Ulises Mercado

Antibody Response to Pneumococcal Polysaccharide Vaccine in Systemic Sclerosis

To the Editor: Systemic sclerosis (SSc) is a connective tissue disorder characterized by cutaneous and visceral fibrosis, and obliterative vasculopathy. The lungs are frequently affected in SSc, and pulmonary disease may significantly influence morbidity and mortality1. Patients with SSc are at increased risk for microbial infections due to the immune effects of the disease itself, and the frequent use of immunosuppressive agents. Current guidelines recommend vaccination with pneumococcal polysaccharide for persons 2 to 64 years of age with chronic illness and for persons 65 years of age or older2,3. Therefore, vaccination might be useful in this infection-prone population provided that the vaccines produce a significant increase in antibody levels. To date, antibody responses to pneumococcal polysaccharide vaccine in patients with SSc are unknown. We evaluated the immunogenicity of this commercial vaccine in patients with SSc during promotional campaigns. Eighteen consecutive patients with SSc, according to the American College of Rheumatology criteria4, attending our outpatient clinic were included. Patients were grouped in subsets as defined by LeRoy, et al 5. Patients who had received pneumococcus vaccination within 5 years prior to study were excluded. There were 17 women and one man of median age 46.5 years (range 31–62) and median disease duration 7.5 years (range 1–12). Diffuse cutaneous SSc … Address reprint requests to Dr. Mercado; E-mail: ulisesmercado{at}uabc.mx

A case of Peutz-Jeghers syndrome associated with duodenal carcinoma and sickle cell anemia

TO THE EDITOR: We recently read the review on Peutz-Jeghers syndrome (PJS) by McGarrity et al. in the March, 2000 issue (1). As pointed out by the authors, PJS patients are known to be at increased risk for GI tract and non-GI tract malignancy. We herein report a case of PJS associated with intestinal carcinoma and sickle cell anemia.

Letters to the editorPeptic ulcer, or should it be called Marshall’s disease?

TO THE EDITOR: I read with interest the proposal by Kapicioglu (1) that the venerable old peptic ulcer may be renamed inflammatory gastric disease, thus defining the relationship between Helicobacter pylori, active chronic gastritis, and peptic ulcer. All of them are intimately related to questions of cause and effect.

Peptic ulcer, or should it be called Marshall's disease.

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