Disseminated Mycobacterium avium Complex Infection in a Patient with Autoantibody to Interferon-.GAMMA.

Abstract

osteomyelitis and disseminated MAC infection. We tested interferon (IFN)-γ production of peripheral blood mononuclear cells (PBMC) of the patient after phytohemagglutinin (PHA)-stimulation and found that these cells produced no or undetectable levels of IFN-γ in the presence of autologous plasma while produced almost normal levels of IFN-γ in the presence of healthy donor's plasma. Since this neutralizing activity was co-purified in the IgG fraction, the immunodeficient state of the patient seemed to be caused by autoantibody to IFN-γ. As far as we know, this is the first report of a Japanese case of disseminated MAC infection presumably due to autoantibody to IFN-γ.

Anti–IFN-γ autoantibodies in adults with disseminated nontuberculous mycobacterial infections are associated with HLA-DRB1*16:02 and HLA-DQB1*05:02 and the reactivation of latent varicella-zoster virus infection

“…7,9,11 Third, a high proportion (71%) of our patients suffered from the reactivation of latent VZV infection, a phenotype rarely reported in either MSMD patients or in patients with anti-IFN-␥ autoantibodies. [7][8][9][10][11][12][13]30 Finally and most importantly, 2 HLA alleles, DRB1*16:02 and DQB1*05:02, occurred with unexpectedly high frequencies among our patients.…”

“…9 Several subsequent case series and reports also identified small groups of patients with unusual autoantibodies of this type. [10][11][12][13] Unlike our patients, nearly half of the reported patients 7-13 had either clinical or laboratory evidence of autoimmune disease or had received steroid therapy, which can disrupt For personal use only. on May 10, 2018.…”

“…[7][8][9][10][11][12][13] In the presence of these autoantibodies, the "physiologic concentration" of IFN-␥ in response to mycobacterial infections is markedly suppressed, and the affected subjects are susceptible to disseminated mycobacterial infections, a phenotype unique to MSMD patients. [30][31][32] Patients with dNTM infections due to anti-IFN-␥ autoantibodies were first reported in 2004.…”

“…[4][5][6][7][8][9] In cases with anti-IFN-␥ autoantibody expression, disseminated NTM (dNTM) infection is the most common clinical presentation. [7][8][9][10][11][12][13] The majority of patients with anticytokine autoantibodies have associated comorbidities, either neoplastic or autoimmune. 4,9,14,15 These comorbidities and their associated therapies may render patients more susceptible to infectious diseases.…”

Disseminated Penicilliosis, Recurrent Bacteremic Nontyphoidal Salmonellosis, and Burkholderiosis Associated with Acquired Immunodeficiency Due to Autoantibody against Gamma Interferon

“…Recently, autoantibody against IFN-␥ has been linked with severe disseminated nontuberculous mycobacteriosis in patients without classical cellmediated immune defects, such as transplantations (hematopoietic stem cells and solid organs), malignancies (especially hematological), systemic immunosuppressive therapies, and AIDS due to human immunodeficiency virus (HIV) infection (4,5,8,10,11,14,20). Patients with these risk factors are also prone to infections by other intracellular pathogens, such as Penicillium marneffei, nontyphoid Salmonella enterica, and Burkholderia spp.…”