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Six patients with systemic lupus erythematosus were treated with high-dose intravenous gammaglobulin. Immunological parameters were studied and included solid-phase immune complex determinations, quantitative immunoglobulins G, A, and M, as well as C3 and C4 concentrations. Pretreatment values of circulating immune complex concentrations as measured by either C1q binding or anti-C3 binding assays were elevated in all patients. Posttreatment values showed reductions in all C1q binding immune complexes (p

A total of 36 intravenous drug abusers (IVDA) were studied for circulating immune complexes (CIC) and serum soluble CD8 antigen (sCD8). None had symptoms or signs of AIDS-related complex or AIDS. sCD8 levels were significantly higher in 18 patients who had HIV antibody (Ab) compared with 18 patients who were HIV Ab negative (1640 +/- 578 virus 804 +/- 264 U/ml, p less than 0.0001). In HIV Ab+ patients but not in HIV Ab- patients, sCD8 levels significantly correlated with percentages and absolute numbers of activated CD3+DR+ peripheral blood mononuclear cells (p = 0.0024 and 0.0183, respectively). Also in HIV Ab+ patients, CIC levels were significantly greater for both anti-C3 binding (13.1 +/- 11.1 versus 2.9 +/- 3.4 micrograms/ml, p = 0.002) and C1q binding (23.5 +/- 20.2 versus 6.3 +/- 4.3 micrograms/ml, p = 0.001) CIC. Serum C4 concentrations were lower in the HIV Ab+ patient group (33.9 +/- 10.1 versus 41.6 +/- 12.4 mg/dL, p = 0.043). In the seropositive group, IgG levels were higher (2206 +/- 859 versus 1615 +/- 645 mg/dl) and total CD4 cell counts were lower (757 +/- 344 versus 1172 +/- 402 cells per mm3), but at a less significant level (p = 0.024 and 0.005, respectively), than that seen for sCD8 and C1q CIC differences. These results suggest that elevations of both the lymphocyte activation marker sCD8 and antigen nonspecific CIC characterize earlier stages of HIV infection in IVDA.

Utilizing a panel of immune complex assays, antigen-antibody complex formation in a 29-year-old man shortly after a spider bite was documented. The clinical picture and laboratory parameters were consistent with a serum sickness reaction. Immune hyperactivity was evidenced by a detectable autoimmune serological response. This constellation of findings may be a common attendant to arthropod envenomation.

In vivo immune clearance of immunoglobulin G sensitized autologous erythrocytes (rbc) was studied in nine patients who fulfilled American Rheumatism Association (ARA) criteria for systemic lupus erythematosus (SLE). Opsonized rbc were radiolabelled with technetium 99. The rate of radioactive blood clearance was measured, as was organ-specific radioactive uptake utilizing area-of-interest (AOI) measurements in a computerized scintigraphic imaging system. It was shown that dynamic quantitation of an AOI corresponding to the heart generated time-activity curves which approximated blood-clearance curves. Calculation of first order clearance (min per 50% decrease in counts) showed a highly significant correlation between rates derived from heart AOI curves and those derived from blood-clearance curves (r = 0.9483, P = 0.0003). Clearance curves showed a monoexponential slope in most patients. Further exploration of organ-specific AOI curves showed that percent splenic uptake and the nature of the splenic uptake curves varied between patients. These studies point toward a variable splenic role in Fc receptor function for SLE patients and further demonstrate the utility of nuclear imaging in studying immune clearance.

Pulmonary disease associated with acquired immunodeficiency syndrome (AIDS) is common and may be secondary to infectious and noninfectious processes.1 One of the noninfectious processes is lymphocytic interstitial pneumonitis (LIP). LIP is an uncommon disorder that was first described by Carrington and Liebow2 in 1966, and is characterized by a diffuse peribronchial and interstitial infiltration of the lung by lymphocytes and plasma cells.3 LIP has been recognized as a common pulmonary complication in cases of pediatric AIDS and appears to be present in as many as 75% of these cases.4 The present Centers for Disease Control (CDC) classification includes LIP as a diagnostic criterion for pediatric AIDS.5

Two patients with systemic lupus erythematosus (SLE) developed progressive chronic pulmonary disease. Pulmonary bronchoalveolar lavage (BAL) and Gallium-67 scanning were performed and were consistent with alveolitis. In one patient, an open lung biopsy was performed and showed the presence of several immunoreactants as well as interstitial pneumonitis. Although mild pulmonary function abnormalities are common in SLE, some patients such as the two described in this report develop progressive and incapacitating pulmonary impairment. The need for developing standardized indices of pulmonary inflammation such as BAL and gallium scanning for the purposes of diagnosis, prognostication, and monitoring treatment responses in systemic lupus erythematosus is stressed.

A 35-year-old Black male with a long history of intravenous drug abuse developed clinical manifestations of Reiter’s syndrome, with significant joint and psoriasiform skin involvement. In addition, he had signs and symptoms compatible with human immunodeficiency virus (HIV) infection and had a positive HIV antibody test confirmed with Western blot testing. Although many dermatologic manifestations of HIV infection have been described, this is the first time that an association with Reiter’s syndrome has been reported. Recently, the development of psoriasis in other patients with HIV infection has been described. Taken together, these occurrences suggest that the purported retroviral relationship with psoriasis and related dermatoses may warrant further examination.