A patient is reported who presented with anemia and oral candidiasis. Investigation revealed a spindle cell thymoma, and a serum inhibitor of heme synthesis associated with pure red cell aplasia. He was also shown to have the Addisonian pernicious anemia defect, diagnosed on the basis of a depressed serum level of vitamin B12, 57Co cyanocobalamin absorption studies, the presence of intrinsic factor blocking antibodies and atrophic gastritis with an elevated serum gastrin level. A serum inhibitor of candida induced lymphocyte transformation, which may have accounted for the chronicity of the candidiasis, was also demonstrated. Following thymectomy, whereas the antibodies to intrinsic factor and gastric mucosa, and the serum inhibitor of candida induced lymphocyte blastogenesis persisted, the inhibitor of heme synthesis disappeared. Moreover, red cell autoagglutinins, associated with a mildly shortened red cell life span, were detected for the first time. Although the patient's anemia improved following thymectomy, mild megaloblastic changes were noted in the bone marrow. Parenteral vitamin B12 therapy reversed these changes and a normal level of hemoglobin has subsequently been maintained. The candidiasis, however, has persisted. It is suggested that the defect in immunohomeostasis in the patient may have resulted from an abnormality or deficiency of specific suppressor T lymphocytes.
|Original language||English (US)|
|Number of pages||9|
|Journal||British Journal of Haematology|
|State||Published - 1977|
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