Letter to the Editor
Immune-mediated Leukopenia due to Chlamydophila pneumoniae Pneumonia
Leucopenia inmunomediada secundaria a neumonía por Chlamydophila pneumoniae
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(B) Posteroanterior X-ray of an 85-year-old patient (henceforth patient Y), showing extensive left pleural thickening and calcification and significant loss of volume in the ipsilateral hemithorax. (C) Axial CT of patient X apparently showing a filling defect in the left main pulmonary artery (arrow), mistakenly interpreted as PTE. 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To our knowledge, this is the first report of a patient with <span class="elsevierStyleItalic">C. pneumoniae</span> pneumonia who developed antineutrophil IgG antibodies.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 37-year-old woman presented with a 1-week history of cough, bloody sputum and fever. Physical examination showed temperature of 38<span class="elsevierStyleHsp" style=""></span>°C and crackles in right lung field. Chest X-ray showed bilateral alveolar infiltrates, corresponding with computed tomography findings of right lower lobe consolidation, and ground glass opacities in left upper lobe and both lower lobes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). ECG was normal. Arterial blood gases: pH: 7.52, PaCO<span class="elsevierStyleInf">2</span> 34<span class="elsevierStyleHsp" style=""></span>mmHg, PaO<span class="elsevierStyleInf">2</span> 67<span class="elsevierStyleHsp" style=""></span>mmHg. Clinical laboratory tests: blood glucose 95<span class="elsevierStyleHsp" style=""></span>mg/dl, urea 18<span class="elsevierStyleHsp" style=""></span>mg/dl, creatinine 0.77<span class="elsevierStyleHsp" style=""></span>mg/dl, sodium 139<span class="elsevierStyleHsp" style=""></span>mmol/l, potassium 2.8<span class="elsevierStyleHsp" style=""></span>mmol/l, chloride 98<span class="elsevierStyleHsp" style=""></span>mmol/l, GOT 44<span class="elsevierStyleHsp" style=""></span>U/l, GPT 44<span class="elsevierStyleHsp" style=""></span>U/l, LDH 510<span class="elsevierStyleHsp" style=""></span>U/l, C-reactive protein 287<span class="elsevierStyleHsp" style=""></span>mg/l, procalcitonin 0.18<span class="elsevierStyleHsp" style=""></span>ng/ml, leukocytes 3080<span class="elsevierStyleHsp" style=""></span>μl, neutrophils (76.7%), hemoglobin 10.1<span class="elsevierStyleHsp" style=""></span>g/dl, platelets 222,000<span class="elsevierStyleHsp" style=""></span>μl. Quick time 68%. Microbiology: sputum, blood culture, and pneumococcal and <span class="elsevierStyleItalic">Legionella</span> urinary antigen tests negative. <span class="elsevierStyleItalic">C. pneumoniae</span> serology was positive in acute-phase serum, with elevated antibody titer with seroconversion (17/4/2013 IgG negative [0.157], IgM negative [0.307]; 2/5/2013 IgG indeterminate [0.992], IgM positive [1.428]) on micro-immunofluorescence. During hospitalization, leukopenia worsened to 1770/μl with neutrophil count of 850<span class="elsevierStyleMonospace">/</span>μl in the presence of IgG-positive antineutrophil antibodies. Antineutrophil antibodies were detected with fluorescence-labeled polyclonal rabbit anti-human IgM and IgG antibodies (fluorescein isothiocyanate [FITC]) (DAKO). Cell suspension was analyzed using flow cytometry (FACS<span class="elsevierStyleSup">®</span>, Becton Dickinson). The patient received levofloxacin for 3 weeks, resulting in radiological resolution of the pneumonia and normalization of blood panels.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">C. pneumoniae</span> is a Gram-negative bacteria, previously known as Taiwan acute respiratory agent (TWAR). It causes 10% of community-acquired pneumonias (CAP) in Europe (12% of CAPs that do not require hospitalization and 3% of those that do).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> It may be responsible for immunological phenomena related to coronary arteriosclerosis,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> but it is unusual for it to cause autoimmune leukopenia associated with antineutrophil IgG antibodies, as occurred in our case.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In autoimmune neutropenia, antibodies develop that act directly against cell membrane antigens, causing peripheral destruction of neutrophils. These antineutrophil antibodies promote phagocytosis of neutrophils opsonized by splenic macrophages.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Autoimmune neutropenia may be primary or secondary and is more common in adults. It is often related to autoimmune diseases (primary biliary cirrhosis, Sjögren syndrome, lupus erythematosus, and rheumatoid arthritis), as well as to exposure to medication (fludarabine, rituximab), solid tumors and blood cancers, neurological diseases, such as multiple sclerosis, or infections. Viral infections, such as human immunodeficiency virus, <span class="elsevierStyleItalic">es Parvovirus</span>¸ or Epstein–Barr virus, bacteria, such as <span class="elsevierStyleItalic">Helicobacter pylori</span>, <span class="elsevierStyleItalic">Escherichia coli</span>, <span class="elsevierStyleItalic">Neisseria meningitidis</span>, <span class="elsevierStyleItalic">Brucella</span> ssp., <span class="elsevierStyleItalic">Salmonella</span> spp. and <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>, and other pathogens, including <span class="elsevierStyleItalic">Toxoplasma gondii</span>, <span class="elsevierStyleItalic">Leishmania</span> spp. and malaria, have also been implicated. However, a review of the literature did not yield any report of autoimmune neutropenia developing as a result of <span class="elsevierStyleItalic">C. pneumoniae</span> infection.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rosario Martín C, Navarro Cubells B, Carrión Valero F. Leucopenia inmunomediada secundaria a neumonía por <span class="elsevierStyleItalic">Chlamidophila pneumoniae</span>. Arch Bronconeumol. 2015;51:663–664.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 550 "Ancho" => 995 "Tamanyo" => 87530 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing right lower lobe consolidation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe community-acquired pneumonia: a possible role for <span class="elsevierStyleItalic">Chlamydia pneumoniae</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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| 2024 March | 48 | 23 | 71 |
| 2024 February | 34 | 24 | 58 |
| 2023 March | 14 | 4 | 18 |
| 2023 February | 64 | 20 | 84 |
| 2023 January | 79 | 31 | 110 |
| 2022 December | 92 | 54 | 146 |
| 2022 November | 90 | 39 | 129 |
| 2022 October | 86 | 42 | 128 |
| 2022 September | 78 | 42 | 120 |
| 2022 August | 59 | 36 | 95 |
| 2022 July | 60 | 53 | 113 |
| 2022 June | 45 | 40 | 85 |
| 2022 May | 76 | 37 | 113 |
| 2022 April | 60 | 29 | 89 |
| 2022 March | 66 | 48 | 114 |
| 2022 February | 66 | 40 | 106 |
| 2022 January | 86 | 38 | 124 |
| 2021 December | 68 | 38 | 106 |
| 2021 November | 48 | 51 | 99 |
| 2021 October | 70 | 52 | 122 |
| 2021 September | 58 | 46 | 104 |
| 2021 August | 55 | 30 | 85 |
| 2021 July | 35 | 27 | 62 |
| 2021 June | 73 | 47 | 120 |
| 2021 May | 65 | 33 | 98 |
| 2021 April | 170 | 76 | 246 |
| 2021 March | 71 | 35 | 106 |
| 2021 February | 53 | 31 | 84 |
| 2021 January | 43 | 13 | 56 |
| 2020 December | 49 | 20 | 69 |
| 2020 November | 59 | 15 | 74 |
| 2020 October | 59 | 18 | 77 |
| 2020 September | 41 | 14 | 55 |
| 2020 August | 39 | 15 | 54 |
| 2020 July | 38 | 15 | 53 |
| 2020 June | 49 | 12 | 61 |
| 2020 May | 44 | 13 | 57 |
| 2020 April | 59 | 28 | 87 |
| 2020 March | 56 | 14 | 70 |
| 2020 February | 39 | 17 | 56 |
| 2020 January | 43 | 13 | 56 |
| 2019 December | 49 | 12 | 61 |
| 2019 November | 33 | 24 | 57 |
| 2019 October | 34 | 15 | 49 |
| 2019 September | 43 | 7 | 50 |
| 2019 August | 54 | 16 | 70 |
| 2019 July | 32 | 13 | 45 |
| 2019 June | 40 | 19 | 59 |
| 2019 May | 58 | 32 | 90 |
| 2019 April | 41 | 46 | 87 |
| 2019 March | 57 | 30 | 87 |
| 2019 February | 47 | 22 | 69 |
| 2019 January | 52 | 11 | 63 |
| 2018 December | 56 | 17 | 73 |
| 2018 November | 111 | 27 | 138 |
| 2018 October | 125 | 19 | 144 |
| 2018 September | 44 | 11 | 55 |
| 2018 May | 23 | 0 | 23 |
| 2018 April | 50 | 5 | 55 |
| 2018 March | 25 | 1 | 26 |
| 2018 February | 39 | 5 | 44 |
| 2018 January | 85 | 6 | 91 |
| 2017 December | 82 | 1 | 83 |
| 2017 November | 24 | 5 | 29 |
| 2017 October | 20 | 5 | 25 |
| 2017 September | 29 | 16 | 45 |
| 2017 August | 31 | 8 | 39 |
| 2017 July | 22 | 6 | 28 |
| 2017 June | 39 | 10 | 49 |
| 2017 May | 25 | 4 | 29 |
| 2017 April | 14 | 5 | 19 |
| 2017 March | 13 | 5 | 18 |
| 2017 February | 22 | 4 | 26 |
| 2017 January | 21 | 7 | 28 |
| 2016 December | 22 | 8 | 30 |
| 2016 November | 37 | 16 | 53 |
| 2016 October | 39 | 18 | 57 |
| 2016 September | 33 | 8 | 41 |
| 2016 August | 30 | 2 | 32 |
| 2016 July | 29 | 5 | 34 |
Show all
