Tevfik Akoglu

Behçet's disease in patients with chronic myelogenous leukemia: possible role of interferon-alpha treatment in the occurrence of Behçet's symptoms.

Abstract Two patients with chronic myelogenous leukemia (CML) who developed characteristic features of Behçets disease (BD) during alpha-interferon (IFN-α) treatment and another patient who had a diagnosis of BD preceding CML are presented. In the first two patients, features of BD appeared 6 months after the initiation of IFN-α treatment; they included recurrent oral aphthae, genital ulceration, arthritis, folliculitis, and a positive skin pathergy test. The third patient, however, had a diagnosis of Behçets disease 4 years before diagnosis of Philadelphia-positive CML. We prospectively examined the skin pathergy reaction in a group of patients with CML, multiple myeloma, and hairy cell leukemia both before and after IFN-α treatment and found two additional patients with CML who developed a positive skin pathergy test following IFN-α treatment.

Efficacy of high‐dose methylprednisolone as a first‐line therapy in adult patients with idiopathic thrombocytopenic purpura

Fifty‐seven adult patients with idiopathic thrombocytopenic purpura (ITP) were treated with either conventional‐dose prednisolone (CDP) (1 mg/kg/d, 36 patients) or high‐dose methylprednisolone (HDP) (30 mg/kg/d, 21 patients), as first‐line treatment. Patients in the HDP arm responded more rapidly (4.7 v 8.4 d), with a higher response rate (80% v 52.7%), and without severe side‐effects. One quarter of the patients (3/12) who were non‐responsive to CDP achieved complete remission when they were treated with HDP. The findings suggest that HDP may be a more effective first‐line treatment than CDP for adult ITP, and it may also be preferred for life‐threatening cases of ITP. However, these results must be confirmed by a randomized study prior to any change in the current practice of employing CDP as first‐line treatment for adult ITP.

Increased CD4+CD16+ and CD4+CD56+ T cell subsets in Behçet's disease

Abstract Behçets disease is a systemic vasculitis of unknown etiology. Various immune abnormalities have previously been shown in Behçets disease. We investigated T lymphocyte subsets associated with cytotoxic activity and natural killer (NK) cells by flow cytometry in 37 patients with Behçets disease, 38 healthy controls, and 17 diseased control patients. Compared to the healthy controls, CD4+CD16+ and CD4+CD56+ subsets were found to be higher in the Behçets disease group as well as in the disease control group (CD4+CD16+: BD=5 ± 3, DC=14 ± 14, HC= 3 ± 2, P=0.001; CD4+CD56+: BD=11 ± 5, DC= 18 ± 17, HC=8 ± 6, P=0.01). CD8+CD16+ and CD8+CD56+ T cell subsets were at normal levels in Behçets disease but found to be elevated in disease controls. Similarly, NK cells (CD16+CD56+) were high only in the disease control group. Significant increases in CD4+CD16+ and CD4+CD56+ cell subsets in Behçets patients and disease controls suggest that T cell activation patterns of these subsets in Behçets disease are similar to those in other inflammatory disorders.

Remitting seronegative symmetrical synovitis with pitting oedema associated with chronic lymphocytic leukaemia.

Abstract: We describe a case of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE syndrome) in a 67-year-old man. Immunophenotyping studies and histology of biopsy specimens revealed chronic lymphocytic leukaemia (CLL). Polyarthritis and oedema were revealed by small doses of corticosteroids. The association of RS3PE syndrome with rheumatological and malign disorders are discussed.

Phagocytosis and oxidative burst by neutrophils in patients with recurrent furunculosis

Neutrophil phagocytosis of fluorescently labelled Staphylococcus aureus and oxidative burst by the neutrophils were assessed by flow cytometry in 22 patients with recurrent furunculosis and in 17 controls. Phagocytosis and oxidative burst were not found to be significantly different between the patients and controls. Low serum iron concentrations were demonstrated in six patients (27%). In these patients with hypoferraemia, oxidative burst was significantly lower than in the patients without hypoferraemia and in the controls. These data suggest that hypoferraemia may be an important predisposing factor in a subgroup of patients with recurrent furunculosis in impairing oxidative killing by neutrophils.

Effect of Interferon-α2a on Neutrophil Adhesion and Phagocytosis in Chronic Myeloid Leukemia and Behçet’s Disease

Abstract: Alpha-interferon (α-IFN) is implicated in a Behçet’s disease (BD)-like syndrome observed in a small number of chronic myeloid leukemia (CML) patients. The effect of α-IFN on neutrophil adhesion and phagocytosis in CML patients, BD patients and healthy volunteers was investigated to clarify the reason for this observation. Ten subjects were studied for each group by incubating neutrophils with various doses of α-IFN. Basal neutrophil adhesions for CML patients, BD patients and healthy volunteers were similar. However, BD patients had greater basal phagocytosis than CML patients, and both groups had greater basal phagocytosis than healthy volunteers. Neutrophil adhesion and phagocytosis of CML patients increased following incubation with higher doses of α-IFN, and phagocytosis approached the high levels observed with BD neutrophils. This study provides evidence that α-IFN activates neutrophils in CML patients in a dose-dependent manner, and leads to a neutrophil function profile that resembles BD.

Subcutaneous Nodules Caused by Pseudomonas aeruginosa: Healing Without Incision and Drainage

In a patient with multiple myeloma, numerous indurated, subcutaneous nodules and pyomyositis due to Pseudomonas aeruginosa were noted. These lesions resolved with ciprofloxacin plus ceftazidime therapy without surgical incision and drainage. Despite another course of cancer chemotherapy after total disappearance, there were no recurrences at the end of 3 months. Quinolones initially combined with other antipseudomonal beta-lactam agents may be the drugs of choice in the management of patients with subcutaneous nodules caused by P. aeruginosa.