Cutaneous anergy without systemic disease: A syndrome associated with mucocutaneous fungal infection

Abstract

This twenty-one year old girl, in good general health, had cutaneous anergy and a ten year history of unusual and chronic superficial fungal infections. She gave a negative response to common skin tests, her skin could not be sensitized either actively or passively, through transfer of lymphocytes, and she had diminished skin-homograft rejection. All noncutaneous immunologic parameters were normal, including protein electrophoresis, immunoglobulins, circulating antibodies, lymphocyte count and lymphocyte stimulation with phytohemagglutinin. Her immediate family had normal skin responses. It is suggested that both her anergy and fungal infections resulted from an underlying defect in dermal reactivity and resistance, on either an immunologic or dermatologic basis. She may represent the first documented case of cutaneous anergy without systemic disease, a syndrome that would have clinical significance. Cutaneous anergy is interpreted as a nonspecific finding that may occur in normal subjects, in dermatologic disease and in a spectrum of immunologic abnormalities.