Marked accumulation of fluorodeoxyglucose and inflammatory cells expressing glucose transporter-3 in immunoglobulin G4-related autoimmune hepatitis

Immunoglobulin (Ig)G4-related autoimmune hepatitis (AIH) is a recently proposed subtype that responds well to steroid treatment; however, its pathogenesis remains unclear. We report here a 65-year-old Japanese woman with skin itching and lip swelling. She had liver injury with jaundice, which persisted despite stopping anti-allergic agents. Blood chemistry revealed highly elevated serum IgG and IgG4 (535 mg/dL) levels, and positive anti-nuclear antibody. The diagnosis of AIH was based on liver biopsy. Notably, the IgG4⁺ /IgG⁺ cell ratio was 85%. On fluorodeoxyglucose (FDG) positron emission tomography/computed tomography, robust signal intensity was found in the liver, and in enlarged lymph nodes and salivary glands with confirmed IgG4⁺ cell infiltration. Immunofluorescence analysis of the liver biopsy specimen indicated clear expression of glucose transporter-3 (Glut-3) in IgG4⁺ inflammatory cells infiltrating into the portal area. This is the first report of simultaneous strong accumulation of FDG and Glut-3 expression in IgG4-related AIH, which might aid in elucidating the pathogenesis of this disease.

Necrotizing lymphadenitis: a clinicopathological and immunohistochemical study of four familial cases and five recurrent cases

We report the clinicopathological and immunohistological findings of nine cases of necrotizing lymphadenitis, consisting of four cases of familial infection and five cases of recurrence. Fever, cervical lymphadenopathy, leucopenia and swelling of the tonsils are characteristic clinical findings. Morphological features of the lymph nodes include the presence of immunoblasts, plasmacytoid T cells, histiocytes and macrophages, the latter with phagocytized nuclear debris derived from degenerated lymphocytes. However, granulocytes are generally absent. Ultrastructurally, tubuloreticular structures are observed not only in lymphoid cells, but in vascular endothelial cells. Immunological studies of peripheral blood using monoclonal antibodies disclose that CD 8+ (Leu 2a+; suppressor/cytotoxic) cells predominate at the onset, but they gradually decrease with the clinical course and the ratio of CD 4+: CD 8+ (helper:suppressor) increases as the disease progresses. However, in the affected lymph nodes, CD4+ (Leu 2a+: helper/inducer) cells often increase with the clinical progression, but the ratio of CD 4+:CD 8+ in the lymph nodes does not correlate with clinical progression. In addition, Ki-67+CD 8+ cells are more often seen than Ki-67+CD 4+ cells. It is suggested that necrotizing lymphadenitis is an infectious disease in which CD 4+ cells are disrupted and CD 8+ cells undergo transformation to blastoid cells. This results in a change in the ratio of T subsets.

[Studies of specific IgE and IgG antibodies in allergic children. Changes in specific IgE and IgG antibodies to egg white, milk, soybean and mite from children with atopic dermatitis]

Egg, milk, soybean, mite (DF)-specific IgG and IgE antibodies were measured in 276 atopic dermatitis children in whom dietary restrictions had never been done. We recommend cleaning house and bed clothes to decrease number of mites and elimination diet according to clinical symptoms and laboratory findings. After elimination periods (approximately 140 days) the same specific antibodies were examined again. In the patients who improved clinically by elimination of foods, the specific IgG antibodies to the foods decreased significantly. The other patients did not improved clinically suggesting that inadequate elimination diet were done and cleaning house and bed clothes was incomplete and/or other types of allergic reactions might exist.