Abstract
Patients with common variable immunodeficiency (CVID) have low-level immunoglobulins involving all classes and include a variety of disorders. Very low levels of serum immunoglobulins (Ig) were discovered in a 67-year-old woman who had been suffered from carpal tunnel syndrome and had been taking low dose of glucocorticoid for several years. Quantitative measurement of serum Ig concentration resulted in IgG 600 mg/dl, IgA 20 mg/dl, IgM 20 mg/dl and IgE 25 u/dl. Analysis of the peripheral lymphocytes revealed that the count was normal (3, 600/cmm) and T:B cell ratio was 78:22 (control 75:25). Surface IgG, A, M bearing cells were detected in normal ratio by direct immunofluorescencec-onjugated antibody method. The amount of Ig synthesis by PWM stimulated peripheral mononuclear cells from the patient was measured in vitro using solid phase radio-immunoassay. Co-culture of normal B cells with patient's T cells resulted in reduced synthesis of all classes of Ig, however, normal B cells incubated with X-ray treated patient's T cells could synthesize normal amounts of all classes of Ig. Moreover, combination of patient's B cells and normal T cells resulted in the synthesis of normal amounts of Ig. Thus, it was demonstrated that low levels of serum Ig in this case were due to hyperfunction of the suppressor T cells.
