Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus
Abstract Background Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous disease, most often preceded by herpes simplex virus (HSV) infection or reactivation. Mycoplasma pneumoniae (Mp) is considered the second major trigger of EM and is often associated with an atypical and more seve...
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doaj-a7003fe3b46b430d8dfddcb05f7810b52021-02-14T12:24:04ZengBMCAllergy, Asthma & Clinical Immunology1710-14922021-02-011711910.1186/s13223-021-00520-xClonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majusSarah M. Volkers0Christian Meisel1Dorothea Terhorst-Molawi2Guido J. Burbach3Dirk Schürmann4Norbert Suttorp5Leif E. Sander6Department of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthInstitute of Medical Immunology, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthDepartment of Dermatology, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthDermatology/Dermato-Oncology Out-Patient Clinic, Vivantes Ambulatory Health Care Centers Berlin-SpandauDepartment of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthDepartment of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthDepartment of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthAbstract Background Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous disease, most often preceded by herpes simplex virus (HSV) infection or reactivation. Mycoplasma pneumoniae (Mp) is considered the second major trigger of EM and is often associated with an atypical and more severe presentation of disease, characterized by prominent mucosal involvement. However, contrary to HSV-associated Erythema multiforme (HAEM), immunological mechanisms of Mp-associated EM remain unclear. Case presentation We present the case of a 50-year-old male patient presenting with community-acquired pneumonia (CAP) and erythema multiforme majus (EMM). Acute Mp infection was diagnosed by seroconversion, with no evidence of HSV infection as a cause of EMM. We performed immune phenotyping of blister fluid (BF) and peripheral blood (PB) T cells and detected a clonally expanded TCRVβ2+ T cell population that was double positive for CD4 and CD8, and expressed the cytotoxic markers granulysin and perforin. This CD4+CD8+ population comprised up to 50.7% of BF T cells and 24.9% of PB T cells. Two years prior to the onset of disease, the frequency of PB CD4+CD8+T cells had been within normal range and it gradually returned to baseline levels with the resolution of symptoms, suggesting an involvement of this population in EMM disease pathophysiology. Conclusions This report is the first to provide a phenotypic description of lesional T cells in Mp-associated EMM. Characterizing the local immune response might help to address pathophysiological questions and warrants further systematic research.https://doi.org/10.1186/s13223-021-00520-xErythema multiformeMycoplasma pneumoniae-associated rash and mucositisT cellsCD4+ CD8+ double-positive T cellsTissue-resident memory T cellsMucosal-associated invariant T cells |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sarah M. Volkers Christian Meisel Dorothea Terhorst-Molawi Guido J. Burbach Dirk Schürmann Norbert Suttorp Leif E. Sander |
spellingShingle |
Sarah M. Volkers Christian Meisel Dorothea Terhorst-Molawi Guido J. Burbach Dirk Schürmann Norbert Suttorp Leif E. Sander Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus Allergy, Asthma & Clinical Immunology Erythema multiforme Mycoplasma pneumoniae-associated rash and mucositis T cells CD4+ CD8+ double-positive T cells Tissue-resident memory T cells Mucosal-associated invariant T cells |
author_facet |
Sarah M. Volkers Christian Meisel Dorothea Terhorst-Molawi Guido J. Burbach Dirk Schürmann Norbert Suttorp Leif E. Sander |
author_sort |
Sarah M. Volkers |
title |
Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus |
title_short |
Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus |
title_full |
Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus |
title_fullStr |
Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus |
title_full_unstemmed |
Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus |
title_sort |
clonal expansion of cd4+cd8+ t cells in an adult patient with mycoplasma pneumoniae-associated erythema multiforme majus |
publisher |
BMC |
series |
Allergy, Asthma & Clinical Immunology |
issn |
1710-1492 |
publishDate |
2021-02-01 |
description |
Abstract Background Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous disease, most often preceded by herpes simplex virus (HSV) infection or reactivation. Mycoplasma pneumoniae (Mp) is considered the second major trigger of EM and is often associated with an atypical and more severe presentation of disease, characterized by prominent mucosal involvement. However, contrary to HSV-associated Erythema multiforme (HAEM), immunological mechanisms of Mp-associated EM remain unclear. Case presentation We present the case of a 50-year-old male patient presenting with community-acquired pneumonia (CAP) and erythema multiforme majus (EMM). Acute Mp infection was diagnosed by seroconversion, with no evidence of HSV infection as a cause of EMM. We performed immune phenotyping of blister fluid (BF) and peripheral blood (PB) T cells and detected a clonally expanded TCRVβ2+ T cell population that was double positive for CD4 and CD8, and expressed the cytotoxic markers granulysin and perforin. This CD4+CD8+ population comprised up to 50.7% of BF T cells and 24.9% of PB T cells. Two years prior to the onset of disease, the frequency of PB CD4+CD8+T cells had been within normal range and it gradually returned to baseline levels with the resolution of symptoms, suggesting an involvement of this population in EMM disease pathophysiology. Conclusions This report is the first to provide a phenotypic description of lesional T cells in Mp-associated EMM. Characterizing the local immune response might help to address pathophysiological questions and warrants further systematic research. |
topic |
Erythema multiforme Mycoplasma pneumoniae-associated rash and mucositis T cells CD4+ CD8+ double-positive T cells Tissue-resident memory T cells Mucosal-associated invariant T cells |
url |
https://doi.org/10.1186/s13223-021-00520-x |
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