ABSTRACT
A 29-year-old monkey handler developed an acute encephalomyelitis with neuromuscular dysfunction that progressed to respiratory arrest on the 18th day of illness. Thereafter, with supportive care, the patient's condition improved steadily. The titer of neutralizing antibodies to H simiae rose from 1:4 (eighth day of illness) to 1:512 (47th day of illness). Apparently the fifth known survivor of H simiae (herpesvirus B) encephalomyelitis, this patient is also remarkable because of virtually complete recovery, apparently the second documented instance of a good outcome.
Subject(s)
Encephalomyelitis/etiology , Herpesviridae Infections/etiology , Herpesviridae , Herpesvirus 1, Cercopithecine , Occupational Diseases/etiology , Adult , Animals , Antibodies, Viral/analysis , Complement Fixation Tests , Encephalomyelitis/immunology , Fluorescent Antibody Technique , Herpesviridae Infections/immunology , Herpesvirus 1, Cercopithecine/immunology , Humans , Macaca , Male , Neurologic Manifestations , Respiratory Insufficiency/etiologyABSTRACT
Of the many associations between histocompatibility antigens and human diseases a prominent one is that between HLA-B27 and inflammatory arthropathies. Hypotheses to explain this association include the B27 gene being linked to a specific immune-response gene required for disease expression and the B27 antigen acting via molecular mimicry with a microorganism or as a microorganism receptor. Alternatively, the HLA-B27 gene might be closely related to a gene which influences bone formation. The finding of a significant association between B27 and Forestier's disease, a disease characterised by abundant new bone formation, supports such a hypothesis.
Subject(s)
Exostoses/immunology , HLA Antigens , Histocompatibility Antigens , Osteogenesis , Spondylitis, Ankylosing/immunology , Aged , Alleles , Epitopes , Exostoses/genetics , Female , Humans , Male , Middle Aged , Sex Factors , SyndromeABSTRACT
Despite the lack of apophyseal or sacroiliac joint involvement, Forestier's disease (vertebral ankylosing hyperostosis) shares with the inflammatory forms of spondylitis, the roentgenographic appearance of spinal new bone formation. Because of this apparent similarity, the prevalence of the HL-A B27 antigen was determined in 47 white patients with Forestier's disease. Sixteen of the patients (34 per cent) possessed the B27 antigen (P is less than 0.001). The mere presence of B27 therefore, does not confirm the diagnosis of inflammatory spondylitis in all patients with roentgenographic evidence of osseous bridging. Applying available epidemiologic information, these data further suggest that patients with the B27 antigen may be at substantial risk of developing Forestier's disease. As Forestier's disease and virtually all of the other B27 associated arthropathies manifest abundant new bone, an association may exist between this antigen and genes controlling new bone formation.
Subject(s)
Exostoses/immunology , HLA Antigens/analysis , Histocompatibility Antigens/analysis , Spondylitis, Ankylosing/immunology , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Ossification, Heterotopic/diagnostic imaging , Ossification, Heterotopic/etiology , Radiography , Spondylitis, Ankylosing/diagnosis , SyndromeABSTRACT
A clinical and radiographic study of 98 patients with definite ankylosing spondylitis (Rome criteria) was undertaken to evaluate differences in men and women with the disease. Clinical manifestations which were atypical in the 18 female patients when compared to those of the men included older age of disease onset, higher incidence of initial and subsequent peripheral joint disease, more common cervical spine symptomatology, and milder disease course. Radiographic differences in the women included a high incidence of cervical spine abnormalities, a combination of cervical spine and sacroiliac joint alterations with a normal intervening thoracic and lumbar segment, and frequent and severe osteitis pubis.