muramidase and Erythema-Nodosum

Rheumatoid arthritis was diagnosed in a 30-year-old woman with erythema nodosum and arthritic symptoms since 1994, and she was treated with anti-rheumatic agents. Mediastinal and bilateral hilar lymphadenopathy and abnormal pulmonary shadows were detected in 1996, and she was admitted to our hospital in 1997. We also recognized the elevation of ACE and lysozyme, and found granulomas in a transbronchial lung biopsy and an arthrosis synovia biopsy. From these findings, sarcoidosis was diagnosed. Sarcoidosis demonstrating erythema nodosum, arthritis, and bilateral hilar lymphadenopathy is called Löfgren's syndrome. In Caucasians, Löfgren's syndrome is frequently encountered, but it is rare in Japanese. Our case had coexisting arthrosis symptoms, and satisfied the diagnosis criteria of rheumatic arthritis. Therefore, the differential diagnosis was important. We emphasize that it is necessary to consider Löfgren's syndrome when diagnosing patients with rheumatic features, even in Japan.

Topics: Adult; Arthritis; Arthritis, Rheumatoid; Biomarkers; Diagnosis, Differential; Erythema Nodosum; Female; Humans; Lung; Lymphatic Diseases; Muramidase; Peptidyl-Dipeptidase A; Sarcoidosis; Syndrome; Synovial Membrane; Tomography, X-Ray Computed

In the deteriorating group of sarcoidosis patients, progress towards pulmonary fibrosis is a major problem. In order to benefit from corticosteroids, it is important for the treatment to start early. We studied a group of 45 patients with sarcoidosis. Most of them were newly detected patients and none were under or had currently received corticosteroid therapy. The patients were followed for at least six months. We found that increased amounts of polymorphonuclear neutrophils (PMN) or lysozyme-positive macrophages (Lys+MF) and mast cells (MC) in bronchoalveolar lavage (BAL) could implicate a bad prognosis.

Topics: Bronchi; Erythema Nodosum; Female; Follow-Up Studies; Humans; Lung Neoplasms; Macrophages; Male; Mast Cells; Middle Aged; Muramidase; Neutrophils; Prognosis; Pulmonary Alveoli; Sarcoidosis; Syndrome; Therapeutic Irrigation

Two groups of sarcoidosis patients were studied. One group of 24 patients had previously had erythema nodosum (EN+), and the other group of 54 patients had never had any such extrathoracic manifestation of the disease (EN-). The two groups were similar with respect to age, disease duration, chest radiographic appearance, and granuloma mass as estimated from the serum concentration of lysozyme. Neutrophil phagocytic function was studied by a kinetic method which allows distinction between Fc- and C3b-receptor-mediated uptake. Fc-receptor function was normal in both groups. The function of C3b receptors was normal in the EN+ groups but significantly reduced in the EN- group. This observation indicates that sarcoidosis associated with erythema nodosum may represent a separate disease entity with respect to the pathogenetic mechanism involved in granuloma formation.

Topics: Adult; Erythema Nodosum; Female; Humans; Immunoglobulin G; Male; Middle Aged; Muramidase; Neutrophils; Phagocytosis; Receptors, Complement; Receptors, Complement 3b; Sarcoidosis; Time Factors

Serum angiotensin-converting enzyme (SACE) was measured in 56 patients with sarcoidosis within three months after diagnosis. Serial analyses were performed in 42 patients, who were followed for two months to one year. SACE was elevated in 49 (70%) of the patients at some time during the period of observation. Erythema nodosum (EN) was present in 14 patients. Only one out of seven had elevated SACE during EN, but four months later SACE was elevated in all 14. In this group there was a negative correlation between SACE and S-lysozyme. Among 42 patients without EN the frequency of SACE elevation was rather constant, about 60%. In half of the patients SACE was normal at first examination, and subsequent elevation was observed in 19%. SACE and S-lysozyme were positively correlated. Enzyme activity was independent of mode of presentation, but a non-significant trend toward higher SACE in patients with pulmonary involvement was observed, and changes in SACE were roughly correlated to roentgenological changes. Among healthy controls, significantly higher SACE levels were found in children up to 17 years of age (reference interval 21.2-42.2 U/ml) than in adults aged 18-65 years (12.0-36.8 U/ml). The observations on patients with sarcoidosis demonstrate that a unique pattern of SACE occurs in those with EN, different from that of patients without EN. The findings support the view that EN is a hallmark of acute-onset sarcoidosis. The value of serial SACE analyses is emphasized.

Topics: Adolescent; Adult; Aged; Erythema Nodosum; Female; Humans; Male; Middle Aged; Muramidase; Peptidyl-Dipeptidase A; Sarcoidosis

Serum lysozyme was assessed in 43 healthy subjects and 183 leprosy patients. Significantly elevated level of lysozyme was observed in sera of leprosy patients as compared to normal individuals. The enzyme levels in leprosy of different types showed elevations in following order, Erythema Nodosum Leprosum (ENL) greater than Lepromatous greater than Borderline greater than Tuberculoid. Enzyme levels in patients with inactive stage were lower than in untreated patients. The serum lysozyme level correlated well with the activity disease in leprosy--clinically and bacteriologically. Thus the estimation of serum lysozyme can be used as one of the parameters of activity of the disease.

Topics: Adolescent; Adult; Aged; Dapsone; Erythema Nodosum; Female; Humans; Leprosy; Male; Middle Aged; Muramidase