Anti golgi antibodies and cryoglobulins

Abstract

Systemic autoimmune diseases are probably the greatest masqueraders in clinical medicine and dependence on laboratory testing is very high. Some of the antibodies directed to cytoplasmic autoantigens are well characterized, such as anti-mitochrondial, anti-ribosomal, anti-microsomal and anti-Golgi complex autoantibodies. Anti-Golgi autoantibodies are polyclonal and often mainly of the IgG isotype. We have detected cytoplasmic anti-Golgi antibody (AGA) and cryoglobulins in a 52 year old female admitted for hematuria and altered consciousness. She was a type 2 diabetes mellitus in urosepsis, with positive rheumatoid factor. Serum from the patient reacted to the Golgi complex by an indirect immunofluorescence technique on HEp-2 cells. The patient tested negative for viral serology and ANA. There were features of joint pain, absence of skin rashes, positive rheumatoid factor, negative ANA, positive anti Golgi antibodies along with features of sepsis. This led us to the diagnosis of Sjogren syndrome presenting with uremic encephalopathy and interstitial pneumonia. A positive anti Golgi antibody pattern must be looked for in an ANA negative patient with suspicious clinical features. We also review the earlier case reports on anti golgi antibodies available.