740 CIRCULATING IMMUNE COMPLEXES IN CHRONIC MUCOCUTANEOUS CANDIDIASIS

Abstract

Chronic mucocutaneous candidiasis (CMC) is characterized by clinical and immunologic variability. Reported findings in CMC have included high levels of candida antibody, free candida antigen and decreased total hemolytic complement (TCH50) which suggested the possibility of circulating immune complexes. Serial samples from 7 CMC patients have been tested for complexes by the radioimmune Raji cell assay which detects complement-fixed IgG immune complexes bound to the complement receptors of cultured lymphoblastoid Raji cells. Three patients had the severe granulomatous form of CMC while 4 had mild disease. Six of the 7 had circulating immune complexes; 16 of 22 sera from the 7 patients were positive with values ranging from 192-1552 μg/ml (normal<16 μg/ml). No correlation can be made with defects in cell-mediated immunity; 2 patients with immune complexes responded normally to candida stimulation (skin test, lymphocyte proliferation, lymphokine production). One patient with granulomatous disease has had high levels of immune complexes both in relapse and remission. The only patient without detectable complexes was tested at a time of minimal involvement. Complement studies (TCH50,Clq,C3) done on 6 of the positive samples were within normal limits. All patients have had positive agglutinins or precipitins for candida. Although the composition of the circulating immune complexes is unknown at this time, a positive Raji cell assay appears to be the most consistent immunologic aberration in the study patients.