Stebbins B. Chandor

Lucio's phenomenon: an immune complex deposition syndrome in lepromatous leprosy.

Abstract Lucios phenomenon is an acute lepra reaction in diffuse lepromatous leprosy characterized by cutaneous infarctions secondary to a necrotizing vasculitis. Five cases of Lucios phenomenon were studied to elucidate the pathogenesis of this complication of leprosy. Direct immunofluorescent studies of the lesions revealed the presence of deposits of complement and immunoglobulin in the walls of dermal blood vessels and in perivascular areas. The deposits were eluted when the cryostat sections of skin were incubated with an acidic buffer. Cryoglobulins of the “mixed type” containing IgG, IgM, IgA, C3, and C1q were found in the serum of four patients. Analysis of the cryoglobulins revealed an enrichment of rheumatoid factor activity in the cryoprecipitate over that of the serum. Immune complexes were found in the serum of all patients. Hypocomplementemia was observed in one patient. These data suggest that Lucios phenomenon is mediated by the deposition of immune complexes in dermal blood vessels.

Childhood lymphoma-leukemia. I. correlation of morphology and immunological studies

Acute lymphocytic leukemia of childhood (ALL) is a heterogeneous disorder. Furthermore, the related lymphomas have been separated arbitrarily according to clinical presentation. This study is based on a combined clinical, morphological (cytological) and immunological evaluation of 49 cases of childhood lymphoma or leukemia. We have identified three separate groups, which in the past have not always been clearly distinguished, but which do appear to have distinctive clinical and cytological features: 1) convoluted lymphocytic lymphoma/leukemia, of probable T cell origin (7 cases), usually associated with thoracic involvement; 2) small noncleaved follicular center cell (FCC) (Burkitt‐like) lymphoma/leukemia, of B cell origin (6 cases), usually associated with abdominal involvement; 3) a heterogeneous (ALL) group (36 cases). This study demonstrates that differentiation of these three entities can often be made on the basis of cytological examination and the features of clinical presentation. It remains to be determined whether these sub‐groups, and other more subtle variations in surface marking (E rosettes) and morphology within the ALL group, reflect important differences in behavior pertinent to selection of therapy.

Immunopathological studies on the cutaneous lesions in sarcoidosis

We examined the immunohistology of the cutaneous granulomas in sarcoidosis. By direct immunofluorescence immunoglobulin deposits were found in the skin lesions of 5 to 8 patients. These consisted of IgM within blood vessel wall (5 patients), IgM at the epidermal-dermal junction (2 patients) and IgG within and around the granuloma (2 patients). A fibrin network was present within the granulomas. Biopsy of a Kveim test site but not of uninvolved skin or of an erythema nodosum lesion showed similar immunofluorescence findings. Sheep erythrocytes sensitized with IgG antibody adhered to epithelioid cells within the granuloma indicating the presence of surface Fc receptors. At the periphery of the granulomas were B-lymphocytes. These findings are similar to those described in nodal and pulmonary sarcoid granulomas, and suggest that humoral antibodies may be important in the pathogenesis of the sarcoid granuloma.

Inadvertent rubella immunization in pregnancy

Abstract Sixty women inadvertently immunized with live rubella vaccine within 90 days before or during pregnancy have been studied. Only 9 of the women were known to be susceptible to rubella prior to immunization. Of these, 6 had normal infants, 1 had a therapeutic abortion, and 2 had spontaneous abortions. Of the remaining 51 women with unknown immune status, 33 were delivered of apparently normal infants and 14 had therapeutic (13) or spontaneous (1) abortions. In addition, the outcome of 4 pregnancies was as follows: one set of twins, a term infant who died at 5 days from hyaline membrane disease, a small premature infant who died, and an infant with a heart murmur. Of the pregnancies that were terminated, in 2 instances rubella virus was isolated from tissue removed at therapeutic abortion. In one instance the virus is probably “wild,” representing natural infection. In the other instance, the virus appears to be of vaccine origin. Histologic examination of abortus tissue revealed nonspecific inflammatory changes in 2 of the known rubella-susceptible women, in 6 in whom the susceptibility was unknown, and in 2 of 5 products of conception obtained from nonimmunized women having therapeutic abortions. No definite statement can be made regarding the embryopathic potential of the rubella vaccine from these data.