Leprosy (Hansen's disease) in South Dakota.

Worldwide Hansen's disease is an important and relatively common disease, but is still very rare in South Dakota. Two patients are described to help demonstrate the wide variety of clinical manifestations associated with Hansen's disease. Since the clinical appearance of Hansen's disease is highly variable, the following six forms of Hansen's disease are described: Indeterminate, tuberculoid (TT), borderline tuberculoid (BT), borderline (BB), borderline lepromatous (BL), and lepromatous leprosy (LL). In addition, three well-recognized reactional forms of leprosy are also described: Type 1 (lepra reaction), type 2 (erythema nodosum leprosum), and type 3 (Lucio's phenomenon). While the disease affects primarily the skin and nerves, health care providers of all disciplines should remain alert for this disease which can present with a high degree of clinical variability.

A solitary variant of congenital self-healing reticulohistiocytosis: solitary Hashimoto-Pritzker disease.

Four neonates had solitary, congenital, rapidly growing, spontaneously ulcerating tumors of the face, trunk, and extremities. No extracutaneous involvement was found, and all lesions spontaneously involuted. Mononuclear cells of the cutaneous infiltrate were Langerhans' cells. These findings expand the spectrum of congenital self-healing reticulohistiocytosis.

A novel eicosanoid is the major arachidonic acid metabolite of cultured human monocytes.

Human peripheral blood monocyte-macrophages (M phi) generate a novel eicosanoid during in vitro culture. The metabolite is generated during incubation of the cells with 14C - arachidonic acid (AA). Lack of prior recognition of this metabolite probably results from the facts that: 1) on thin-layer chromatography (TLC) in two standard solvent systems, the novel metabolite co-chromatographed with either prostaglandin D2 or thromboxane B2, and 2) its generation, under the conditions studied, does not occur until between 90 and 180 minutes after culture initiation which is a time period beyond that used for most leukocyte studies. The generation of the metabolite is inhibited by nordihydroguaiaretic acid (NDGA) but not by indomethacin. Base hydrolysis did not alter its migration on TLC. On both reversed phase and straight phase high pressure liquid chromatography (HPLC), the novel peak isolated by TLC elutes as a single major peak of radioactivity with a retention time different from the known leukotrienes, hydroxy acids, or their metabolites. Furthermore, the peak isolated on HPLC has a single ultraviolet absorption maximum at 270 nm. M phi cultured for 1 week prior to a 24 hour incubation with 14C-AA generated proportionally less of the novel eicosanoid (roughly 68% of total radiolabeled product) than did M phi cultured for 3 weeks prior to a similar incubation with 14C-AA (roughly 86% of total radiolabeled product). Under the conditions studied, the novel eicosanoid is the major AA metabolite generated from exogenous AA by cultured M phi and it appears to be generated in increasing quantity as the M phi differentiate.

Arachidonic acid metabolism among human mononuclear leukocytes. Lipoxygenase-related pathways.

Human peripheral blood mononuclear cells were isolated and assessed for the presence of contaminating polymorphonuclear leukocytes and platelets. Incubations of these cell isolates were performed in the presence or absence of the calcium ionophore A23187 and/or 1-14C-labeled or unlabeled arachidonic acid. Using reverse phase high pressure liquid chromatography with simultaneous monitoring of ultraviolet light absorption at 229 and 280 nm and, where appropriate, of radioactivity, our studies reveal that human peripheral blood mononuclear cells generate leukotrienes C4 and B4 (LTC4 and LTB4) and 5-hydroxyeicosatetraenoic acid (5-HETE) following stimulation with A23187. The ratio of LTC4 to LTB4 was approximately 10-fold greater among the mononuclear cells than among similar incubations of polymorphonuclear leukocytes. Furthermore, the mononuclear cells failed to metabolize LTB4 into the omega-hydroxy or omega-carboxy derivatives that were always present in, and very characteristic of incubations of polymorphonuclear leukocytes. Depletion of monocytes from the mononuclear cells by double adherence resulted in virtual loss of the generation of 5-lipoxygenase-derived products by the remaining nonadherent cells, supporting the conclusion that the monocytes and not the lymphocytes were the source of LTC4, LTB4, and 5-HETE. The presence of both 12-HETE and the cyclooxygenase-derived 12-hydroxyheptadecatrienoic acid correlated with the degree of platelet contamination, suggesting that the platelets account for the presence of these compounds.

Experimental uveitis. Elicited by peptidoglycan-polysaccharide complexes, lipopolysaccharide, and muramyl dipeptide.

Uveitis could be a reaction to bacterial debris disseminated to the eye from extraocular sites of infection. In this study, we relate the composition of several bacterial components to their inflammatory properties in the eye. Groups of rabbits were injected intravitreously with peptidoglycan-polysaccharide (PG-PS) complexes isolated from group A streptococci, Escherichia coli lipopolysaccharide (LPS), or synthetic muramyl dipeptide (MDP). The lipid A region of LPS and the glycan backbone of PG are chemical analogues; MDP is the minimal biologically active subunit of PG. All of these molecules elicited uveitis as observed both clinically and histologically. The MDP elicited an acute inflammation characterized by a heterophil and monocyte infiltrate that subsided within 16 days. The PG-PS and LPS elicited chronic inflammation characterized by mononuclear and lymphocyte infiltration and severe necrosis of the retina.

Sulindac-induced anaphylaxis.

This communication describes the first known report of sulindac-induced anaphylaxis. A 17-year-old patient who ingested a single tablet of sulindac developed pruritus, hives, and dyspnea. Blood pressure was not detectable. The patient was treated with epinephrine, a corticosteroid, and an antihistamine. Recovery was complete. The ability of this class of drugs to produce dangerous reactions is discussed.