Atypical T lymphoproliferative disorder demonstrating in vitro suppressor and helper characteristics

Abstract

A patient initially diagnosed on surface marker status as having T cell chronic lymphatic leukemia (T-CLL) was found to have arthropathy and recurrent pulmonary infarction associated with a high anti-DNA antibody titer. The T cells from this patient, on assessment in an in vitro pokeweed mitogen driven B cell system, demonstrated suppressor and helper characteristics but lacked antibody dependent cellular cytotoxicity (ADCC) activity and natural killer (NK) activity. Using peripheral blood mononuclear cells (PBM) from patients with Hashimoto''s thyroiditis and normals, it was shown that the patient''s T cells suppressed IgG and thyroid autoantibody production. Irradiation of the patient''s PBM inhibited the suppressor effect and a residual helper effect remained. The patient was treated with systemic steroids for exacerbations of arthropathy which caused a fall in lymphocyte count. After 36 mo. the DNA binding activity spontaneously improved and the lymphocytosis disappeared. T-cell proliferations demonstrating functional activity must be assessed within the context of any underlying non-hematoogical clinical and laboratory findings.