A case of hypereosinophilic syndrome with LDH linked to IgG, A and M (κ, λ)-its sequential disappearance of Ig M, A and G by treatment

Abstract

A 45-year-old female developed fever, erythema over the whole body, and swelling of general lymph nodes from mid-May 1984. At that time, the LDH was 929IU/l, each fraction was clear, and no anomaly was detected by immunoprecipitation reaction in free liquid media. The WBC in peripheral blood was 20, 900/μl, 18% of which were mature eosinophils. After administration of prednisolone at a daily dose of 30mg, the patient recovered and left the hospital. In February of the following year, fever and general erythema recurred. The WBC in peripheral blood was 31, 800/μl, of which mature eosinophils accounted for 42%. In sternal myelograph, mature eosinophils accounted for 9.2%. No whipworm eggs were found. A slight enlarged heart shadow and pericardial cavity fluid were noted, and a skin biopsy disclosed acanthosis and an infiltration of eosinophils around the blood vessels, but no vasculitis. The LDH in mid-March was 1, 182IU/l, and isozymes in each fraction were indistinct and LDH-linked immunoglobulins LDH-Ig G, A, M (κ, λ) were detected by immunoprecipitation reaction in free liquid media (molecular weight 520, 000). She was diagnosed of hypereosinophilic syndrome. From mid-March she was administered prednisolone at a daily dose of 40mg. The temperature declined gradually, the general erythema and pericardial cavity fluid subsuided, and the peripheral blood eosinophils also disappeared. The LDH became normalized in about October. At the end of March, the anomaly pattern was type 3-5, and LDH-Ig G, A (κ, λ) was detected. In mid-April, the anomaly pattern was 3-5, and LDH-Ig G (κ, λ) was observed. At the end of May, the anomary disappeared and not detected by immunoprecipitation reaction in free liquid media, but in the same serum after 2 weeks in cold storage, anomaly of type 3-5 appeared, and LDH-Ig G (κ, λ) was detected by immunoprecipitation reaction in free media. At the end of May 1986, the LDH was 231IU/l, the isozyme fractions were clear, and no anomaly was detected by immunoprecipitation reaction in free liquid media, nor was it detected in the same serum after 2 weeks in cold storage. This case presents three interesting points in considering the onset mechanism of LDH-Ig. 1) At the time of the first admission, the LDH was high, but no anomaly was noted. At the time of the second admission, when the LDH increased again, an anomaly occurred. 2) As a results of treatment, LDH-IgM, IgA, IgG disappeared in this sequence. 3) No anomaly was noted in the serum sampled during the process, but an anomaly was found in same serum after 2 weeks in cold storage.