitial pulmonary amyloidosis. Am J Med 67:879-882, 1979.
Pulmonary functions
Pulmonary amyloidosis
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