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Leukocytoclastic Vasculitis Following Staphylococcal Protein A Column Immunoadsorption Therapy: Two Cases and a Review of the Literature

Leukocytoclastic Vasculitis Following Staphylococcal Protein A Column Immunoadsorption Therapy:... Abstract Background: Protein A immunoadsorption is a novel therapy for the treatment of diseases mediated by pathogenic autoantibodies. This procedure consists of circulating patients' plasma through a column containing staphylococcal protein A, which binds to the Fc portion of IgG, enabling removal of IgG. Presently, protein A immunoadsorption is used in the treatment of idiopathic thrombocytopenic purpura, but may be more widely used as an immunomodulator in human immunodeficiency virus infection and metastatic carcinoma. Observations: We present two histologically documented cases of leukocytoclastic vasculitis in the setting of protein A immunoadsorption. This potentially severe adverse effect is probably more common than the literature reflects and should be recognized by physicians who are treating patients with protein A column pheresis. Conclusions: The pathogenesis of protein A therapy-associated leukocytoclastic vasculitis remains unclear. Further study of vasculitis in the setting of protein A column pheresis may lead to modifications of this therapy, resulting in fewer adverse effects. Protein A-associated leukocytoclastic vasculitis may serve as a useful model of the relation of immune complexes and vasculitis.(Arch Dermatol. 1995;131:707-709) References 1. Kessler SW. Rapid isolation of antigens from cells with Staphylococcus protein A antibody absorbent: parameters of the interaction of antibody-antigen complexes with protein A . J Immunol. 1975;115:1617-1624. 2. McDougal JS, Redecha PB, Inman RD, Christian CL. Binding of immunoglobulin G aggregates and immune complexes in human sera to staphylococci containing protein A . J Clin Invest. 1979;63:627-636.Crossref 3. Snyder HW, Ernst NR, Grosmire LS, Balint JP, Yoshida LH, Jones FR. Selective removal of antigen-complexed IgG from cat plasma by adsorption onto a protein A silica matrix . J Immunol Methods. 1987;101:209-217.Crossref 4. Langone JJ. Immune complex formation enhances the binding of staphylococcal protein A to immunoglobulin G . Biochem Biophys Res Commun. 1980;94:473-479.Crossref 5. Pinsky CM. Selective removal of plasma components to achieve immune modulations . Semin Hematol. 1989;26( (suppl 1) ):1-51. 6. 'Communicating With the Immune System' Using the PROSORBA Immunabsorption Treatment Column . Seattle, Wash: IMRÉ Corp; 1991. 7. Jones FR, Baliant JP, Snyder HW. Selective extracorporeal removal of immunoglobulin G and circulating immune complexes: a review . Plasma Ther Transfus Technol. 1986;7:333-339. 8. Cochran SK, Snyder HW, Balint JP, et al. Minimal toxicity during protein A immunoadsorption therapy (Prosorba column) for chronic refractory idiopathic thrombocytopenic purpura . Blood. 1990;76( (suppl 1) ):452a. 9. Handelsman H. Protein A Columns for the Treatment of Patients With Idiopathic Thrombocytopenic Purpura and Other Indications . Washington, DC: Agency for Health Care Policy and Research; (March) 1991. 10. Guthrie TH Jr, Oral A. Immune thrombocytopenia purpura: a pilot study of staphylococcal protein A immunomodulation in refractory patients . Semin Hematol. 1989;26:3-9. 11. Ainsworth SK, Pilia PA, Pepkowitz SH, O'Brien P. Toxicity following protein A treatment of metastatic breast adenocarcinoma . Cancer. 1988;61:1495-1500.Crossref 12. Snyder HW, Henry DH, Messerschmidt GL, et al. Minimal toxicity during protein A immunoadsorption treatment of malignant disease: an outpatient therapy . J Clin Apheresis. 1991;6:1-10.Crossref 13. Messerschmidt GL, Henry DH, Snyder HW Jr, et al. Protein A immunotherapy in the treatment of cancer: an update . Semin Hematol. 1989;26:19-24. 14. Mittelman A, Bertram J, Henry DH, et al. Treatment of patients with HIV thrombocytopenia and hemolytic uremic syndrome with protein A (Prosorba column) immunoadsorption . Semin Hematol. 1989;26:2615-2618. 15. Smith RE, Gottschall JL, Pisciotta AV. Life-threatening reaction to staphylococcal protein A immunomodulation . J Clin Apheresis. 1992;7:4-5.Crossref 16. Dzik WH, Duncan LM. Case records of the Massachusetts General Hospital . N Engl J Med. 1994;331:792-800. Case 35-1994.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Leukocytoclastic Vasculitis Following Staphylococcal Protein A Column Immunoadsorption Therapy: Two Cases and a Review of the Literature

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690180083015
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Protein A immunoadsorption is a novel therapy for the treatment of diseases mediated by pathogenic autoantibodies. This procedure consists of circulating patients' plasma through a column containing staphylococcal protein A, which binds to the Fc portion of IgG, enabling removal of IgG. Presently, protein A immunoadsorption is used in the treatment of idiopathic thrombocytopenic purpura, but may be more widely used as an immunomodulator in human immunodeficiency virus infection and metastatic carcinoma. Observations: We present two histologically documented cases of leukocytoclastic vasculitis in the setting of protein A immunoadsorption. This potentially severe adverse effect is probably more common than the literature reflects and should be recognized by physicians who are treating patients with protein A column pheresis. Conclusions: The pathogenesis of protein A therapy-associated leukocytoclastic vasculitis remains unclear. Further study of vasculitis in the setting of protein A column pheresis may lead to modifications of this therapy, resulting in fewer adverse effects. Protein A-associated leukocytoclastic vasculitis may serve as a useful model of the relation of immune complexes and vasculitis.(Arch Dermatol. 1995;131:707-709) References 1. Kessler SW. Rapid isolation of antigens from cells with Staphylococcus protein A antibody absorbent: parameters of the interaction of antibody-antigen complexes with protein A . J Immunol. 1975;115:1617-1624. 2. McDougal JS, Redecha PB, Inman RD, Christian CL. Binding of immunoglobulin G aggregates and immune complexes in human sera to staphylococci containing protein A . J Clin Invest. 1979;63:627-636.Crossref 3. Snyder HW, Ernst NR, Grosmire LS, Balint JP, Yoshida LH, Jones FR. Selective removal of antigen-complexed IgG from cat plasma by adsorption onto a protein A silica matrix . J Immunol Methods. 1987;101:209-217.Crossref 4. Langone JJ. Immune complex formation enhances the binding of staphylococcal protein A to immunoglobulin G . Biochem Biophys Res Commun. 1980;94:473-479.Crossref 5. Pinsky CM. Selective removal of plasma components to achieve immune modulations . Semin Hematol. 1989;26( (suppl 1) ):1-51. 6. 'Communicating With the Immune System' Using the PROSORBA Immunabsorption Treatment Column . Seattle, Wash: IMRÉ Corp; 1991. 7. Jones FR, Baliant JP, Snyder HW. Selective extracorporeal removal of immunoglobulin G and circulating immune complexes: a review . Plasma Ther Transfus Technol. 1986;7:333-339. 8. Cochran SK, Snyder HW, Balint JP, et al. Minimal toxicity during protein A immunoadsorption therapy (Prosorba column) for chronic refractory idiopathic thrombocytopenic purpura . Blood. 1990;76( (suppl 1) ):452a. 9. Handelsman H. Protein A Columns for the Treatment of Patients With Idiopathic Thrombocytopenic Purpura and Other Indications . Washington, DC: Agency for Health Care Policy and Research; (March) 1991. 10. Guthrie TH Jr, Oral A. Immune thrombocytopenia purpura: a pilot study of staphylococcal protein A immunomodulation in refractory patients . Semin Hematol. 1989;26:3-9. 11. Ainsworth SK, Pilia PA, Pepkowitz SH, O'Brien P. Toxicity following protein A treatment of metastatic breast adenocarcinoma . Cancer. 1988;61:1495-1500.Crossref 12. Snyder HW, Henry DH, Messerschmidt GL, et al. Minimal toxicity during protein A immunoadsorption treatment of malignant disease: an outpatient therapy . J Clin Apheresis. 1991;6:1-10.Crossref 13. Messerschmidt GL, Henry DH, Snyder HW Jr, et al. Protein A immunotherapy in the treatment of cancer: an update . Semin Hematol. 1989;26:19-24. 14. Mittelman A, Bertram J, Henry DH, et al. Treatment of patients with HIV thrombocytopenia and hemolytic uremic syndrome with protein A (Prosorba column) immunoadsorption . Semin Hematol. 1989;26:2615-2618. 15. Smith RE, Gottschall JL, Pisciotta AV. Life-threatening reaction to staphylococcal protein A immunomodulation . J Clin Apheresis. 1992;7:4-5.Crossref 16. Dzik WH, Duncan LM. Case records of the Massachusetts General Hospital . N Engl J Med. 1994;331:792-800. Case 35-1994.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Jun 1, 1995

References