PATHOLOGY OF THE IMMUNE RESPONSE 



enlarged spleen and lymph nodes, anaemia, thrombocyto- 

 penia, skin eruption (sometimes with fever) ; occasionally 

 localized defects in bone due to proliferation of mesenchymal 

 cells are observed. In some sections from cases of this type 

 eosinophils are abundant, in others lipoidal degeneration of 

 reticular cells may be seen. It is a point of very considerable 

 interest that the younger the age at which the condition appears 

 the more malignant the course. Older children may recover. 

 In many ways this resembles disseminated lupus in a 

 different age-group — a random and variable output of for- 

 bidden clones with failure of homeostatic control would 

 provide a basis for most of the features. There is perhaps 

 a suggestion that in infants and young people normal homeo- 

 static control is effective and sensitive but that when the 

 rare situation arises by which control is abrogated the effects 

 can be acute and gross. 



(a) The L.E. cell test 



This is now generally considered to represent a demonstra- 

 tion that the serum contains an antibody-like globulin that 

 reacts with, and facilitates the phagocytic ingestion of, nuclear 

 material containing DNA. Recent studies with fluorescent 

 antibody techniques make this interpretation almost certain 

 (Godman and Deitch, 1957; Holman and Kunkel, 1957). 



Different methods of performing the test vary in their 

 sensitivity and there are various appearances — for example, 

 the so-called 'Tart' cells — which may lead to doubts in the 

 interpretation of results. Using one of the more sensitive 

 methods (Magath and Winkle, 1952), Cowling and Thomas 

 (1957) have recently analysed their positive results from 

 patients studied in Melbourne. Amongst their thirty-nine 

 positive cases were the following: D.L.E., 9, rheumatoid 

 arthritis, 8; chronic hepatitis, 10; haemolytic anaemia, 2; 

 thrombocytopenic purpura, 2; peripheral arterial disease, 

 6; carditis and pericarditis, 2. 



The association with collagen diseases is striking and it 



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