The clinical manifestations and geographic distribution of loiasis overlap with those of other human filarial parasites, presenting challenges in the specific diagnosis of loiasis that may lead to delays in appropriate therapy. A recombinant antigen (Ll-SXP-1), preferentially recognized by serum samples from experimentally infected rhesus monkeys, was identified from a Loa loa L3 cDNA library. IgG4 antibody reactivity to purified Ll-SXP-1 was assessed by means of ELISA, using serum samples from patients with loiasis, lymphatic filariasis, onchocerciasis, mansonellosis, or other helminthiases and healthy control subjects. The assay was 56% sensitive and 98% specific for loiasis. Antibody reactivity was detectable before microfilaremia in experimentally infected rhesus monkeys and declined (but did not disappear) after diethylcarbamazine therapy in infected patients. IgG4 antibodies to recombinant Ll-SXP-1 are a highly specific marker of L. loa infection and may be useful for the diagnostic evaluation of persons with filariasis of unclear etiology.
An association between sarcoidosis and multiple myeloma (MM) has been reported in several case reports. In these cases, sarcoidosis is chronically active, systemic, diagnosed at a later age than controlled groups, and often precedes the diagnosis of multiple myeloma by several years. We present the first case of a 43-year-old asymptomatic man with abnormal renal function and monoclonal gammopathy who was simultaneously diagnosed with renal sarcoidosis and MM. He was successfully treated with Thalidomide and steroids and remains in remission after two years of follow up. Pathophysiology of sarcoidosis and MM with special focus on potential link between the two diseases is discussed.
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