ABSTRACT
In a previous study, it was shown that the serum levels of type III procollagen aminoterminal peptide (P3NP) were significantly greater in patients receiving methotrexate (MTX) treatment for psoriasis than in untreated control patients with psoriasis. Although levels were highest in patients with hepatic fibrosis and cirrhosis, serum P3NP concentrations in those patients with normal liver histology on light microscopy were also shown to be significantly higher than in controls. In the present study, liver biopsies from 22 such 'normal' patients were examined by electron microscopy, in order to determine whether P3NP levels correlated with ultrastructurally demonstrable fibrosis. Fibrosis in the perisinusoidal space of Disse was present in as many as 82% of biopsies. Although the prevalence of such fibrosis in psoriasis patients who have not received MTX is unknown, the high prevalence of Disse space fibrosis and of raised P3NP in MTX-treated patients suggests that MTX causes subtle liver damage in a majority of treated patients. However, we were unable to show a statistical correlation between P3NP and the degree of Disse space fibrosis.
Subject(s)
Dermatologic Agents/adverse effects , Liver Cirrhosis/blood , Liver/drug effects , Methotrexate/adverse effects , Peptide Fragments/blood , Procollagen/blood , Psoriasis/drug therapy , Adult , Aged , Biomarkers/blood , Dermatologic Agents/therapeutic use , Female , Humans , Liver/ultrastructure , Liver Cirrhosis/chemically induced , Liver Cirrhosis/pathology , Male , Methotrexate/therapeutic use , Middle AgedABSTRACT
OBJECTIVES: To document the incidence of histological vasculitis in amputation specimens from patients with severe digital ischaemia secondary to systemic sclerosis (SSc), and to look for an association between anticardiolipin (aCL) antibodies and severe digital ischaemia in SSc. METHODS: This was a retrospective review of patients with SSc who underwent amputation for digital ischaemia over a three year period. RESULTS: Five of nine patients had histological vasculitis, four of whom had aCL antibodies, although these were not present in high titre. CONCLUSION: Vasculitis does occur in SSc, at least in that subgroup with severe peripheral ischaemia. These findings could have implications for treatment of this subgroup of patients with SSc.
Subject(s)
Amputation, Surgical , Fingers/blood supply , Ischemia/etiology , Scleroderma, Systemic/complications , Vasculitis/etiology , Adult , Antibodies, Anticardiolipin/blood , Arteries/pathology , Female , Fingers/surgery , Humans , Ischemia/surgery , Middle Aged , Retrospective Studies , Scleroderma, Systemic/immunology , Vasculitis/immunology , Vasculitis/pathologyABSTRACT
A 51 year old man with Waldenström's macroglobulinaemia presented with a malabsorptive syndrome related to extensive small bowel lymphangiectasia caused by immunoglobulin accumulation. The patient's plasma had strong lupus anticoagulant activity and the IgM lambda paraprotein displayed specificity for the negatively charged phospholipids phosphatidyl serine and phosphatidyl inositol, as well as the neutral phosphatidic acid. Despite treatment for the macroglobulinaemia the patient died and at necropsy was found to have myocardial ischaemia and segmental infarcts in the spleen and kidney. The coexistence of these relatively rare findings suggests a possible association between Waldenström's macroglobulinaemia with gastrointestinal manifestations and paraprotein specificity for phospholipid.
