SOCS-1 1478 CA/del gene polymorphism affects survival in colorectal carcinoma

Aims and Background

Suppressor of cytokine signaling 1 (SOCS1) is a prototype molecule of the SOCS family. Alterations in the SOCS1 expression have been reported in human cancers and some studies suggest that SOCS1 might act as a tumor suppressor in carcinogenesis. In the present study, we aimed to evaluate the association of SOCS1 promoter -1478CA/del gene polymorphism detected in DNA isolated from the tissues of patients with colorectal cancer (CRC) for histopathological characteristics and survival.

Patients and Methods

For the study, we retrospectively enrolled 53 patients with resected colon due to CRC and 23 control subjects with no systemic illness. SOCS1- 1478CA/del gene polymorphism was determined using the polymerase chain reaction-restriction fragment length polymorphism methodology. These results were evaluated in relation to histopathological features and survival results and analyzed statistically. A P value equal to or less than 0.05 was considered significant.

Results

Neither control subjects nor the CRC group showed a significant association with SOCS1 -1478CA/del gene polymorphism (p = 0.248). SOCS1 -1478CA/del gene polymorphism was not significantly associated with histopathological features either. However, in the overall survival (OS) analysis, those patients with the del/del allele were found to have a 3.9-fold greater risk of mortality compared to those with CA/CA allele (p = 0.05). Progression-free survival (PFS) was also significantly different in such patients (p = 0.05).

Conclusion

The present study examining the association of SOCS1 -1478CA/del gene polymorphism with CRC showed that CRC patients with del/del allele had both significantly shorter PFS and OS versus those with CA/CA or CA/del allele.

Serum mannose-binding lectin (MBL) gene polymorphism and low MBL levels are associated with neonatal sepsis and pneumonia

OBJECTIVE

The aim of this study was to determine the serum mannose-binding lectin (MBL) levels and the frequency of MBL gene polymorphisms in infants with neonatal sepsis.

STUDY DESIGN

Between January 2008 and January 2010, a total of 93 infants were included in this study and 53 of them had neonatal sepsis diagnosis as study group and 40 infants who had no sepsis according to clinical and laboratory findings as control group.

RESULT

Serum MBL levels were found to be low in 17 of 93 infants. Eleven of them were in the sepsis group and six of them were in the control group. Serum MBL levels were significantly lower in infants with sepsis compared with the control group. Frequencies of genotype AB and BB were also significantly higher in the study group compared with the control group. Most importantly, presence of B allele of MBL exon 1 gene was found to be associated with an increased risk for neonatal sepsis. Additionally, in the study group, the mean serum MBL levels were found to be significantly lower in the premature infants compared with the term infants. Pneumonia, bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH) were significantly higher in infants with MBL deficiency compared with infants with normal MBL levels.

CONCLUSION

Low MBL levels and presence of B allele of MBL exon 1 gene were found to be important risk factors for development of both neonatal sepsis and pneumonia, especially in premature infants. Low MBL levels and MBL gene polymorphisms might also be associated with inflammation-related neonatal morbidities such as BPD and IVH.

Autoimmunity and hepatitis A vaccine in children

BACKGROUND

Universal vaccination remains the most effective way of preventing the spread of many infectious diseases. Although most adverse effects attributed to vaccines are mild, rare reactions such as autoimmunity do occur.

OBJECTIVES

We aimed to evaluate the possible role played by hepatitis A vaccine (HAV) in inducing the synthesis of autoantibodies. The study included 40 healthy children vaccinated with 2 doses of HAV at a 6-month interval. The children were investigated for autoantibodies including anti-nuclear antibodies (ANAs), anti-smooth muscle antibodies, anti-nDNA, anti-microsomal antibodies, anti-cardiolipin (aCL) immunoglobulin (Ig) M/IgG, anti-ds DNA, ANA profile, and anti-neutrophil cytoplasmic antibody profile.

RESULTS

One month after the first dose, ANAs at a titer of 1:100 and aCL IgG at 23.7 IgM phospholipid units were detected in 4 children and 1 child, respectively. Of the ANA-positive children, 1 also had ASMA positivity, and another had perinuclear and cytoplasmic ANCA positivity. After the second dose, 3 of the children had aCL IgM. In addition, 2 distinct children had positive anti-thyroid microsomal antibodies and ANA after the second dose. The presence of these autoantibodies following vaccination was statistically significant (P = .002). At month 12 of the study, only 2 children continued to be ANA-positive at the same titer as after the first vaccine dose.

CONCLUSIONS

Although HAV can induce the production of autoantibodies, none of the children developed autoimmune disorders. Long-term follow up is necessary to check whether autoimmune disorders develop in children who still have ANA. Genetic, immunological, environmental, and hormonal factors are also important in the development of vaccine-induced autoimmunity.

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy

OBJECTIVE

To evaluate the efficacy of intrauterine lidocaine plus buccal misoprostol in reducing the discomfort caused by endometrial biopsy with a suction curette.

METHODS

In this double-blind, randomized, placebo-controlled trial 126 women undergoing endometrial biopsy were administered a 200-microg tablet of misoprostol buccally, followed by a 5-mL uterine instillation of either of 2% lidocaine or a saline solution. The main outcome measures were the intensity of pain during, immediately following, and 20 min following the biopsy, as assessed on a 10-cm visual analog scale. Statistical analysis was performed using the Friedman test with the Bonferroni correction, the t test, and the chi(2) test.

RESULTS

There were no statistically significant differences between the study and control groups in mean age, parity, or relevant medical history. A statistically significant difference in pain scores was noted in premenopausal women during the procedure (lidocaine, 4.93+/-1.67; placebo, 6.17+/-1.26; P<0.001) as well as immediately later (lidocaine, 4.12+/-1.14 vs. placebo, 5.42+/-1.08; P<0.001) and 20 min later (lidocaine, 3.60+/-1.10; placebo, 4.22+/-1.46; P<0.001). No significant differences in pain scores were observed in postmenopausal women for any of the 3 time points (6.72+/-2.01, 5.18+/-1.22, and 4.56+/-0.80, respectively; P>0.05). The number needed to treat was 2.6 (95% confidence interval, 1.9-4.8).

CONCLUSION

Intrauterine lidocaine plus buccal misoprostol appears to be effective in decreasing pain in premenopausal women undergoing endometrial biopsy with a suction curette.

Expression of gelatinase (MMP-2 and MMP-9) and cyclooxygenase-2 (COX-2) in endometrial carcinoma

OBJECTIVE

Matrix metalloproteinases (MMPs) are key players in the degradation of extracellular matrix and basement membranes, and are thus important in tumor invasion. Gelatinases (MMP-2 and MMP-9) in particular are prognostic factors in many solid tumors. In this study the immunohistochemical expression of both COX-2 and matrix metalloproteinases has been shown for the first time in endometrium carcinoma.

METHODS

Forty-two endometrial carcinoma tissues were immunostained for MMP2 antibody (1:100, Rabbit polyclonal), MMP9 antibody (1:100, Rabbit polyclonal) and CoX2 antibody (1:100, Epitope specific rabbit antibody).

RESULTS

90.5% of the cases were positive for MMP-2 and MMP-9, and 83.3% of the cases were positive for COX-2. A statistically significant association was found between COX-2 overexpression and FIGO stage (p = 0.001). A positive correlation was also found with histological grade (p = 0.006), myometrial invasion (p = 0.033), vascular invasion (p = 0.017), and lymphatic invasion (p = 0.007). A positive correlation was found between MMP-2 overexpression and vascular and lymphatic invasion (p = 0.030 and p = 0.003, respectively). MMP-9 overexpression was also found to be correlated with vascular and lymphatic invasion (p = 0.001 and p = 0.012, respectively). Furthermore, there was a statistically significant correlation between MMP-2 and MMP-9 overexpression (p = 0.0001).

CONCLUSION

The results showed that COX-2, MMP-2 and MMP-9 were expressed in a high percentage of primary endometrial carcinomas and their expressions may be associated closely with parameters of tumor aggressiveness.

Evaluation of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, and interleukin-10 levels as diagnostic and prognostic parameters in patients with community-acquired sepsis, severe sepsis, and septic shock

The diagnostic value of procalcitonin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-10 levels in differentiating sepsis from severe sepsis and the prognostic value of these levels in predicting outcome were evaluated and compared in patients with community-acquired sepsis, severe sepsis, and septic shock in the first 72 h of admission to the hospital. Thirty-nine patients were included in the study. The severe sepsis and septic shock cases were combined in a single "severe sepsis" group, and all comparisons were made between the sepsis (n=21 patients) and the severe sepsis (n=18 patients) groups. Procalcitonin levels in the severe sepsis group were found to be significantly higher at all times of measurements within the first 72 h and were significantly higher at the 72nd hour in patients who died. Procalcitonin levels that remain elevated at the 72nd hour indicated a poor prognosis. C-reactive protein levels were not significantly different between the groups, nor were they indicative of prognosis. No significant differences in the levels of tumor necrosis factor-alpha were found between the sepsis and severe sepsis groups; however, levels were higher at the early stages (at admission and the 24th hour) in patients who died. Interleukin-10 levels were also higher in the severe sepsis group and significantly higher at all times of measurement in patients who died. When the diagnostic and prognostic values at admission were evaluated, procalcitonin and interleukin-10 levels were useful in discriminating between sepsis and severe sepsis, whereas tumor necrosis factor-alpha and interleukin-10 levels were useful in predicting which cases were likely to have a fatal outcome.

Synthesis of Some Novel Azo Derivatives of 3,5-Dimethly-1-(2-hydroxyethyl)pyrazole as Potent Analgesic Agents

A series of 1-(2-hydroxyethyl)-3,5-dimethylpyrazolylazo derivatives, incorporating thiosemicarbazide 2a-c, 1,3,4-thiadiazole 3a-c, and 1,2,4-triazole-3-thione 4a-c were synthesized. The structure of these novel synthesized compounds 2a-c, 3a-c, and 4a-c was confirmed by spectral analysis. All these compounds were screened for their analgesic activity. Hot-plate and tail-immersion tests were used for the determination of the analgesic activity. Morphine, an analgesic through both spinal and supraspinal pathways, was used as a standard test drug. All compounds were administered at a dose of 100 mg/kg i.p. Among the compounds, 2-(butylamino)-5-[((1-(2-hydroxyethyl)-3,5-dimethylpyrazole-4-yl)azo)phenyl]-1,3,4-thiadiazole 3a and 4-[((1-(2-hydroxyethyl)-3,5-dimethylpyrazole-4-yl)azo)phenyl]-4-(2-phenethyl)-2,4-dihydro-3H-1,2,4-triazole-3-thione 4c showed analgesic effects in both tests. Especially 4c exerted strong analgesia starting at 30 min after injection.

CD24 expression is a poor prognostic marker in endometrial carcinoma

OBJECTIVE

CD24 is a cell adhesion molecule that has been implicated in metastatic tumor progression of various solid tumors. Its expression is known to be related to the prognosis of several kinds of tumors. This study was designed to examine the prognostic significance of CD24 in endometrial cancer patients.

METHODS

Forty-four endometrial carcinoma tissues were immunostained for CD24 antibody (Ab2, clone 24 C02). Cytoplasmic and membranous immunoreactivity were scored semiquantitatively by Fisher's exact test.

RESULTS

CD24 expression was detected in 34 (77.3%) out of 44 cases. Membranous and cytoplasmic staining of CD24 was significantly associated with the International Federation of Gynecology and Obstetrics (FIGO) grade (p = 0.011 and p = 0.002, respectively) and nodal status (p = 0.002 and p = 0.000, respectively).

CONCLUSION

Our data suggests that CD24 expression in endometrial carcinoma as detected by immunohistochemistry might be a new marker for a more aggressive endometrial cancer biology. CD24 is commonly up-regulated in endometrial cancer and this corroborates the importance of CD24 in tumor progression among these cases.

Mucinous adenocarcinoma arising from the gastrointestinal epithelium in benign cystic teratoma of the ovary--case report

Benign cystic teratoma of the ovary (BCTO) is the most common ovarian germ cell tumor occurring predominantly in early adulthood. Malignant transformation of a BCTO is rare, with an incidence of 2%. Most benign cystic teratomas with malignant transformations are squamous cell carcinomas with just 6.8% being adenocarcinomas. We present a rare case of adenocarcinoma arising from the gastrointestinal epithelial elements of BCTO based on the microscopic examination and immunohistochemical studies. Adenocarcinoma arising from gastrointestinal epithelium within BCTOs is extremely rare. This is the fifth reported case of adenocarcinoma arising in gastrointestinal epithelium of a BCTO.

Magnetic resonance imaging and diffusion-weighted imaging in methylmalonic acidemia

Methylmalonic acidemia (MMA) is an inborn disorder of amino acid metabolism, often presenting with neurological symptoms. We present the results of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) of the brain in a 16-month-old male patient with classic neurological and laboratory findings for MMA. MRI demonstrated the hyperintensity within globi pallidi both on T2-weighted image and DWI during the acute episode of metabolic acidosis.

Therapy of acute hepatitis C with interferon-alpha2b plus ribavirin in a health care worker

Hepatitis C virus can be transmitted to health care workers through needlestick accidents. In this report, the result of short-term therapy with interferon-alpha2b plus ribavirin combination of acute hepatitis C in a health care worker who infected through laboratory accident was presented. The patient received combination of interferon-alpha2b (5 MU three times a week) plus ribavirin (1000 mg daily) for three months. Aminotransferase levels were normalised and clearance of HCV RNA was obtained in the first month of the therapy. After 19 months of follow-up, he had undetectable levels of HCV RNA so sustained response (clearance of HCV RNA and normalisation of aminotransferases at least six months after cessation of therapy) was achieved. According to this result, short-term therapy of acute hepatitis C with interferon-alpha2b plus ribavirin may be an alternate to others.

Bone mineral density of the spine and femur in early postmenopausal Turkish women with endemic skeletal fluorosis

The aim of this prospective, comparative study was to investigate the bone mineral density (BMD) changes in a group of early postmenopausal Turkish women with endemic skeletal fluorosis and to study effects of endemic fluorosis on BMD. Bone mineral density of L2-L4 vertebra, femur neck, femur trochanter, and Ward's triangle were measured in 45 female patients with endemic skeletal fluorosis and 41 age-matched controls by dual X-ray absorbtiometry (DXA). The BMD of L2-L4 vertebra and Ward's triangle were higher in the endemic fluorosis group than in the control group (P < 0.001). Patients with endemic fluorosis had higher femur neck and femur trochanter BMDs than did controls (P < 0.01 and P < 0.05, respectively). There was a positive correlation between serum fluoride content and BMD at the spine (r = 0.345, P = 0.001), femoral neck (r = 0.274, P = 0.011), Ward's triangle (r = 0.295, P = 0.006), and trochanter (r = 0.217, P = 0.045). In conclusion, higher bone mineral density levels were seen in early postmenopausal women with endemic skeletal fluorosis. BMD measurement is a tool in the diagnosis and management of this preventable crippling disease.

Clinical equivalence of intranasal estradiol and oral estrogens for postmenopausal symptoms

OBJECTIVES

The aim was to demonstrate the equivalent efficacy of intranasal estradiol (Aerodiol Servier, Istanbul, Turkey) 300 mg/day relative to a standard oral estradiol therapy of 2 mg/day and to assess the therapeutic value of the potential benefits of Aerodiol.

METHODS

Two hundred and one postmenopausal women with severe menopausal symptoms were recruited to the trial. Women received either intranasal Aerodiol 300 microg/day (one spray delivery of 150 microg per nostril) or an oral estradiol 2 mg for 24 weeks. Severity of symptoms were compared based on the Kupperman index (KI) at the end of 24 weeks.

RESULTS

The KI score decreased markedly in both groups between W0 and W24. At W24, the two treatments were shown to be statistically equivalent (P<0.001). The incidence of adverse events was very similar in both groups; those related to treatment were of mild or moderate intensity in 95% of cases for the nasal group and 90% for the oral group.

CONCLUSIONS

In conclusion, pulsed estrogen therapy using Aerodiol is safe, easily used and highly efficient in alleviating postmenopausal symptoms with a dose of 300 microg. The dose of 300 microg in one administration per day offers the optimal therapy whilst being easily adaptable to each patient's clinical response.

Placenta accreta associated with a ruptured pregnant rudimentary uterine horn. Case report and review of the literature

Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity and mortality. A case of pregnancy in a rudimentary uterine horn with rupture 14 weeks after last menstrual period and is complicated with placenta accreta is presented. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn of a bicornuate uterus. Histologic examination of the specimen showed that placenta was accreta. The relative literature is reviewed and the association of placenta accreta in such situations is pointed out.

Lipid peroxidation in umbilical arterial blood at birth: the effects of breech delivery

OBJECTIVE

To determine oxygen free radical activity in breech presentation at birth and relate it to umbilical cord blood acid-base status.

DESIGN

A series of 63 singleton deliveries (28 cephalic deliveries as controls), 23 breech deliveries with normoacidemia, and 12 breech deliveries with mild acidaemia) had determination of malondialdehyde and acid-base parameters.

SETTING

The delivery suite in the Department of Obstetrics and Gynaecology at the Süleyman Demirel University, Isparta, Turkey.

PARTICIPANTS

Sixty-three singleton infants born at term with spontaneous or induced labour and initially normal fetal heart rate tracing.

METHODS

After delivery, umbilical cord arterial and venous blood samples were collected for the determination of malondialdehyde concentrations. Oxygen saturation, pO2, pCO2, pH, and base excess were also measured.

MAIN OUTCOME MEASURES

Umbilical cord arterial and venous blood gases and malondialdehyde levels.

RESULTS

There was a significant correlation between umbilical arterial and venous levels of malondialdehyde and all acid-base parameters (P < 0.001). There were negative correlations between malondialdehyde levels and pH, pO2 and bicarbonate, while there was a positive correlation between malondialdehyde concentrations and pCO2. A positive correlation between malondialdehyde levels and base excess was present in the control group and total breech group (n = 35). The malondialdehyde levels in the total breech group, nonacidaemic breech group (n = 23) and the mildly acidaemic breech group (n = 12) were significantly higher than those in the control group (P < 0.0001). However, acid-base parameters in the nonacidaemic breech group were not statistically different from those in the control group.

CONCLUSION

Lipid peroxidation products (malondialdehyde) existed to some extent in the umbilical cords of newborns with normal acid-base parameters in breech delivery. Our data support the contention that lipid peroxide may be a more sensitive measure for metabolic dysfunctions due to fetal hypoxia than acid-base balance.

Prenatal diagnosis of cloacal exstrophy before rupture of the cloacal membrane

We describe a case of cloacal exstrophy what was diagnosed prenatally by ultrasound and confirmed at birth. We also review the literature on 15 previous prenatally diagnosed cloacal extrophy cases.

The effect of melatonin application on lipid peroxidation during cyclophosphamide therapy in female rats

OBJECTIVE

Our purpose was to investigate whether melatonin has any protective effect against lipid peroxidation induced by cyclophosphamide.

MATERIAL AND METHODS

We used an animal model to study the effect of melatonin. Fifteen female Wistar rats (180-200 gram in weight) were randomly assigned to three different groups. Group 1 (n = 5) received saline injections as a control. Group 2 (n = 5) received cyclophosphamide. Group 3 (n = 5) received cyclophosphamide + melatonin. The animals were sacrificed two hours after cyclophosphamide administration and blood samples were taken and used for assaying superoxide dismutase (SOD) activity, glutathione peroxidase (GP) activity for the antioxidative enzymes, and malondialdehyde (MDA) level as an index of lipid peroxidation.

RESULTS

MDA levels were more increased in the second group compared with the control group (p < 0.01). In the third group, they were significantly lower than in the second group (p < 0.05). SOD and GP activities were found to be decreased significantly in the second group compared with the control group (p < 0.05 and p < 0.01, respectively). They were found to be elevated in the third group compared with the second group (p > 0.05 and p < 0.05, respectively).

CONCLUSIONS

The above results suggest that melatonin has a protective role in cyclophosphamide induced lipid peroxidation in rats. Besides scavenging the highly toxic free radicals, melatonin also stimulates the antioxidant enzyme activity of GP.

Effect of ovarian involvement on the frequency of luteinized unruptured follicle in endometriosis

OBJECTIVE

When we review the current literature on endometriosis and luteinized unruptured follicle (LUF), we see that most of the studies deal with only the association between LUF frequency and the severity of endometriosis. Our purpose was to evaluate the effect of ovarian involvement on LUF frequency in endometriosis and assess the relationship between endometriosis and LUF in infertile women.

STUDY DESIGN

This study is a prospective analysis covering a total of 126 infertile women between 22 and 35 years of age who underwent diagnostic laparoscopy from September 1995 to August 1997 in the Department of Obstetrics and Gynecology at Süleyman Demirel University, Isparta, Turkey. Endometriosis was diagnosed in 58 of these patients. All had received a revised American Fertility Society staging score at the time of the laparoscopic diagnosis. Diagnosis of LUF was made when the following criteria were fulfilled: absence of ultrasonic signs of ovulation, and absence of an ovulation ostium on the follicle by laparoscopy, despite increased serum progesterone. Statistical evaluation was performed using chi2 test and Fisher's exact test where appropriate.

RESULTS

The prevalence of LUF in mild, moderate and severe endometriosis cases was 13.3, 41.2 and 72.7%, respectively. The LUF frequencies were 45.9% in 37 endometriosis patients with ovarian involvement, 9.5% in 21 cases without ovarian involvement, and 5.9% in 68 cases without endometriosis. A statistically significant difference was observed between the LUF rate in the group with ovarian involvement and that without involvement (chi(2) = 8.06, p < 0.001).

CONCLUSION

In summary, in this study we noted a significant increase in LUF frequency in endometriosis patients with ovarian involvement.

High-density lipoproteins differentially modulate cytokine-induced expression of E-selectin and cyclooxygenase-2

Atherogenesis is a multifactorial chronic inflammatory disease in which low plasma levels of HDLs are a strong predictor of the condition. Although the mechanism of protection by HDLs is not precisely known, HDLs have been shown to influence many of the events involved in the development of atherosclerosis. Previously we have shown that HDLs inhibited the cytokine-induced expression of adhesion molecules (E-selectin, VCAM-1, and ICAM-1) by endothelial cells (ECs). As the complete transcriptional regulation of all 3 genes requires the NF-kappaB family of transcription factors, we examined the effect of HDLs on activation of NF-kappaB. We also investigated the effect of HDLs on 2 other cytokine-induced genes, granulocyte-macrophage colony-stimulating factor (GM-CSF) and cyclooxygenase (Cox-2; prostaglandin H2 synthase, EC 0.1.14.99.1). E-selectin expression in response to tumor necrosis factor-alpha (TNFalpha) was, as expected, inhibited in ECs that had been preincubated with HDLs. However, the level of secretion of GM-CSF in the same cultures was no different from control. In a similar manner, although HDLs had no effect on steady-state mRNA levels of GM-CSF, the levels of E-selectin were significantly inhibited by HDLs. In transient cotransfection experiments we found that HDLs inhibited the cytokine-induced expression of a reporter gene driven by the E-selectin proximal promoter (-383 to 80) but had no effect on the expression of a reporter gene driven under the control of the proximal promoter of GM-CSF (-627 to 28). As would be predicted from this differential response, HDLs did not influence the nuclear translocation or DNA binding of NF-kappaB, or alter the kinetics of degradation and resynthesis of the inhibitory protein IkappaBalpha. We found that HDLs synergized with cytokine to enhance the expression of Cox-2 and induce the synthesis of its main EC product, prostacyclin (PGI2), a potent inhibitor of platelet and leukocyte functions. In conclusion, HDL induces an antiinflammatory phenotype in cytokine-induced ECs, synergizing with cytokine to induce elevation of Cox-2 in addition to inhibiting adhesion molecule expression. Our studies show that these differential effects are mediated in a manner that is likely to be independent of NF-kappaB per se.

Immunological evaluation of erythema nodosum in tularaemia

During two tularaemia outbreaks in the Bursa region of Turkey in 1991, a total of 98 patients were diagnosed and evaluated. Thirteen of these patients had erythema nodosum, which is accepted as a secondary skin manifestation. The patients with erythema nodosum, 21 patients without any skin lesions, and 20 healthy controls were studied. Comparable elevations of levels of IgG, IgA, and IgM were detected in the two tularaemia groups. There was no difference in complement C3c and C4 levels between the groups. All of the patients with erythema nodosum had elevated circulating immune complex (CIC) levels, when compared with the patients without skin lesions and the control group. The acute phase response (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) of the erythema nodosum group was significantly higher than the patients with normal skin, and healthy controls (P < 0.001). Serum transferrin levels were significantly decreased in both of the tularaemia groups (P < 0.001). Serum soluble interleukin-2 receptor levels (SIL-2R) were significantly elevated in both tularaemia groups (P < 0.001), and the elevation was more marked in the erythema nodosum group (P < 0.05). Histopathological evaluation of biopsies from two patients with erythema nodosum showed dermal oedema, a perivascular lymphocytic infiltrate, and panniculitis. No immunoglobulin or complement deposits were detected on immunofluorescence. Erythema nodosum in the course of tularaemia is associated with many immunological changes, although it is not clear whether these findings are related to the increased tissue response, or whether they play a role in the pathogenesis of the erythema nodosum.