Autoimmune Thyroiditis Induced by Bartonella henselae (Cat-Scratch Disease) Might Be Reversible.

INTRODUCTION: Bartonella henselae infection leads to development of cat-scratch disease (CSD) but may also trigger of autoimmune thyroiditis (AIT). CASE PRESENTATION: We describe a 4-year-old boy with a severe fever of unknown etiology, disseminated neck lymphadenopathy, and a headache. Treatment with antibiotics was employed, but finally a left tonsillectomy, selective left lymphadenectomy, and immunophenotyping were performed to exclude lymphoma. Histologic examination excluded lymphoma but revealed CSD. IgG against B. henselae and Bartonella quintana was positive. A goiter was also found and positive anti-thyroid antibodies confirmed AIT. Two months later, the thyroid was not palpable, normal on ultrasound, and both anti-thyroid antibodies were negative. The full reversibility was documented, and 6-year follow-up showed that the patient remains disease free. CONCLUSION: This is the first report that AIT triggered by B. henselae/B. qunitana might be reversible if the pathogenetic factor is eliminated at an early stage of disease.

Proinflammatory cytokines in monitoring the course of disease and effectiveness of treatment with etanercept (ETN) of children with oligo- and polyarticular juvenile idiopathic arthritis (JIA).

BACKGROUND: The demonstration of the quantitative prevalence of specific cytokines in JIA formed the basis for the introduction of biological anticytokine drugs to treatment. Routine assessment of the concentration of these cytokines in blood serum may enable earlier decision making on the legitimacy of biological treatment (anti-TNF). The aim of the study was to assess the diagnostic value of TNFalpha, IL-6, and IL-1beta in monitoring the course of the disease and effectiveness of treatment with etanercept of children with oligo- and polyarticular JIA. METHODS: In a 1-year prospective study, cytokine levels were measured using ELISA in serum samples for 19 JIA patients in whom no clinical improvement was noted in spite of treatment with disease modifying antirheumatic drugs (DMARDs) and glucocorticosteroids (GCS). All the patients started treatment with ETN. The control group included healthy children (n = 18). RESULTS: Concentrations of TNF-a and IL-6 in blood serum at time 0 were significantly higher than in the control group. IL-6 concentration decreased during treatment with ETN in children in the inactive phase of the disease. Mean concentrations of TNF-a in serum increased several dozen times irrespective of clinical improvement. TNFalpha concentrations were statistically significantly higher in patients in the inactive phase of the disease in comparison with those in the active phase and correlated with the dose of ETN. Only the concentration of IL-6 correlated with the JADAS-27 value at all time points. CONCLUSIONS: We conclude that IL-6 may serve as a biomarker of activity of the disease in children with JIA treated with ETN.

Serum TNF-α levels and indicators of disease activity in children with oligoarticular juvenile idiopathic arthritis (oJIA) in the first year of the disease.

BACKGROUND: Juvenile idiopathic arthritis is the most common arthropathy in childhood. Clinical assessment in JIA patients is based on clinical examination and conventional parameters of inflammation. Regardless of the JIA form, a distinctive characteristic of JIA is joint inflammation, which is sustained by an imbalance between pro- and anti-inflammatory factors. A significant amount of research has confirmed elevated levels of TNF-alpha in the serum and synovial fluid of JIA patients. The aim of the study was to compare serum TNF-alpha levels and indicators of disease activity in children with newly diagnosed oJIA in the first year of the disease and to assess the diagnostic value of TNF-alpha. METHODS: In a 1-year prospective study, TNF-alpha levels were measured using ELISA in serum samples for 22 oJIA patients. The control group consisted of 16 healthy children. The data were correlated with disease activity indicators and CHAQ score. RESULTS: Concentrations of TNF-alpha were significantly higher in the study group than in the control group at time 0 [10.03 pg/mL (2.16 - 15.53) vs. 0.00 pg/mL (0.00 - 0.12); p < 0.001] and at time 2 [0.00 pg/mL (0.00 - 9.26) vs. 0.00 pg/mL (0.00 - 0.12); p = 0.014]. The analysis of changes in TNF-alpha concentrations in the study group over time showed no statistically significant differences. No correlation between concentrations of TNF-alpha and any of the analyzed indicators of disease activity and CHAQ was found. CONCLUSIONS: Assessment of TNF-alpha concentration in blood serum in children with oJIA has no diagnostic value in monitoring the severity of the disease and the effectiveness of treatment.