Sjögren's syndrome and vitiligo in a woman with posttransfusion microchimerism

Sex differences in Sjögren's syndrome: a comprehensive review of immune mechanisms

Autoimmune diseases (ADs) are estimated to affect between 5 and 8 % of the US population, and approximately 80 % of these patients are women. Sjögren’s syndrome (SS) is an AD that occurs predominately in women over men (16:1). The hallmark characteristic of SS is diminished secretory production from the primary exocrine gland and the lacrimal or salivary glands resulting in symptoms of dry eye and mouth. The disease is believed to be mediated by an inflammatory and autoantibody response directed against salivary and lacrimal gland tissues. This review will examine the literature on sex differences in the immune response of patients and animal models of Sjögren’s syndrome in order to gain a better understanding of disease pathogenesis.

The association between perioperative allogeneic transfusion volume and postoperative infection in patients following lumbar spine surgery

BACKGROUND

Perioperative allogeneic red blood cell transfusion is a risk factor for surgical site infection. The purpose of this study was to determine if the volume of perioperative allogeneic red blood cell transfusion influences the risk of surgical site infection following lumbar spine procedures.

METHODS

A retrospective matched case control study was performed by reviewing all patients who had undergone lumbar spine surgery at our institution from 2005 to 2009. Surgical site infections (spinal or iliac crest) were identified, all within thirty days of the procedure. Controls were matched to the infection cohort according to age, sex, body mass index, diabetic status, smoking status, Charlson Comorbidity Index, length of surgery, and procedure. A conditional logistic regression was performed to examine the association between transfusion volume and surgical site infection. The results were summarized by an odds ratio.

RESULTS

A total of 1799 lumbar procedures were identified with an infection rate of 3.1% (fifty-six cases). On the basis of the numbers, there was no significant difference in the matched variables between the infection cohort and the matched controls. The volume of transfusion was significantly associated with surgical site infection (odds ratio, 4.00 [95% confidence interval, 1.96 to 8.15]) after adjusting for both unmatched variables of preoperative hemoglobin level and volume of intraoperative blood loss.

CONCLUSIONS

In this retrospective matched case control study, the association between surgical site infection following lumbar spine surgery and volume of perioperative allogeneic red blood cell transfusion was supported.

[Fetal microchimerism in rheumatic diseases]

Fetal microchimerism is the presence of fetal cells inmaternal tissues and vice versa, i.e., the coexistence of2 different cellular populations from genetically differentindividuals within a single person. The most frequentcause of microchimerism is pregnancy, in which there is abi-directional fetal-maternal interchange of cells duringpregnancy and delivery. Fetal cells have been demonstrated in the tissues ofpatients with rheumatic, endocrine or infectious diseases,as well as in those of healthy individuals. Microchimerism has been most extensively studied insystemic sclerosis. It seems that during pregnancyallogenic fetal or maternal cells cross the placenta bidirectionallyand persist in the systemic circulation andtissues of both mother and child. Subsequently, they areactivated, resulting in is a graft-against-host reactionassociated with the onset of clinical manifestations.Microchimerism has been also studied in otherconnective tissue diseases.

Anemia, allogenic blood transfusion, and immunomodulation in the critically ill

Anemia and allogenic RBC transfusions are exceedingly common among critically ill patients. Multiple pathologic mechanisms contribute to the genesis of anemia in these patients. Emerging risks associated with allogenic RBC transfusions including the transmission of newer infectious agents and immune modulation predisposing the patient to infections requires reevaluation of current transfusion strategies. Recent data have suggested that a restrictive transfusion practice is associated with reduced morbidity and mortality during critical illness, with the possible exception of acute coronary syndromes. In this article, we review the immune-modulatory role of allogenic RBC transfusions in critically ill patients.

Cutaneous vasculitis in primary Sjögren syndrome: classification and clinical significance of 52 patients

To analyze the different clinical and histologic types of cutaneous vasculitis in patients with primary Sjögren syndrome (SS), we investigated the clinical and immunologic characteristics of 558 consecutive patients with primary SS from our units and selected those with clinical evidence of cutaneous lesions, excluding drug reactions and xeroderma. All patients fulfilled 4 or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993. A total of 89 (16%) patients presented with cutaneous involvement (88 female patients and 1 male; mean age, 51.8 yr). The main cutaneous involvement was cutaneous vasculitis, present in 52 (58%) patients. There were 51 (98%) female patients and 1 (2%) male, with a mean age at diagnosis of cutaneous vasculitis of 51 years (range, 20-80 yr). Fourteen presented with cryoglobulinemic vasculitis, 11 with urticarial vasculitis, and the remaining 26, with cutaneous purpura not associated with cryoglobulins. A skin biopsy specimen was obtained in 38 patients (73%). Involvement of small-sized vessels was observed in 36 (95%) patients (leukocytoclastic vasculitis), while the remaining 2 (5%) presented with medium-sized vessel vasculitis (necrotizing vasculitis). Patients with cutaneous vasculitis had a higher prevalence of articular involvement (50% vs 29%, p = 0.044), peripheral neuropathy (31% vs 4%, p < 0.001), Raynaud phenomenon (40% vs 15%, p = 0.008), renal involvement (10% vs 0%, p = 0.028), antinuclear antibodies (88% vs 60%, p = 0.002), rheumatoid factor (78% vs 48%, p = 0.004), anti-Ro/SS-A antibodies (70% vs 43%, p = 0.011), and hospitalization (25% vs 4%, p = 0.005) compared with SS patients without vasculitis. Six (12%) patients died, all of whom had multisystemic cryoglobulinemia.In conclusion, cutaneous involvement was detected in 16% of patients with primary SS, with cutaneous vasculitis being the most frequent process. The main characteristics of SS-associated cutaneous vasculitis were the overwhelming predominance of small versus medium vessel vasculitis and leukocytoclastic versus mononuclear vasculitis, with a higher prevalence of extraglandular and immunologic SS features. Small vessel vasculitis manifested as palpable purpura, urticarial lesions, or erythematosus maculopapules, with systemic involvement in 44% of patients in association with cryoglobulins in 30%. Life-threatening vasculitis was closely related to cryoglobulinemia.