Abstract
Splenectomy is indicated for patients with hypersplenism, and it is well known that various kinds of immunological problems may develop following this procedure. An IgG subclass abnormality, however, has not been described before. We present a 15-year-old Japanese boy whose serum level of IgG 2 was higher than that of IgG 1 one month after splenectomy, and both of them returned to the normal range in six months.
This patient had an autotransplantation of bone for his multiple osteocystoma at the age of 10. He never experienced a severe form of infection. His platelet count started to decrease around the age of 10. From twelve to fifteen years of age, when the platelet level fell to 60, 000/μl, a bleeding tendency such as nasal bleeding and purpura became obvious. At 15, this boy was admitted to our hospital for splenectomy because his spleen was getting significantly larger, and the platelet count was further decreasing. The serum IgG concentration was low, 559 mg/dl, with subclasses IgG 1 350 mg/dl and IgG 2 181 mg/dl before the splenectomy. The serum level of IgG 1 and IgG 2 elevated to 637 mg/dl and 895 mg/dl, respectively one month following the splenectomy. It required six months that these IgG subclasses returned to the normal level. This may be due to the different distribution of B cells and plasma cells producing IgG subclasses in various organs.
