[成人复发性非典型分枝杆菌感染：考虑针对γ干扰素的自身抗体！]
[Recurrent atypical mycobacterial infections in the adult: think of autoantibodies against interferon-gamma !].
作者信息
Picque J-B, Blot M, Binois R, Jeudy G, Simonet A-L, Cagnon J, Mahy S, Duong M, Buisson M, Chavanet P, Piroth L
机构信息
Département d'infectiologie, CHU de Dijon, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, 21079 Dijon cedex, France.
出版信息
Rev Med Interne. 2012 Feb;33(2):103-6. doi: 10.1016/j.revmed.2011.11.012. Epub 2012 Jan 10.
INTRODUCTION
Disseminated non-tuberculosis mycobacterial infections are associated with a defect of the cellular immune response. They have been mainly reported in AIDS patients. Cases related to the presence of anti-interferon-γ autoantibodies are rare.
CASE REPORT
We report a non HIV-infected 45-year-old Thai woman, with a past medical history of Graves' disease. She presented with recurrent disseminated and severe non-tuberculous mycobacterial infections that were related to the production of anti-interferon-γ autoantibody. The diagnosis was suspected in the presence of a negative interferon-γ release assay (IGRA) including with the positive control, and evidenced by the identification of specific antibodies.
CONCLUSION
Anti-interferon-γ autoantibody production is a rare cause of non tuberculous mycobacterial infection. Such a mechanism should be suspected in non HIV-infected patients and especially in those having an Asiatic ethnicity or an associated immune disorder. A negative IGRA (including with the positive control) is a reliable diagnostic tool and should be completed with the identification of specific autoantibodies.
引言
播散性非结核分枝杆菌感染与细胞免疫反应缺陷有关。主要在艾滋病患者中报道过此类感染。与抗干扰素-γ自身抗体存在相关的病例罕见。
病例报告
我们报告一名45岁未感染HIV的泰国女性，既往有格雷夫斯病病史。她反复出现播散性严重非结核分枝杆菌感染，与抗干扰素-γ自身抗体的产生有关。在包括阳性对照在内的干扰素-γ释放试验（IGRA）结果为阴性时怀疑有该诊断，通过鉴定特异性抗体得以证实。
结论
抗干扰素-γ自身抗体产生是非结核分枝杆菌感染的罕见原因。在未感染HIV的患者中，尤其是具有亚洲人种背景或伴有免疫紊乱的患者中，应怀疑存在这种机制。IGRA阴性（包括与阳性对照相比）是一种可靠的诊断工具，应通过鉴定特异性自身抗体来完善诊断。
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