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A 22-year-old woman presented with fever, chills, photophobia, and headaches, followed by a centrally clearing erythematous skin eruption, migratory polyarthralgias, conjunctivitis, and subsequently, tender, nodular skin lesions. Antibodies to Borrelia burgdorferi were consistent with acute Lyme disease. Skin biopsy revealed acute septal panniculitis. This dermatologic manifestation has not been previously described in Lyme disease.

Pulmonary hypertension has been reported rarely in patients with systemic lupus erythematosus (SLE). During the past 31/2 yr we have observed pulmonary hypertension as a major clinical manifestation of their disease in four of 43 patients with well-documented SLE followed at out institution. Pulmonary hypertension could be attributed to underlying lung disease in three and was considered to be primary in the remaining patient. Neither hydralazine nor prednisone administration had any effect on the course of the pulmonary hypertension in these patients. The presence of pulmonary hypertension in the course of active SLE may be more common than previously recognized.

We isolated from the serum of a patient with recurrent skin infections an IgG immunoglobulin that irreversibly inhibits the random motility and chemotactic responsiveness of polymorphonuclear leukocytes. Although the patient's leukocytes behaved like normal cells with respect to adherence, phagocytosis, degranulation, and generation of the superoxide anion, they did not migrate normally toward standard chemotactic stimuli. Normal human polymorphonuclear leukocytes behaved similarly after incubation with the patient's serum. Inhibition of motility was not associated with cyutotoxicity. Inhibitory activity could be removed completely from the patient's serum by treatment with either agarose-bound anti-human IgG or Sepharose-bound staphylococcal protein A. Exposure of normal polymorphonuclear leukocytes to as little as 1.25 microgram per milliliter (0.00125 g per liter) of the patient's purified IgG caused significant inhibition of random motility and chemotactic responsiveness (P < 0.01). Thus, IgG immunoglobulins can inhibit leukocyte motility specifically and irreversibly, and thereby adversely affect host defenses against invading microorganisms.