Disappearance of cerebrospinal fluid oligoclonal bands after natalizumab treatment of multiple sclerosis patients

Intrathecal immunoglobulin synthesis in an oligoclonal pattern is the most common immunologic abnormality detected in MS patients. Various treatments, such as immunomodulators and immunosuppressors, have not been found to modify it. Natalizumab hinders migration of encephalitogenic T-cells into the central nervous system (CNS), reducing inflammatory response. Its impact on CSF oligoclonal bands (OCBs) has not been demonstrated. This report describes its effect in four out of six patients with multiple sclerosis after a mean of 10 infusions: the CSF was negative for OCBs at the second lumbar puncture. In conclusion, natalizumab treatment can reduce CSF OCBs to undetectable levels, although the clinical significance of this observation is not yet known.

Disseminated Histoplasma capsulatum in a Patient with Hyper IgM Immunodeficiency

Immunodeficiency with hyper immunoglobulin M (IgM) (dysgammaglobulinemia type I) was first described in 1961.1 It is defined by low or absent serum levels of immunoglobulin G (IgG) and immunoglobulin A (IgA) but elevated or normal levels of IgM and immunoglobulin D.2 An intrinsic B cell class switching defect had been implicated as the pathophysiology.3,4 There is also strong evidence to suggest that a T cell defect, the absence of a T cell ligand for the CD4O antigen on B cells may be the underlying immunologic abnormality.5,6 Additionally, there is clinical evidence that these patients develop infections common to individuals with T cell defects such as Pneumocystis carinii,7 cryptococal meningitis and sepsis, (unpublished personal experience) Cryptosporidium,8 and Giardia lamblia.9

Immunologic Abnormality in Meniere's Disease

Patients with Meniere's disease were investigated for possible immunologic abnormalities. A total of 104 cases—55 bilateral and 49 unilateral—were examined. Immune activity was assessed using four types of immune parameters: (1) the erythrocyte sedimentation rate (ESR) and C-reative protein levels (CRP); (2) serum immunoglobulin levels (IgG, IgM, and IgA); (3) complement levels (C3, C4, and CH50); and (4) autoantibody levels (rheumatoid factor, anti-DNA antibody, and antinuclear antibody). Patients with severe immunologic abnormalities (16% of the bilateral cases and 2% of the unilateral cases) typically displayed bilateral severe hearing loss, bilateral decreased vestibular response, and excellent responsiveness to steroid treatment. As patients with bilateral involvement account for approximately 30% of all cases of Meniere's disease in Japan, immunologic involvement may be assumed in about 6% of the total. The severity of these patients' symptoms and their responsiveness to steroid treatment suggest that the possibility of immunologic involvement is well worth investigation in Meniere's disease.