Key words : herpes zoster, skin reaction, systemic lunus erythematosus (SLE)

Transcription

1 Key words : herpes zoster, skin reaction, systemic lunus erythematosus (SLE)

2 Fig. 1 Cumulative percent of cases with herpes zoster in relation to systemic lupus eryth- (SLE). Patients with SLE who had ematosus herpes zoster (9 cases) before diaymosis of SLE were omitted. Fig. 2 Dose of prednisolone (mg/day) when a patient with systemic lupus erythematosus had herpes zoster. Horizontal bars represent means Table 1 Crude incidence of herpes zoster in patients with systemic lupus erythematosus (SLE) No. of patients 119 No. of patients with zoster 56(47%) twice or more 11 before diagnosis of SLE 9 after diagnosis of SLE 50(42%) Person-Years observed* 918 Rate per 100 Person-Years 5.45 * The number of years observed is after diagnosis of SLE. (SD).

3 Table 2 Renal disorder and herpes zoster in patients with systemic lupus erythematosus Table 3 Complement fixation (CF) antibodies to varicella zoster virus in patients with systemic lupus erythematosus subjects (SLE) and in normal *not significant. * *Persistent proteinuria greater than 0.5g/day or cellular cast positive. *Antibody determined by complement fixation was considered positive when the titer was 1/4 or higher Fig. 3 Antibody titers to varicella zoster virus (VZV) determined by the neutralization test in patients with systemic lupus erythematosus (SLE) and in normal subjects. Horizontal bars represent means (SD). The titers in patients with SLE and a history of herpes zoster are significantly higher (p < 0. 01) than those in another groups. Table 4 Skin test reactions to varicella zoster virus (VZV) antigen in patients with systemic lupus erythematosus (SLE) and in normal subjects *Skin reactions to VZV antigen was considered positive when a diameter of erythema was 5mm or more

4 Table 5 Comparison of the characteristics of SLE patients based on the skin reactions *Skin reactions to varicella zoster virus antigen **Cumn1Pment fiyatinn greater than 0.5g/day or cellular cast positive. Table 6 Effect of prednisolone on skin reactions to varicella zoster virus *Patients with systemic lupus erythematosus who had not received steroid therapy

5 4) Nagafuchi, S., Iwahashi, T., Higa, K., Kusaba, T., Dan, K. & Mori, R.: Delayed type hypersensitivity (DTH) skin reaction to varicella- zoster virus antigen in patients with systemic lupus erythematosus (SLE). Fukuoka Acta Medica, 79 : , ) Tan, E.M., Cohen, A.S., Fries, J.F., Masi, A.T., McShane, D.J., Rothfield, N.F., Schaller, J.G., Talal, N. & Winchester, R.J. : The 1982 revised criteria for the classification of sys- lupus erythematosus. Arthritis temic Rheum., 25 : , ) Kamiya, H., Ihara, T., Hattori, A., Iwasa, T., Sakurai, M., Izawa, T., Yamada, A. & Takaha-

6 shi, M.: Diagnostic skin reactions with varicella virus antigen and clinical application of the test. J. Infect. Dis., 136 : 784 \788, ) Asano, Y., Shiraki, K., Takahashi, M., Nagai, H., Ozaki, T. & Yazaki, T.: Soluble skin test antigen of varicella-zoster virus prepared from the fluid of infected cultures. J. Infect. Dis., 143 : 684 \692, ) Ginzler, E., Diamond, H., Kaplan, D., Weiner, M., Schlesinger, M. & Seleznick, M.: Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus. Arthritis Rheum., 21 : 37 \44, ) Gold, E. & Godek, G.: Complement fixation studies with a varicella-zoster antigen. J. Immunol., 95 : 692 \695, ) Blaese, R.M., Grayson, J. & Steinberg, A.D. : Increased immunoglobulin-secreting cells in the blood of patients with active systemic lupus erythematosus. Am. J. Med., 69 : 345 \350, ) Stites, D.P.: Clinical laboratory methods of detection of cellular immune function. In Basic and Clinical immunology. (Stites, D.P., Stobo, J.D., Fundenberg, H.H., Wells, J.V. eds), p. 366 Lange Medical Publications, Drawer L. Los, Altos, ) Fauci, A.S., Dale, D.C. & Balow, J.E. : Glucocorticosteroid therapy : Mechanism of action and clinical considerations. Ann. Intern. Med., 84 : 304 \315, ) Rinehart, J.J., Wuest, D. & Ackerman, G.A. : Corticosteroid alteration of human monocyte to macrophage differentiation. J. Immunol., 129 : 1436 \1440, ) Smolen, J.S., Chused, T.M., Leiserson, W.M., Reeves, J.P., Alling, D. & Steinberg, A.D. : Heterogeneity of immunoregulatory T-cell subsets in systemic lupus erythematosus. Correlation with clinical features. Am. J. Med., 72 : ) Horwitz, D.A.: Lymphocytes and immune regulation in systemic lupus erythematosus. In Dubois' lupus erythematosus. (Walance, D.J. & Dubois, E.L. ed.), p. 194 \210, Lea and Febiger, Philadelphia, ) Bakke, A.C., Kirkland, P.A., Kitridou, R.C., Quismorio, F.P. Jr., Rea, T., Ehresmann, G.R. & Horwitz, D.A.: T lymphocyte subsets in systemic lupus erythematosus. Correlations with corticosteroid therapy and disease activity. Arthritis Rheum., 26 : 745 \750, Herpes Zoster in Connective Tissue Diseases: I. Association with Systemic Lupus Erythematosus and Its Immunological Abnormalities Yasuo YAMAUCHI, Kohei NAGASAWA, Yoshifumi TADA, Hiroshi TSUKAMOTO, Shigeru YOSHIZAWA, Takehito MAYUMI, Yoshiyuki NIHO & Tomohiro KUSABA The First Department of Internal Medicine, Faculty of Medicine, Kyushu University We determined the incidence of herpes zoster (HZ) in 119 patients with systemic lupus erythematosus (SLE). HZ occurred in 56 patients (47%), and 9 patients had had HZ even before SLE developed. After diagnosis of SLE, an incidence of zoster was high, 5.45 cases per 100 person-years. It was found that the susceptibility to HZ was not related to the presence of renal disorder or maximum dose of corticosteroids. The patients with SLE who had had HZ showed significantly higher antibody titers than those without a history of HZ and normal subjects as assayed by both complement fixation technique and neutralization test. On the other had, only 17 of 55 patients (31%) with SLE showed positive skin reactions to varicella zoster virus (VZV) antigen, whereas all 15 normal subjects had positive reactions. In the patients who were receiving less than 10 mg/day of prednisolone, 11 of 17 (65%) had positive skin reactions to VZV antigen, whereas only 4 of 31 (13%) patients who were receiving 10 mg/day or more prednisolone showed positive reactions. It was of interest that in 7 patients with SLE who had not received corticosteroids, only 2 (29%) patients showed positive skin reactions to VZV antigen. These results suggest that high incidence of HZ in patients with SLE is probably due to an impaired cellular immunity because of both underlying disease and corticosteroid treatment.