A Case of IgM Deficiency with B Cell Deficiency Detected by ABO Discrepancy in a Patient with Acute Osteomyelitis

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.

A Case of IgM Deficiency with B Cell Deficiency Detected by ABO Discrepancy in a Patient with Acute Osteomyelitis

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.

Pyogenic Infection of Deep Joint after Major Burn Injury / 대한정형외과학회잡지

PURPOSE: To report the clinical findings and the results of treatment on hematogenous pyogenic arthritis after major burn injury. MATERIALS AND METHODS: A retrospective analysis was made of 11, 797 major burn injury patients from January 1996 to June 2004. Severity of burn by involved body surface area, time of diagnosis, and laboratory findings were analyzed. Direct spread of infection from injured skin to superficial joint was excluded. RESULTS: Hematogenous infection was complicated in 26 joints of 22 patients (0.19% of overall cases). The mean age was 43.6 years, and mean follow-up was 46 months. The body surface area of burn injury was averaged 34.7%. The common involved area was hip in 10 patients, spine and shoulder in five patients, respectively. From the time of injury, average interval to development of symptom was 4.1 weeks, and to establish the diagnosis was 6.3 weeks. The most common isolated pathogen was Methicillin-resistant Staphylococcus aureus. A total of 22 joints underwent surgical treatment. The clinical results of the patients were poor in 72% due to recurrent infection and persistent pain. CONCLUSION: The results of this study suggest that major burn injury may be an important risk factor of hematogenous pyogenic arthritis. Careful clinical suspicion should be important for early diagnosis and treatment.

Roles of Distal Centralizer in Cemented Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study was performed to find out the influencing factors on cement mantle thickness in cemented total hip arthroplasty. MATERIALS AND METHODS: Eighty patients were randomly enrolled who received total hip arthroplasty with the third generation cementing technique. Four types of femoral prosthesis (20 patients in each type) were used: Centralign (Zimmer, Warsaw, IN), Precision (Howmedica, Rutherford, NJ), Omnifit (Osteonics, Allendale, NJ), and Elite Plus (Depuy, Warsaw, IN). Size of femoral prosthesis, diameter of stem tip, shape and size of centralizer, and the condition of cement mantle on the radiograph were analyzed. RESULTS: Between the two groups of same or above C1 (> or =C1; A, B, and C1, n=69) and C2 (n=11) by Barrack classification, there was no difference in age, sex, underlying disease, size of applied stem, Dorr ratio, and the distance between stem tip and plug. The difference of distal diameter between centralizer and stem was less than 2 mm in 18 patients, and same or above 2 mm in 62 patients. C2 was more frequently observed in patients with the diameter difference or =2 mm (22.2% vs. 11.3%). However, C2 developed in all types of femoral stems, irrespective of their shapes, even the diameter difference was > or =2 mm. CONCLUSION: The diameter of distal centralizing device should be at least 2 mm larger than that of stem tip for an optimal cement mantle thickness. In addition, centralizers investigated in this study should be carefully used, and more improved shape of centralizer is required for the successful cement mantle formation.