Skip to main content
PMC home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1985 Feb 1;132(3):261–263.

Fulminant gangrene in transient cold agglutinemia associated with Escherichia coli infection.

P Poldre, W Pruzanski, H M Chiu, D A Dotten
PMCID: PMC1346707  PMID: 3881156

Abstract

Fulminant gangrene of the fingers, toes and nose developed in a 57-year-old woman with Escherichia coli pneumonia. Cryoglobulinemia was noted, and the cryoglobulin was identified as IgM-IgG with anti-I cold agglutinin activity. The cold agglutinins possessed potent lymphocytotoxic and monocytotoxic activity and weaker granulocytotoxic activity. Treatment with plasmapheresis, steroids and antibiotics led to complete clinical recovery, although amputation of several toes was necessary. The patient died 1 1/2 years later; the main findings at autopsy were chronic and acute pyelonephritis and acute bacterial endocarditis. This seems to be the first case of IgM-IgG cold agglutinemia occurring during the course of E. coli infection and the third case of fulminant gangrene complicating transient cold agglutinemia.

Full text

PDF
261

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ARRIGONI MARTELLI E., SAITA G. Emoglobinuria parossistica con sindrome di Raynaud e gangrena della mano sinistra da crioagglutininemia a titolo elevato in soggetto con crisi angiospastiche da strumento vibrante. Med Lav. 1956 Nov;47(11):630–638. [PubMed] [Google Scholar]
  2. DACIE J. V. The presence of cold haemolysins in sera containing cold haemagglutinins. J Pathol Bacteriol. 1950 Apr;62(2):241–257. doi: 10.1002/path.1700620212. [DOI] [PubMed] [Google Scholar]
  3. FERRIMAN D. G., DACIE J. V., KEELE K. D., FULLERTON J. M. The association of Raynaud's phenomena, chronic haemolytic anaemia, and the formation of cold antibodies. Q J Med. 1951 Jul;20(79):275–292. [PubMed] [Google Scholar]
  4. GADDY C. G., POWELL L. W., Jr Raynaud's syndrome associated with idiopathic cryoglobulinemia and cold agglutinins; report of a case and discussion of classification of cryoglobulinemia. AMA Arch Intern Med. 1958 Sep;102(3):468–477. doi: 10.1001/archinte.1958.00030010468020. [DOI] [PubMed] [Google Scholar]
  5. Goldberg L. S., Barnett E. V. Mixed gamma G-gamma M cold agglutinin. J Immunol. 1967 Oct;99(4):803–809. [PubMed] [Google Scholar]
  6. Harboe M., Torsvik H. Protein abnormalities in the cold haemagglutinin syndrome. Scand J Haematol. 1969;6(6):416–426. doi: 10.1111/j.1600-0609.1969.tb01836.x. [DOI] [PubMed] [Google Scholar]
  7. Hippe E., Jensen K. B., Olesen H., Lind K., Thomsen P. E. Chlorambucil treatment of patients with cold agglutinin syndrome. Blood. 1970 Jan;35(1):68–72. [PubMed] [Google Scholar]
  8. KUMAR S., SINGH M. M., BHATIA B. B., MANGALIK V. S. Symmetrical peripheral gangrene in acquired hemolytic anemia. Acta Haematol. 1958 Jun;19(6):369–377. doi: 10.1159/000205457. [DOI] [PubMed] [Google Scholar]
  9. King J. W., May J. S. Cold agglutinin disease in a patient with Legionnaires' disease. Arch Intern Med. 1980 Nov;140(11):1537–1539. [PubMed] [Google Scholar]
  10. Kreger B. E., Craven D. E., McCabe W. R. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980 Mar;68(3):344–355. doi: 10.1016/0002-9343(80)90102-3. [DOI] [PubMed] [Google Scholar]
  11. Kuenn J. W., Weber R., Teague P. O., Keitt A. S. Cryopathic gangrene with an IgM lambda cryoprecipitating cold agglutinin. Cancer. 1978 Oct;42(4):1826–1833. doi: 10.1002/1097-0142(197810)42:4<1826::aid-cncr2820420422>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  12. Mitchell A. B., Pergrum G. D., Gill A. M. Cold agglutinin disease with Raynaud's phenomenon. Proc R Soc Med. 1974 Feb;67(2):113–115. [PMC free article] [PubMed] [Google Scholar]
  13. NELSON M. G., MARSHALL R. J. The syndrome of high-titre cold haemagglutination. Br Med J. 1953 Aug 8;2(4831):314–317. doi: 10.1136/bmj.2.4831.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pruzanski W., Delmage K. J. Cytotoxic and cytolytic activity of homogeneous cold agglutinins on peripheral blood monocytes. Clin Immunol Immunopathol. 1977 Jan;7(1):130–138. doi: 10.1016/0090-1229(77)90037-x. [DOI] [PubMed] [Google Scholar]
  15. Pruzanski W., Faird N., Keystone E., Armstrong M. The influence of homogeneous cold agglutinins on polymorphonuclear and mononuclear phagocytes. Clin Immunol Immunopathol. 1975 Jul;4(2):277–285. doi: 10.1016/0090-1229(75)90063-x. [DOI] [PubMed] [Google Scholar]
  16. Pruzanski W., Farid N., Keystone E., Armstrong M., Greaves M. F. The influence of homogeneous cold agglutinins on human B and T lymphocytes. Clin Immunol Immunopathol. 1975 Jul;4(2):248–257. doi: 10.1016/0090-1229(75)90060-4. [DOI] [PubMed] [Google Scholar]
  17. Pruzanski W., Shumak K. H. Biologic activity of cold-reacting autoantibodies (second of two parts). N Engl J Med. 1977 Sep 15;297(11):583–589. doi: 10.1056/NEJM197709152971105. [DOI] [PubMed] [Google Scholar]
  18. Pruzanski W., Sutton D. M., Pantalony D. Angioimmunoblastic lymphadenopathy: an immunochemical study. Clin Immunol Immunopathol. 1976 Jul;6(1):62–76. doi: 10.1016/0090-1229(76)90061-1. [DOI] [PubMed] [Google Scholar]
  19. Richard J. L., Vives J. F., Bizot M., Jambon C., Schved J. F., Vallat G. A propos d'un syndrome lympho-prolifératif avec IgM monoclonale cryoprécipitante et hémagglutinante à froid. Spécificité anti-Pr1d. Rev Fr Transfus Immunohematol. 1980 Feb;23(1):69–80. doi: 10.1016/s0338-4535(80)80106-1. [DOI] [PubMed] [Google Scholar]
  20. RØRVIK K. The syndrome of high-titre cold haemagglutination; a survey and a case report. Acta Med Scand. 1954;148(4):299–308. [PubMed] [Google Scholar]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES