A woman with acute myelopathy in pregnancy: case presentation

Abstract

PracticeFor the full versions of these articles see bmj.com a common cause for community acquired pneumonia, but recurrent infections are unusual in a young, healthy non-smoker. Thus repeated infections with these organisms should prompt investigations for possible underlying immunodeficiency.When evaluating patients with recurrent infection, use the acronym SPUR (severe, persistent, unusual, or recurrent) to prompt appropriate investigations for underlying causes. In this case scenario, chronic medical conditions such as diabetes or renal disease, which are associated with an increased tendency to recurrent infection, are effectively excluded by appropriate initial laboratory investigations. The clinical picture does not suggest immunodeficiency involving cellular immunity (most commonly resulting from infection with HIV), although a history of high risk sex or of misuse of intravenous drugs may indicate the need for screening. Secondary antibody deficiencies result most commonly from immunosuppression in lymphoid malignancy or more rarely from protein loss from either the renal or gastrointestinal tracts. Lymphoid malignancies should be considered but are unlikely in the absence of weight loss, fevers, lymphadenopathy, or splenomegaly and with a normal full blood count. The primary antibody deficiency syndromes are a group of rare disorders with a prevalence of around 1 in 50 000 which can present at any age and are characterised by the inability to produce clinically effective antibody responses to infection. With these disorders, delay in diagnosis remains a problem and contributes to chronic disease. He has no weight loss or night sweats. On examination he has bilateral basal crackles in the lungs, normal tympanic membranes, no facial tenderness, and no lymphadenopathy or splenomegaly. A full blood count is normal; random and fasting blood glucose, urea, creatinine, and liver enzymes are all normal, and urinalysis is negative for blood and protein. Sputum culture identifies the presence of Haemophilus influenzae. A chest radiograph is reported as normal.

Homology between Klebsiella pneumoniae and human aquaporin-4: no evidence for cross-reactivity in neuromyelitis optica. A study on 114 patients

“…Moreover, Kpsp infection is not rare, and immunity to Kpsp has been previously implicated in the aetiopathogenesis of a number of autoimmune conditions, such as ankylosing spondylitis or Crohn's disease [14]. In addition, infection with K. pneumoniae has been reported in association with a first attack of optic neuritis or AQP4-Ab positive LETM in some patients [15,16]. We, therefore, hypothesized that infection with K. pneumoniae may play a role in the immunopathogenesis of NMO.…”

Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?

“…In animal models, the transfer of human AQP4-IgG bound mouse placental AQP4, activated coinjected human complement and led to the induction of placentitis and fetal death (34). In parallel, several regions of necrosis with multiple infarcts were observed in a patient with NMOSD who miscarried in the second trimester, mainly in the maternal part of the placenta (35). AQP4 immunostaining showed a complete loss of immunoreactivity.…”