Delayed-type Hypersensitivity Research Articles

Tofacitinib: A Treatment Option for Recalcitrant Polymorphic Light Eruption and Its Mechanistic Rationale.

Background: Polymorphous light eruption is largely characterized by a delayed-type (type IV) hypersensitivity reaction to 1 or more undefined endogenous ultraviolet-induced skin antigens. Objectives: To evaluate the efficacy of tofacitinib in refractory cases of polymorphous light eruption. Methods: Seven patients who had failed multiple systemic treatments or relapsed within 2 weeks of existing systemic agents with concomitant photoprotection were offered tofacitinib after written consent. Results: Initiation of tofacitinib led to a marked reduction of itching (mean ± SD 3.1 ± 1.12 days) followed by clinical resolution (mean ± SD 2.6 ± 1.1 weeks). The duration of therapy ranged from 1 to 3 months (mean ± SD 2 ± 0.63 months), and 4 of 7 patients had a recurrence in 5.5 weeks and were again initiated on tofacitinib with a prompt response. Conclusion: Tofacitinib inhibits Janus kinase (JAK)1 and JAK3 thus it can abrogate the effects of the predominant cytokine milieu of polymorphic light eruption (PMLE) and thus reduce the expression of aberrant inflammatory T lymphocyte expression in PMLE.

Microbial eczema: modern possibilities of consistent topical therapy

At the present stage, there is an increase in the prevalence of allergic spectrum diseases. Epidemiological studies and the active introduction of genomic technologies in recent years have made it possible to accumulate data indicating the significant role of bacteria and fungi in the development of sensitization, which is one of the triggering and supporting factors for the course of microbial eczema. Dermatosis has a chronic relapsing course, in the formation of which delayed-type hypersensitivity, free-radical processes, and violations of the epidermal barrier play a significant role. A number of studies have noted the relationship between the development of microbial eczema and genetic factors, neuroendocrine and vegetative-vascular disorders. Features of etiopathogenesis and the recurrent nature of the course of microbial eczema necessitate an integrated approach to the management of patients with this dermatosis. Treatment of the disease includes elimination of the action of bacterial and fungal agents, anti-inflammatory therapy and restoration of the epidermal barrier. To suppress the infection, the appointment of antibacterial and antifungal drugs is indicated. However, their use as monotherapy in patients with eczema can provoke an exacerbation of the allergic process. In this regard, the article describes the current possibilities of using topical glucocorticosteroid drugs in combination with antibiotics and antimycotics. Attention is focused on ways to prevent complications and a staged approach to the management of patients with microbial eczema, the important components of which, after stopping the infectious process, are the suppression of inflammation and the restoration of the epidermal barrier. We present our own observations of patients with microbial eczema treated with preparations containing combinations of glucocorticosteroid with antibiotics and antimycotics, glucocorticosteroid with ceramides.

Neutrophil Infiltration in Allergic Contact Dermatitis to Nickel.

Allergic contact dermatitis (ACD) is traditionally recognized as a T-cell-mediated delayed-type hypersensitivity reaction. However, many patients with ACD have been reported to experience rapid-onset ACD reactions within hours of re-exposure on skin areas previously exposed to the contact allergen. In this study, three nickel-allergic patients were patch tested for nickel twice at the same skin site over 21 days. The results demonstrated that neutrophils are rapidly recruited to the skin sites previously exposed to nickel, leading to the rapid onset of ACD. Considering that many patients with ACD are frequently re-exposed to contact allergens on the same skin areas in their daily lives, we propose that mechanisms involved in neutrophil recruitment could be potential targets for future ACD treatment.

Immunomodulatory effects of epiphytic Loranthus micranthus leaf extracts collected from two host plants: Psidium guajava and Parkia biglobosa

BackgroundImmunological abnormalities are implicated in the pathogenesis of many chronic diseases. Due to the drug-related adverse effects of currently available orthodox immunomodulators, natural immunomodulators are being looked upon as potential agents to replace them in therapeutic regimens. This research aimed to investigate the immunomodulatory potential of L. micranthus extracts epiphytic on Psidium guajava (LMPGE) and Parkia biglobosa (LMPBE).MethodsPhytochemical screening and acute toxicity testing were carried out to identify the phytoconstituents and safety profiles of the extracts. The extracts’ innate and adaptive immunomodulatory potentials were determined in experimental animals using in vivo leucocyte mobilization, delayed-type hypersensitivity (DTH) response, hemagglutination antibody titre, and cyclophosphamide-induced myelosuppression models. Levamisole was used as the standard drug throughout the study.ResultsCompared to LMPBE, LMPGE contained significantly (p < 0.05) more tannins, cyanogenic glycosides, saponins, reducing sugars, glycosides, flavonoids, and alkaloids. Furthermore, the groups treated with the extracts had a significant (p < 0.05) increase in the total number of leucocytes, neutrophils, basophils, and antibody titers relative to the untreated control. In the same way, the treatment raised TLC in cyclophosphamide-intoxicated rats, with 250 mg/kg b. w. of LMPGE and LMPBE recording 9712.50 ± 178.00 and 8000.00 ± 105.00 × 109 /L, respectively, compared to 3425.00 ± 2 5.00 × 109 /L in the untreated group. Overall, LMPGE was more effective.ConclusionsThe findings from this study suggest that L. micranthus epiphytic in Psidium guajava and Parkia biglobosa has possible immune stimulating potential.

Delayed drug hypersensitivity to anti-tuberculosis drug: a new desensitization scheme.

Tuberculosis is a communicable illness and one of the leading causes of death, especially in developing countries like Turkey. One of the problems that must be managed well in the treatment of tuberculosis is drug hypersensitivity. The first-line agents are very important for the success of treatment. Alternative drugs are more toxic and less successful in treatment. Therefore, it is very important to be able to include first-line drugs in the post-hypersensitivity regimen. At this point, the success of desensitization comes to the fore. There are fewer studies on rapid drug desensitization in delayed-type drug hypersensitivity to anti-tuberculosis drugs. The primary aim of the study was to determine the prevalence of delayed-type hypersensitivity reactions in drug-sensitive cases; the secondary aim was to determine the appropriate treatment management. This was a retrospective study. Demographic features, tuberculosis diagnostic indicator, clinical signs of developing a hypersensitivity reaction, reaction time, desensitization scheme and treatment were evaluated. A total of 41 tuberculosis cases were included in the study. Twenty-six of the cases were male; mean age (mean ± SD) 55.44 ±16.93 years; 70.7% of them were diagnosed bacteriologically; 70.7% of them were diagnosed with pulmonary tuberculosis. The most common skin finding was maculopapular drug eruption. The development time (mean ± SD) of the reaction in patients who developed a reaction was 34.93 ±39.62 days. The responsible agent could be identified in 15 reactions. The most common drug responsible for the reaction was rifampicin. Successful desensitization was achieved in 19 (46.3%) cases with the sensitive regimen. The duration of treatment was 8.97 ±3.44 months. When evaluated in terms of treatment results, cure and treatment completion were accepted as treatment success. In this case, 30 (73.2%) patients successfully completed the treatment. Our study is one of the largest series in which delayed-type hypersensitivity develops under tuberculosis treatment and the desensitization scheme is recommended. A practical, easy desensitization scheme had been shared in this paper.

In Vitro and In Vivo Methods for Analysis of Nanoparticles' Potential toInduce Delayed-Type Hypersensitivity Reactions.

Delayed-type hypersensitivity (DTH) reactions are among the common reasons for drug withdrawal from clinical use during the post-marketing stage. Several in vivo methods have been developed to test DTH responses in animal models. They include the local lymph node assay (LLNA) and local lymph node proliferation assay (LLNP). While LLNA is instrumental in testing topically administered formulations (e.g., creams), the LLNP was proven to be predictive of drug-mediated DTH in response to small molecule pharmaceuticals. Global efforts in reducing the use of research animals lead to the development of in vitro models to predict test-materials' mediated DTH. Two such models include theanalysis of surface marker expression in human cell lines THP-1 and U-937. These tests are known as the human cell line activation test (hCLAT) and myeloid U937 skin sensitization test (MUSST or U-SENS), respectively. Here we describe experimental procedures for all these methods, discuss their in vitro-in vivo correlation, and suggest a strategy for applying these tests to analyze engineered nanomaterials and nanotechnology-formulated drug products.

The immunostimulatory effects of fucoidan on the cellular and humoral immune response in Wistar rats.

Natural product active ingredients are currently being studied rigorously worldwide and offer a viable substitute for traditional immunotherapy for various medical disorders. The objective of the study was to investigate the immunostimulatory properties of fucoidan in albino Wistar rats. For the current study, forty rats were divided into five groups of rats that were used in good condition. In-vivo experiments of fucoidan were carried out in Wistar albino rats, such as the cyclophosphamide-caused myelosuppression, the delayed-type hypersensitivity (DTH) response, the phagocytic activity, the haemagglutinating antibody (HA) titer, and the neutrophil adhesion test. The phagocytic index increased significantly in response to Fucoidan in a dose-dependent manner, as well as enhanced DTH reaction, and HA titer caused by sheep red blood cells sheep red blood cells. Additionally, fucoidan decreased myelosuppression in rats after cyclophosphamide treatment and enhanced neutrophil adhesion with nylon fiber. These findings imply that fucoidan has immunostimulant properties and could potentially utilised to treat immune-depression diseases.

Comparative analysis of the effects of cyclophosphamide and dexamethasone on intestinal immunity and microbiota in delayed hypersensitivity mice.

The T cell-mediated delayed-type hypersensitivity (DTH) response is critical for elucidating cellular immune mechanisms, especially the role of memory T cells upon antigen re-exposure. This study aimed to investigate the specific effects of the immunosuppressive drugs Cyclophosphamide (CY) and Dexamethasone (DEX) on intestinal immunity and microbiota in a DTH mouse model, contributing to a more nuanced understanding of their immunomodulatory mechanisms. Female BALB/c mice were sensitized to 2,4-dinitrofluorobenzene (DNFB) and randomly allocated into control, CY, and DEX groups. The impact of CY and DEX on immune function was assessed through measurement of thymus and spleen indices, lymphocyte proliferation in mesenteric lymph nodes (MLNs) using MTT assay, and flow cytometric analysis of T cell subsets and TCR expression. Intestinal secretory IgA (sIgA) was quantified by ELISA, and gut microbiota diversity was evaluated using 16S rRNA gene sequencing. CY and DEX significantly reduced the immune function in DNFB-induced sensitized mice, as indicated by decreased thymus and spleen indices, MLN enlargement, intestinal sIgA content, and ear swelling degree. Flow cytometry revealed that CY increased the proportion of total CD3+ T cells but reduced CD3+CD69+ activated T cells and CD3+TCRγ/δ+ T cells, while DEX increased CD3+CD4+ helper T cells. Both drugs induced distinct changes in gut microbiota diversity and structure, with CY enhancing α diversity and DEX reducing it. The study demonstrates that CY and DEX have distinct regulatory effects on the immune organ index, distribution of T cell subsets, and diversity and structure of gut microbiota on DTH-induced immune responses mice, suggesting their differential influence on intestinal mucosal immunity. These findings have implications for the development of targeted immunotherapies and understanding the interplay between immunosuppressive drugs and gut microbiota.

Immunomodulatory effects of Ulva-derived polysaccharides, oligosaccharides, and residues in a murine model of delayed-type hypersensitivity.

Ulva, an edible green alga, contains sulfated polysaccharides and oligosaccharides that possess immunomodulatory and anti-inflammatory properties. The objective of this study was to investigate the anti-allergic effects of Ulva-derived samples of polysaccharides (UP), oligosaccharides (UO), and residues (UR) on delayed-type hypersensitivity (DTH) in mice. Oral treatment of mice with UP, UO, and UR (250 mg/kg body weight) daily noticeably improved the DTH reaction as evidenced by attenuation of footpad swelling and cell infiltration at the allergen-challenge site. Although the Ulva samples had limited impacts on the production of serum total IgG, decreased concentrations of allergen-specific IgG and IgG2a and an increased concentration of IgG1 were observed in the treated mice. Moreover, treatment with them suppressed allergen-induced IFN-γ and TNF-α secretion and elevated IL-4 secretion. However, none of the Ulva sample treatments could modulate the production of IL-10. Concordantly, the in situ data reveal that the Ulva sample treatments suppressed IFN-γ and TNF-α expression at the allergen-injection site. These findings collectively suggest the potential of UP, UO, and UR as functional food candidates for the management of delayed-type hypersensitivity.

Effect of MgO NPs that synthesis by Streptococcus spp. on immune system in rabbits

Abstract&#x0D; The current study describes a low-cost, environmentally friendly, and repeatable magnesium oxide nanoparticle manufacturing process mediated by Streptococcus spp. The UV spectrophotometer, Atomic Force Microscopy (AFM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and Field Emission Scanning Electron Microscopy (FE-SEM) were all used to characterize the nanoparticles. The crystallographic cubic pattern seen by the XRD indicates that the structure of nanoparticles is mostly crystalline. The characterisation peaks and functional groups of MgO nanoparticles were identified using FTIR analysis. Furthermore, the study of MgO NPS produced by S. salivarius and S. mutans using field-emission scanning electron microscopy (FESEM) revealed that their average diameters were 49.85 nm and 66.15 nm, respectively. The findings of all immunological tests conducted in this investigation showed that MgO NPs produced by S. mutans and S. salivarius were substantially different from the control group (P 0.05) for systemic and mucosal antibody, respectively. In comparison to the control group, which had a mean value of (10)(1), MgO NPs biosynthesized from S. mutans and S. salivarius generated titers with mean values (1280)(2560) and (128)(256), respectively. In contrast to the control group, where the mitotic index resulted in a mean value of (3.56), the findings for the mitotic index were (10.16)(7.83). LIF in the test groups (51.33)(44.1) were significant compared to the control group (102.5).The MgO NPs elicited cellular immunity (delayed type hypersensitivity), which led to an increase in the spleen weight index in both test groups compared to the control.

Investigation of immunomodulatory activity of hericium erinaceus on cyclophosphamide-induced immunosuppression in mice

The study was conducted to assess the immunostimulatory effect of Hericium Erinaceus on cyclophosphamide-induced immunodeficient mice. Animals were administered Hericium Erinaceus orally at 0.72 g/kg b.w and 1.44 g/kg b.w for seven consecutive days. On the 4th day, CP (200 mg/kg) was intraperitoneally injected into mice. The results illustrated that Hericium Erinaceus at 0.72 g/kg b.w only posed an immunostimulating potency in the cyclophosphamide-induced immunosuppression model. Besides, Hericium Erinaceus at 1.44 g/kg b.w ameliorated the effects of CP on delayed-type hypersensitivity (DTH) response, relative spleen weight, serum IL-2, TNF-α concentration, and micro-histological images of spleen and thymus substantially. This suggested the potential of Hericium Erinaceus to treat immunosuppression diseases in clinical practice.

Clinical features of allergic contact dermatitis to sandals: a case series

Background: Allergic contact dermatitis (ACD) is a skin inflammation caused by a type 4 delayed-type hypersensitivity reaction. One of the most common types of ACD is shoe dermatitis, characterized by pruritic or painful bilateral and symmetrical erythema, papules, vesicles, scaling, crusting, lichenification, or fissures at the site of footwear contact. Case series: We present seven patients with allergic contact dermatitis caused by rubber flip-flop sandals who presented with acute to chronic eczema and leukoderma. Patients range in age from 4 to 65 years old, with symptoms lasting from 5 months to 2 years. Two of the seven patients had a history of atopy. Conclusion: Flip-flop sandals are the most common offending footwear in Indonesian ACD patients because they are appropriate and comfortable in hot and humid climates like Indonesia. Rubber and rubber chemicals, preservatives, shoe adhesives, and leather materials are the most common offending allergens.

The role of intralesional immunotherapy in Condyloma Acuminata

Intralesional immunotherapy is one of the immunotherapy modalities that can be given to patients with condyloma acuminata (CA) with a high success rate both in inhibiting progression and preventing recurrence of genital warts. Intralesional immunotherapy regimens that are currently being studied are the use of vaccines and cytokines. Some of the antigens studied for use as therapy in genital warts include Candida albicans, measles, mumps and rubella (MMR), and Tuberculin/Purified Protein Derivate (PPD), Mycobacterium w, and Bacille Calmette-Guerin (BCG). Vaccines and cytokines work by inducing a delayed-type hypersensitivity response to warts tissue, both through cellular and humoral immune responses, mediated by CD8+ T lymphocytes, CD4+ T lymphocytes, B lymphocytes and regulatory T cells so that this can eliminate HPV virus infection in CA. This literature review aims to provide an understanding of the use of intralesional immunotherapy as an effective alternative therapy in CA.

IMMUNOSTIMULANT ACTIVITY OF HANTAP (STERCULIA COCCINEA JACK) LEAVES EXTRACT ON NON-SPECIFIC AND SPESIFIC IMMUNE RESPONSES

Objective: This study aims to determine the immunostimulant effect and the effective dose of hantap leaf ethanolic extract against non-specific and specific immune responses.&#x0D; Methods: The immunostimulant activity of the extract was tested by the carbon clearance method (non-specific response). The effect of the extract on delay-type hypersensitivity/DTH (cellular-specific response) was determined by the paw edema method. The number of leukocyte cells and the percentage of leukocyte cell types were also calculated. The antibody titer (humoral-specific response) test was carried out by the hemagglutination method.&#x0D; Results: The results of the non-specific immune response demonstrated that three doses of hantap leaf extract, when compared to the negative control, could accelerate the rate of carbon elimination and increase the phagocytosis index. Hantap leaf extract can provide an immunomodulatory effect by increasing the delayed-type hypersensitivity response by showing a greater volume of leg swelling than the negative control received CMC Na 0.5%, which was significantly different (p&lt;0.05), increasing leukocyte count and leukocyte differential and increasing primary and secondary antibody titers. The effective dose of hantap leaves extract was 200 mg/kg body weight.&#x0D; Conclusion: This study proves that hantap leaf extract has an immunomodulatory effect that increases the immune system (immunostimulant)

Characterization of T-Helper Immune Phenotype in Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) Endorses a Delayed-Type Hypersensitivity Reaction.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a cutaneous drug eruption with a characteristic distribution of erythema on the gluteal/inguinal region and intertriginous areas with unclear pathogenesis. In this study, we aimed to characterize the T-helper immune phenotype in SDRIFE in comparison with psoriasis and eczema to further the understanding of the pathophysiology and immune response of this rare disorder. Immunohistochemical staining was performed on 9 skin biopsies each from SDRIFE, psoriasis, and eczema using immunohistochemistry for CD3 and dual CD4/T-bet, CD4/GATA3, and CD4/RORC to quantify the percentage of Th1, Th2, and Th17 cells, respectively. A significant difference was detected in the average percentage of Th1 between all 3 groups with the highest percentage of Th1 cells seen in psoriasis, followed by SDRIFE and eczema. SDRIFE showed significantly lower Th2 expression as compared to both psoriasis and eczema. There was a trend towards a higher average percentage of Th17 in psoriasis and SDRIFE, and the ratio of Th17:Th2 was significantly higher in samples of SDRIFE compared with both eczema and psoriasis. The findings characterize SDRIFE as a Th1 and possibly Th17-driven process, which could inform future therapeutic options and substantiate the model of SDRIFE as a delayed-type hypersensitivity reaction.

Preliminary study of immunomodulatory effects of fermented garlic honey on non-specific immune responses

Introduction: Honey and Garlic is recognized to offer several health advantages due to its numerous constituents, one of which being flavonoids. Flavonoids’ pharmacological activity includes antibacterial, antioxidant, antifungal, antiviral, and immunomodulatory properties. Honey's immunomodulatory action plays a vital role in immune system boosting. The purpose of this study is to determine the immunomodulatory effect of fermented garlic honey, which is considered to have a synergistic effect, using two alternative techniques. Methods: Macrophage phagocytic activity is the first approach, while the delayed type hypersensitivity is the second. Each method used 30 male rats (Rattus norvegicus) divided into 5 groups, where each group consisted of 6 rats. Group I negative (Placebo 0,005 g/kg BW), group II positive (Stimuno 0,005 g/kg BW), group III FGH dose I (1,5 g/kg BW), group IV FGH dose II (3 g/kg BW), group V FGH dose III (4,5 g/kg BW). The dosage form was orally given for 21 days. The Macrophage phagocytic activity method measured %activity of macrophage phagocytosis using a microscope. The rats were injected with an antigen which is Staphylococcus aureus by intraperitoneal route. Results: The Delayed Type Hypersensitivity was measured volume change of the rat’s feet at the 4, 24, and 48 hours using a plethysmometer. Based on the results, fermented garlic honey had an immunomodulatory effect. The dose 2 (3 g/kg BW) has the highest effectiveness as an immunomodulator. Fermented Garlic Honey may be concluded to be efficient as an immunomodulator by enhancing the macrophage phagocytic activity indicator and lowering the edema volume of the rat. Conclusion: Fermented garlic honey can increase the immune system and can be used as an immunostimulant. The most effective dose of fermented garlic honey as immunomodulator is dose 2 was 3 g/kg BW.

Stevens-Johnson syndrome and toxic epidermal necrolysis: case series and brief literature review

Stevens-Johnson syndrome (SJS) and toxic epi- dermal necrolysis (TEN) are rare forms of delayed-type drug hypersensitivity reactions (DHRs) with extensive skin necrosis and exfoliation. Drugs are the main cause of SJS and TEN in both adults and children. The most common medications are allopurinol, aromatic antiepileptics and sulfonamides with seasonal, geographical and ethnic variations. The purpose of this paper is to present the cases of SJS/TEN which were successfully treated during the year of 2021 in our department and to provide a brief literature review.

Delayed-Type Hypersensitivity: An Excellent Indicator of Anti-tumor Immunity With Wilms' Tumor 1 (WT1) Dendritic Cell Vaccine Therapy.

It is a well-known fact that anti-tumor immunity is a crucial long-term survival factor in cancer. Wilms' tumor 1 (WT1) dendritic cell vaccine therapy (WT1-DC) is an immuno-cell therapy that has been implemented against various cancers as a tumor-specific immunotherapy targeting the common cancer antigen WT1. Seven doses of WT1-DC vaccine were administered to six patients, three of whom had stage IV lung cancer with metastases and the other three had stage IV pancreatic cancer with metastases, all of whom were receiving chemotherapy and had similar physical conditions. Their immune response was assessed using delayed-type hypersensitivity (DTH) and immune profile status (IPS)such as blood neutrophil percentage, lymphocyte percentage, and neutrophil-to-lymphocyte (N/L) ratio. In lung cancer, DTH increased with repeated DC administration, and IPS improved with it, whereas in pancreatic cancer, DTH did not increase, and IPS worsened from the fifth inoculation. Fever in the 37° range was observed after DC administration in lung cancer, but not in pancreatic cancer. These results suggest that DTH and IPS are correlated in dynamics and that DTH is a good indicator of the state of anti-tumor immunity. Since IPS is a prognostic factor in advanced cancer, the magnitude of DTH due to WT1-DC inoculation is auseful indicator to estimate the patient's prognosis. Although DTH is an extremely simple test, its clinical significance has not been fully investigated. The present study demonstrates the importance of DTH in cancer treatment with WT1-DC.

A Comparative Study on the Mechanism of Delayed-Type Hypersensitivity Mediated by the Recombinant Mycobacterium tuberculosis Fusion Protein ESAT6-CFP10 and Purified Protein Derivative

While purified protein derivative (PPD) is commonly used as skin diagnostic reagent for tuberculosis (TB) infection, it cannot distinguish effectively Bacillus Calmette–Guérin (BCG) vaccination from Mycobacterium tuberculosis (MTB) complex and nontuberculous mycobacteria infection. The new skin reagent ESAT6-CFP10 (EC) has favorable sensitivity and specificity, which can overcome limitations associated with PPD. At present, EC skin test reactions are mainly characterized by erythema, while PPD mainly causes induration. We conducted a comparative study on the potential differences between EC-induced erythema and PPD-induced induration using a guinea pig model. The size of EC-dependent erythema was similar to that of PPD-induced induration, and an inflammatory response characterized by the infiltration of monocytes, macrophages and lymphocytes, as well as tissue damage, appeared at the injection site. The lymphocytes included CD4+ T and CD8+ T cells, which released IFN-γ as the main cytokine. Both EC erythema and PPD induration could lead to increased levels of acute-phase proteins, and the differential pathways were similar, thus indicating that the main induced immune pathways were similar. The above results indicated that erythema produced by EC could generate the main delayed-type hypersensitivity (DTH) response characteristic of PPD induration, thereby suggesting that erythema might also have a certain diagnostic significance and provide a possible theoretical basis for its use as a diagnostic indicator for detecting MTB infection.

Headache as initial presentation of human chronic necrotizing granulomatous meningoencephalitis: A rare case report

Chronic necrotizing granulomatous meningoencephalitis is an idiopathic inflammatory disease with possible autoimmune mediated delayed type hypersensitivity response. It commonly affects the central nervous system of dogs, and on rare occasions cats. However, this inflammatory disease has rarely been reported in humans. A 69-year-old woman presented with subacute intermittent sharp headaches. Brain MRI revealed multifocal enhancing lesions and edema as well as multifocal signal abnormality throughout the supratentorial and infratentorial parenchyma. Cerebrospinal fluid showed elevated opening pressure, pleocytosis, and elevated protein. MRA head, MRV head, cerebral angiogram, extensive serum and CSF work up for infectious and autoimmune etiologies were also unremarkable. Brain biopsy revealed necrotizing granulomatous inflammation with dystrophic calcification. High dose of methylprednisolone followed by a 6-week prednisone taper resolved her headache and the brain MRI abnormalities. This case demonstrates the response of necrotizing granulomatous meningoencephalitis in humans to steroids.