Faculty Bibliography

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.

Adenosine specifically inhibits superoxide anion generation by N-formyl-methionyl-leucyl-phenylalanine-stimulated neutrophils without affecting either degranulation or 'aggregation.' We present data that also supports the hypothesis that adenosine engages a specific cell surface receptor to mediate inhibition of stimulated neutrophils. Theophylline (10 and 100 mu M), a competitive antagonist at adenosine receptors, reversed the effects of adenosine (0.1 mu M) on superoxide anion generation by stimulated neutrophils. The adenosine analogue 5'N-ethylcarboxamidoadenosine (NECA) was a more potent inhibitor of superoxide anion generation than either N6-phenylisopropyladenosine (PIA) or adenosine, an order of potency consistent with that previously demonstrated for adenosine A2 receptors. 2-Chloroadenosine inhibited superoxide anion generation at concentrations similar to NECA. [3H]-NECA and [3H]-2-chloroadenosine bound to a single receptor on intact neutrophils. The characteristics of the receptors for [3H]-NECA and [3H]-2-chloroadenosine were similar (Kd = 0.22 and 0.23 mu M, respectively; number of binding sites = 9.31 and 11.1 X 10(3) sites/cell, respectively). NECA, 2-chloroadenosine, adenosine, and PIA inhibited binding of [3H]-NECA with a rank order similar to that for inhibition of superoxide anion generation (NECA = 2-chloroadenosine greater than adenosine greater than PIA). There was 50% inhibition of superoxide anion generation by NECA at approximately 20% receptor occupancy. Adenosine, derived from damaged tissues, may serve as a specific, endogenous modulator of superoxide anion generation by activated neutrophils through interaction at this newly described receptor on human neutrophils

A 59-year-old man had disseminated tuberculosis and microscopic hematuria, red cell casts, and normal renal function. Renal biopsy revealed focal mesangial proliferation with exclusively IgA deposits, diagnostic of IgA nephropathy. After institution of antituberculous therapy, the urinary abnormalities resolved. There is evidence to suggest that tuberculosis, in addition to other conditions associated with mucosal exposure to antigens producing an IgA immune response, can result in IgA nephropathy. This glomerulopathy is reported as a potential renal complication of concurrent mycobacterial infection.

Five male homosexuals, four of whom had Kaposi's sarcoma, presented with painful swelling of the lower extremity. The overlying skin was erythematous and exquisitely tender. Deep vein thrombosis was strongly suspected in all patients. Venography, however, revealed no evidence of venous occlusion. This condition, which in this report is termed the hyperalgesic pseudothrombophlebitis syndrome, appears to be another unusual manifestation of the acquired immune deficiency syndrome. It should be considered among the entities known to mimic deep vein thrombosis and must be recognized in order to prevent unnecessary anticoagulation in these patients.

A 57-year-old man with primary amyloidosis was initially seen with hematuria, cutaneous bleeding, and hepatosplenomegaly. Factor X was determined to be 10% to 16% of normal plasma values. Administration of vitamin K-dependent factor concentrate transiently improved in vitro clotting tests but did not alter the clinical course. Following a splenectomy, bleeding ceased and factor X levels returned to normal, remaining so despite discontinuation of factor concentrate infusion. Amyloid fibrils extracted from the patient's spleen were determined to be derived from lambda V1 light chains. The importance of splenectomy as an effective therapeutic modality is discussed