A case of hypogammaglobulinemia with a complication of hepatitis B with bridging necrosis

A 23 year-old male who had a past history of recurrent infection, was admitted to our hospital with the complaint of general malaise and fever. Laboratory examination revealed IgG 430mg/dl, IgA 62ml/dl and IgM 43mg/dl with hypertransaminasenemia, in conjunction with HBs-Ag (+) and HBe-Ag (+). Liver biopsy specimen showed a lobular massive necrosis with proliferation of the small biliary ducts and with slight lymphocytosis and plasmacytosis.Immunological examination with peripheral lymphocytes revealed the decrease of the immunoglobulin-secreting cells detected by plaque-forming-cell assay and marked reduction of OKT 4 (+) cells and of surface immunoglobulin bearing cells. In vitro culture of the unfractionted peripheral lymphocytes from this patient in the presence of pokeweed mitogen (PWM) showed a decreased immunoglobulin production when compared with the normal control. In addition, In vitro co-culture of B cells of this patient and T cells of the control in the presence of PWM revealed the decreased production of immunoglobulin, suggesting the impared function of B cells of this patient, in addition to the reduced number of B cells. In the same type of experiments, the helper function of T cells of this patient to In vitro Immunoglobulin synthesis, was found to be impared.Some discussions have been made concerning the hypo γ-globulinemia in cojunction with severe liver disease and the lymphocyte dysfunction of this patient.